Gastroparesis

What Is Gastroparesis?

Gastroparesis is a condition in which food stays in your stomach for longer than it should. You might hear your doctor call it delayed gastric emptying.

Gastroparesis Symptoms

You may have:

• Heartburn or gastroesophageal reflux disease (GERD)
• Upset stomach
• Throwing up undigested food
• A feeling of fullness quickly when you eat
• Bloating
• Lack of appetite and weight loss
• Trouble controlling blood sugar
• Belly pain

Gastroparesis Causes and Risk Factors

For most people, doctors can’t determine what brought on gastroparesis. It tends to affect women more than men.

Diabetes is the most common known cause of gastroparesis. It can damage nerves -- including the vagus nerve, which regulates your digestive system -- and certain cells in your stomach.

Other causes of gastroparesis include:

• Injury to your vagus nerve from surgery
• A lack of thyroid hormone (hypothyroidism)
• Viral stomach infections (gastroenteritis)
• Medications such as narcotics and some antidepressants
• Parkinson's disease
• Multiple sclerosis
• Rare conditions such as amyloidosis (deposits of protein fibers in tissues and organs) and scleroderma (a connective tissue disorder that affects your skin, blood vessels, skeletal muscles, and internal organs)

Gastroparesis Complications

Problems might happen:

• When you can’t keep fluids down, and you can become dehydrated
• If your body can’t get the nutrients it needs, you may become malnourished.
• If food stays in your stomach too long and ferments, which can lead to the growth of bacteria
• When food hardens into a solid lump called a bezoar. This can block food from passing into your small intestine.
• If you have diabetes. Your blood sugar levels may rise when food finally leaves your stomach and enters your small intestine. Gastroparesis makes it harder to control your blood sugar.

Gastroparesis Diagnosis

Your doctor will ask about your symptoms and medical history. They’ll also do a physical exam. They may order tests including:

• Radioisotope gastric-emptying scan (gastric scintigraphy). Your doctor will give you food that contains a very small amount of something radioactive. Then, you lie under a scanning machine. If more than 10% of food is still in your stomach 4 hours after eating, you have gastroparesis.
• Blood tests. These can spot dehydration, malnutrition, infection, or blood sugar problems.
• Barium X- ray. You’ll drink a liquid (barium), which coats your esophagus, stomach, and small intestine and shows up on an X-ray. This is also known as an upper GI (gastrointestinal) series or a barium swallow.
• Gastric emptying breath tests (13C-GEBTs). This is a non-radioactive test that measures how fast your stomach empties after you eat a meal that has a chemical element called the 13C isotope added to it.
• Gastric manometry. Your doctor passes a thin tube through your mouth and into your stomach to check electrical and muscular activity, and to figure out how fast you’re digesting.
• Electrogastrography. This measures electrical activity in your stomach using electrodes on your skin.
• The smart pill. You swallow a tiny electronic device that sends information about how fast it’s traveling as it moves through your digestive system.
• Ultrasound. This imaging test uses sound waves to create pictures of your organs. Your doctor may use it to rule out other diseases.
• Upper endoscopy. Your doctor passes a thin tube called an endoscope down your esophagus to look at the lining of your stomach.

Gastroparesis Treatment

Depending on the cause, gastroparesis can be chronic, which means it lasts a long time. You can take steps to manage and control it.

Changes to diet for gastroparesis

Changing your eating habits is one of the best ways to control gastroparesis symptoms. You might try eating six small meals each day rather than three larger ones. This way, you have less food in your stomach and don’t feel as full.

Have more liquids and low-residue foods, such as applesauce instead of whole apples. Drink plenty of water and fluids like low-fat broths, soups, juices, and sports drinks. Avoid high-fat foods, which can slow digestion, and high-fiber foods, which are harder to digest.

Make sure you’re getting enough of the right nutrition. Your doctor might send you to a dietitian who can help you find foods you like that are easy to digest.

Don’t lie down for 2 hours after you eat. Gravity can help your digestion and keep food or acid from traveling into your throat. Gentle exercise like walking can help you feel better.

Medications for gastroparesis

Your doctor might give you medicines including:

• Metoclopramide (Reglan): You take this drug before eating. It causes your stomach muscles to contract and move food along. It also helps with upset stomach and vomiting. Side effects include diarrhea, drowsiness, anxiety, and, rarely, a serious neurological disorder.
• Erythromycin: This antibiotic also causes stomach contractions and helps move food out. Side effects include diarrhea and the growth of resistant bacteria if you take it for a long time.
• Antiemetics: These drugs help control nausea.

Other treatments for gastroparesis

If you have diabetes, controlling your blood sugar levels will keep you from having serious problems.

Your doctor might need to give you a feeding tube or jejunostomy tube. They put it in through your belly and into your small intestine. To feed yourself, you’ll put nutrients into the tube, and they’ll go directly into your small intestine. This way, they skip your stomach and get into your bloodstream faster.

Your doctor can also inject botulinum toxin (such as Botox) into your pylorus, the valve from your stomach to your small intestine. This relaxes the valve, keeping it open for longer so your stomach can empty.

Electrical stimulation uses electrodes attached to your stomach wall to trigger stomach contractions.

In a procedure called per-oral pyloromyotomy (POP), your doctor uses an endoscope to cut your pylorus valve so it’s easier for your stomach to empty.

Although surgery can sometimes cause gastroparesis, patients who have obesity and diabetes might have gastric bypass surgery. Your doctor creates a small pouch from the top part of your stomach and attaches it to the lower end of your small intestine. This limits how much food you can eat.

If your case is severe, you might also need intravenous nutrition or parenteral nutrition, in which nutrients go straight into your bloodstream through a catheter in a vein in your chest. Doctors tend to use this for only a short time.

Read more on: digestive disorders