What is Gastroparesis?
Gastroparesis is the technical term for slowed stomach emptying. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls the movement of food from the stomach through the digestive tract. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.
What causes Gastroparesis?
The most common cause of gastroparesis is diabetes. People with diabetes have high blood sugar, which then damages nerves and blood vessels. Over time, high blood glucose can damage the vagus nerve.
Other causes include surgery on the stomach or vagus nerve, viral infections, anorexia nervosa or bulimia, medications, gastroesophageal reflux disease (GERD), smooth muscle disorders such as amyloidosis and scleroderma, nervous system diseases including Parkinsons disease, and metabolic disorders such as hypothyroidism.
What are the symptoms of Gastroparesis?
Signs and symptoms of Gastroparesis are heartburn, pain in the upper abdomen, nausea, vomiting of undigested food (sometimes several hours after a meal), early feeling of fullness after eating a few bites of food, weight loss due to poor absorption or low calorie intake, bloating, and lack of appetite.
What are the complications of Gastroparesis?
If food lingers too long in the stomach, bacteria may overgrow and cause fermentation of the food. This causes gas, bloating and possibly pain.
Gastroparesis can make diabetes worse by making glucose control more difficult. Since gastroparesis makes stomach emptying unpredictable, a person's blood glucose levels can be erratic and difficult to control.
How is Gastroparesis diagnosed?
Your doctor will rule out other causes of your symptoms first through a few different tests. An upper endoscopy allows your doctor to look at the lining of your stomach and check for any abnormalities. To rule out any gallbladder or pancreatic causes, an ultrasound may be ordered.
Once other causes have been ruled out, your doctor will order one of the following gastric emptying tests to confirm a diagnosis of gastroparesis.
Gastric emptying scintigraphy - This involves eating specially made eggs or toast that contain a small amount of radioactive substance that shows up on scans. The dose of radiation from this is not dangerous. The scan measures the rate of stomach emptying at 1, 2, 3, and 4 hours. When more than 10 percent of the meal is still in the stomach after 4 hours, the diagnosis of gastroparesis is confirmed.
How is Gastroparesis treated?
Several medications are used to treat gastroparesis. Your doctor may try different medications or combinations to find the most effective treatment.
Metoclopramide (Reglan). This drug stimulates stomach muscle contractions to help emptying. It also helps reduce nausea and vomiting. Reglan is taken 20 to 30 minutes before meals and at bedtime. Side effects of this drug include fatigue, sleepiness, depression, anxiety, and problems with physical movement.
Erythromycin. This antibiotic also improves stomach emptying. It works by increasing the contractions that move food through the stomach. Side effects include nausea, vomiting, and abdominal cramps.
Domperidone. This drug works like metoclopramide to improve stomach emptying and decrease nausea and vomiting. The FDA is reviewing domperidone, which has been used elsewhere in the world to treat gastroparesis. Use of the drug is restricted in the United States.
Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, an antiemetic can help with nausea and vomiting. Antibiotics will clear up a bacterial infection. If you have a bezoar in the stomach, the doctor may use an endoscope to inject medication into it to dissolve it.
Changing your eating habits can help control gastroparesis. You should eat several small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. In more severe cases, a liquid or pureed diet may be prescribed.
The doctor may recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion—a problem you do not need if you have gastroparesis—and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long.
If a liquid or pureed diet does not work, you may need surgery to insert a feeding tube. The tube is inserted through the skin on your abdomen into the small intestine. The feeding tube bypasses the stomach and places nutrients and medication directly into the small intestine. These products are then digested and delivered to your bloodstream quickly. You will receive special liquid food to use with the tube. A feeding tube is used only when gastroparesis is severe or the tube is necessary to stabilize blood glucose levels in people with diabetes.
Parenteral nutrition refers to delivering nutrients directly into the bloodstream, bypassing the digestive system. The doctor places a thin tube called a catheter in a chest vein, leaving an opening to it outside the skin. For feeding, you attach a bag containing liquid nutrients or medication to the catheter. The fluid enters your bloodstream through the vein. Your doctor will tell you what type of liquid nutrition to use.
This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult period with gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.
Gastric Electrical Stimulation
A gastric nerve stimulator is a surgically implanted, battery-operated device that releases mild electrical pulses to help control nausea and vomiting associated with gastroparesis. This option is available to people whose nausea and vomiting do not improve with medications. Further studies will help determine who will benefit most from this procedure, which is available in a few centers across the United States.
Botulinum Toxin Injection
The use of botulinum toxin has been associated with improvement in symptoms of gastroparesis in some patients; however, further research on this form of therapy is needed.