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Gastroparesis

What is Gastroparesis?

In this group of uncommon disorders, patients suffer from symptoms which are suggestive of blockage (obstruction) of the stomach, yet investigations show no evidence of a mechanical blockage. The underlying problem is disturbance of the hormonal and nervous control of stomach emptying.

Symptoms of Gastroparesis

Because of inability to eat properly, weight loss also occurs and in diabetic patients these problems may interfere with control of blood sugar levels.

How is gastroparesis diagnosed?

The diagnosis is usually suspected from the characteristic symptoms but investigations are necessary to rule out mechanical blockage in the stomach or duodenum and to exclude other problems such as a peptic ulcer or stomach tumor. At endoscopy there may be a lot of fluid and food residue in the stomach even though the patient has fasted properly for the procedure. Normally, the stomach is seen to undergo regular muscular contractions during endoscopy and these may be weak or absent in patients with this problem. Endoscopy also confirms that the exit from the stomach to duodenum (pylorus) is open and that no blockage exists.

Barium X-rays (an upper GI series) may also be useful as the radiologist can observe stomach contractions and watch the flow of barium as it passes through and out of the stomach.

To confirm the diagnosis it is possible to perform a gastric emptying study. In this test patients are given a standardized test meal (for example, scrambled eggs) which contains tiny amounts of a harmless radioisotope and drink containing a different radioisotope. Using a special camera, it is possible to measure the rate at which both solids and liquids are emptied from the stomach and determine whether a significant delay in gastric emptying is present or not. Other tests are also performed to try to establish the underlying cause.

What treatments are available for gastroparesis?

Gastroparesis can be a very difficult problem to treat. In a few cases which may be viral in origin, the symptoms often slowly improve and disappear over six months to two years. In other cases, including those resulting from diabetes, the problem may be irreversible. Careful assessment by a dietitian helps to ensure that patients receive adequate nutrition. Small, frequent meals are generally advised and a low fat diet may be helpful as fat slows down gastric emptying. A low-fiber diet may reduce the feeling of bloating.

Several medications are available which help the stomach empty faster. Not all patients respond to these medications but they are certainly worth trying. Medications to alleviate nausea may also help symptoms as will strict control of blood sugar levels in diabetic patients.

Surgery is not helpful in management of this disorder but sometimes patients with very severe problems benefit from placement of a feeding tube into the small intestine.

What is gastroparesis?

Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine.

Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract.

The GI Tract

The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food.

Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.

Drawing of the digestive tract with the stomach, small intestine, and jejunum labeled.
Gastroparesis slows or stops the movement of
food from the stomach to the small intestine.

Causes

For reasons that are still unclear, gastroparesis is more commonly found in women than in men.

Symptoms

The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food, sometimes several hours after a meal. Other symptoms of gastroparesis include

Symptoms may be aggravated by

Symptoms may be mild or severe, and they can occur frequently in some people and less often in others. The symptoms of gastroparesis may also vary in intensity over time in the same individual. Sometimes gastroparesis is difficult to diagnose because people experience a range of symptoms similar to those of other diseases.

Diagnosis

Gastroparesis is diagnosed through

Tests for gastroparesis

Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the health care provider may perform one or more of the following tests:

Treatment

Treatment of gastroparesis depends on the severity of the person's symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic, or long-lasting, condition. Gastroparesis is also a relapsing condition; the symptoms can come and go for periods of time. Treatment helps people manage the condition so they can be as comfortable and active as possible.

A health care provider may also recommend:

When a person has severe symptoms:

A health care provider may recommend a dietitian to help a person plan meals that minimize symptoms and ensure all nutritional needs are met.

When the most extreme cases of gastroparesis lead to severe nausea, vomiting, and dehydration, urgent care may be required at a medical facility where IV fluids can be given.

Medications

Several prescription medications are available to treat gastroparesis. A combination of medications may be used to find the most effective treatment.

Botulinum Toxin

Botulinum toxin is a nerve blocking agent also known as Botox. After passing an endoscope into the stomach, a health care provider injects the Botox into the pylorus, the opening from the stomach into the duodenum. Botox is supposed to help keep the pylorus open for longer periods of time and improve symptoms of gastroparesis. Although some initial research trials showed modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections, other studies have failed to show the same degree of effectiveness of the Botox injections.¹

¹ Bai Y, Xu MJ, Yang X, et al. A systematic review on intrapyloric botulinum toxin injection for gastroparesis. Digestion. 2010;81(1):27-34.

Gastric Electrical Stimulation

This treatment alternative may be effective for some people whose nausea and vomiting do not improve with dietary changes or medications.

Jejunostomy

If medications and dietary changes don't work, and the person is losing weight or requires frequent hospitalization for dehydration, a health care provider may recommend surgically placing a feeding tube through the abdominal wall directly into a part of the small intestine called the jejunum. The surgical procedure is known as a jejunostomy.

The jejunostomy is used only when gastroparesis is extremely severe.

Parenteral Nutrition

When gastroparesis is so severe that dietary measures and other treatments are not helping, a health care provider may recommend parenteral nutrition, an IV liquid food mixture supplied through a special tube in the chest.

This approach is a less preferable alternative to a jejunostomy and is usually a temporary treatment to get through a difficult period of gastroparesis.

Gastroparesis and Diabetes

An elevated blood glucose level directly interferes with normal stomach emptying, so good blood glucose control in people with diabetes is important. However, gastroparesis can make blood glucose control difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Gastric emptying is unpredictable with gastroparesis, causing a person's blood glucose levels to be erratic and difficult to control.

The primary treatment goals for gastroparesis related to diabetes are to improve gastric emptying and regain control of blood glucose levels. In addition to the dietary changes and treatments already described, a health care provider will likely adjust the person's insulin regimen.

To better control blood glucose, people with diabetes and gastroparesis may need to

A health care provider will give specific instructions for taking insulin based on the individual's needs and the severity of gastroparesis.

In some cases, the dietitian may suggest eating several liquid or puréed meals a day until gastroparesis symptoms improve and blood glucose levels are more stable.

Complications of gastroparesis

The problems of gastroparesis can include:

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