Gastroparesis is a disorder that occurs when the stomach takes too long to empty its contents. Also known as delayed gastric emptying, this disorder has different symptoms such as vomiting, nausea, quickly feeling full and delayed gastric emptying.
Causes of Gastroparesis
The cause of this disorder is not known yet. However, it is thought to be associated with disrupted nerve signals in the stomach. Food tends to move slowly through the stomach when the nerve responsible for digestion (vagus nerve) is affected by certain factors.
The stomach not being able to react to a meal, and also being too sensitive to the signals from the nervous system are key players in the development of this condition.
Most types of gastroparesis fall under one of these categories;
- Unknown or Idiopathic
Diabetes is a common cause of gastroparesis as it causes severe damage to the vagus nerve, especially one that is not appropriately controlled. Over time, nerves get damaged by high blood sugar.
About 36 percent of gastroparesis cases do not have an identifiable cause. This is known as idiopathic. Most times, this condition results from a viral illness; however, there isn’t enough scientific proof to support this claim.
The nerve in the stomach can also be damaged due to surgeries that involve the stomach or other digestive organs. Nearly 13 percent of cases are linked with postsurgical causes.
Who is at risk of developing gastroparesis?
There are other conditions that are not common but related to gastroparesis. They include;
- Autoimmune diseases
- Cystic fibrosis
- Thyroid disorders
- Medications that slow the rate at which the stomach empties food
- Parkinson’s disease
- Some cancers
- Amyloidosis which is a condition that leads to abnormal protein buildup in organs
- Viral infections
Symptoms of Gastroparesis
Gastroparesis symptoms can range from mild to severe. They may occur in some people and not occur in others. The symptoms include;
- Loss of appetite
- Weight loss
- Eating a little and feeling full
- Upper abdominal pain
How Gastroparesis is diagnosed
Your doctor will ask you questions about your medical history and also perform a physical examination. Your doctor might also want to run some tests to rule out other possible causes of your symptoms. The tests might include;
- Blood tests: This can be used to check for diabetes and other conditions.
- An upper endoscopy: This procedure involves the passing of a long thin tube fixed with a camera known as endoscope down your oesophagus to your stomach. The endoscope enables your doctor to check for any blockages or abnormalities in the stomach.
- An Ultrasound: Ultrasounds create an image of your organs using sound waves. It is used to rule out gall bladder disease, liver disease, and pancreatitis.
Once your doctor has ruled out other possible causes of your symptoms. Further tests will be conducted to see how well your stomach empties. These tests include;
- SmartPill: It is a capsule that contains a device for tracking the speed at which food travels through your digestive tract.
- Carbon breath test: In this test, the digestive system is used in tracking carbon dioxide production.
- Gastric emptying scintigraphy test: In this scan, you eat a little amount of food with a harmless radioactive substance so your doctor can track the speed at which food is digested and emptied from your stomach.
How is Gastroparesis Treated?
The first step in treating gastroparesis, especially if its caused by a condition like diabetes is by improving the control of that underlying condition.
After that, your doctor might recommend diet changes, medication, and in some cases, surgery.
A common part of treatment for gastroparesis is seeing a dietitian – a food and nutrition expert.
Your dietitian can recommend foods to you that can be easily digested by your body, allowing it to absorb more nutrients. Your dietitian might make suggestions such as;
- Take a daily multivitamin if tolerated
- Limit carbonated beverages and alcohol
- Drink liquid with high calorie
- Eat four to six meals per day
- Take pureed foods instead of solid foods
- Eat well-cooked vegetables
- Limit certain diary and foods
- You should avoid food that has a lot of fibre, for example, orange
- Eat low-fat foods
- Ensure that there is time after meals before lying down to sleep
You might not be able to drink liquid or take solid foods if you have severe gastroparesis. Until your condition improves, you might need to use a feeding tube. It will be beneficial to your condition if you quit smoking too.
your doctor may also prescribe one or more drugs to treat your gastroparesis. Medications to control vomiting and nausea caused by gastroparesis include;
- Ondansetron (Zofran)
- Promethazine (Phenergan)
- Prochlorperazine (Compro)
Other medications that help with digestion and stimulate your stomach include;
- Erythromycin (EES)
- Domperidone (Motilin)
- Metoclopramide (Reglan)
You should talk to your doctor to know which medication is right for you as these drugs can cause different side effects.
If after medications, problems like vomiting and malnutrition persist, your doctor may decide to do an operation on your stomach. For gastroparesis, surgery is done to help your stomach empty more effectively.
A stomach stimulator known as a gastric electrical stimulator (GES) can be implanted into your stomach. This device is approved by the FDA for people that do not respond to medications.
Studies have revealed that in the first year after this surgery, about 97 percent of people with a gastric electrical stimulator experience less vomiting and are able to gain weight.
Experimental Treatment Options
Vagal nerve stimulation
The vagus nerve is a major player in the digestion process. In 2018, a study began to examine the use of vagal nerve stimulation for individuals with gastroparesis. This study aims at analysing the effectiveness of self-administered nerve stimulation twice a day.
The hope is that vagal nerve stimulation will help in reducing nerve problems and inflammation associated with gastroparesis.
Botulinum toxin type A
This is a toxin that reduces muscle activity. It has been studied in gastrointestinal tract disorders and also in gastroparesis.
In some studies, the condition was improved by injecting the medication into the pyloric sphincter muscle. However, more studies need to be conducted before it can be recommended for use because of the small size of previous studies and also the contradictory results.
Complications of Gastroparesis
- Poor wound healing
- Muscle weakness
- Decreased urine output
- Reduced blood pressure
- Rapid breathing
- Electrolyte imbalances
- Increased heartbeat
- Weakened immune system
Gastroparesis can also result in an overgrowth of bacteria as it causes food to stay in the stomach for too long. The food can also harden into masses in the stomach called bezoars, thereby causing nausea, vomiting and even obstruction in the stomach.
Gastroparesis can also make it harder to manage blood glucose levels which is essential for people with diabetes.
See your doctor or primary healthcare provider immediately if you start noticing signs of gastroparesis. They’ll conduct a thorough examination before diagnosing the condition. If you do have the condition, work with your doctor or see a dietitian to develop a treatment plan that suits your health needs.