Gastroparesis

Gastroparesis (GP) is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach’s motility is slowed down or doesn’t work at all, preventing your stomach from emptying properly.

Diagnosing Gastroparesis

Your physician will review your symptoms and medical history and complete a physical examination, including blood tests. If he or she finds it likely that you have gastroparesis or is unsure and wants to rule out other diseases and disorders, there are a few tests available. This is especially important with gastroparesis, because many of the symptoms are similar to other disorders, such as functional dyspepsia.

• Gastric emptying scans allow your healthcare team to measure the speed at which you digest food. For this test, you consume a tiny amount of radioactive material with a small meal, which allows technicians to monitor the rate at which it passes through your digestive system by periodically using a camera to check where the radioactive meal is. If it stays in the stomach for too long, then it can indicate gastroparesis.
• An upper gastrointestinal series involves consuming a barium drink in front of an x-ray machine after fasting. The barium is a chalky liquid that shows up on x-rays, allowing the technicians to see details in the gastrointestinal tract. This can help them find any anomalies in stomach function.
• Gastroscopy involves a physician using a small, flexible tube with a camera and a light (endoscope) to look at the upper parts of the digestive system, including the esophagus, stomach, and duodenum. This test is helpful to detect bezoars or any other abnormalities in the stomach.
• Abdominal ultrasound is useful for identifying if there are any physical abnormalities that might be causing symptoms.
• Gastric or duodenal manometry involves using a long thin tube that measures muscle strength and patterns within the esophagus and through the lower esophageal sphincter into the stomach.

Signs and Symptoms

Gastroparesis can interfere with normal digestion, cause nausea, vomiting and abdominal pain. It can also cause problems with blood sugar levels and nutrition. Although there’s no cure for gastroparesis, changes to your diet, along with medication, can offer some relief.

Signs and symptoms of gastroparesis include:

• Vomiting
• Nausea
• Abdominal bloating
• Abdominal pain
• A feeling of fullness after eating just a few bites
• Vomiting undigested food eaten a few hours earlier
• Acid reflux
• Changes in blood sugar levels
• Lack of appetite
• Weight loss and malnutrition

What causes Gastroparesis?

The most common cause of gastroparesis is diabetes mellitus type 1 or type 2. High levels of glucose in the blood can cause chemical changes to the vagus nerve. This type of gastroparesis can be especially dangerous, because the delayed gastric emptying leads to more intense blood sugar spikes in those with diabetes, causing a cycle of blood sugar highs and lows that continues to affect the vagus nerve.

Gastroparesis is typically associated with some form of damage to the vagus nerve, which can occur in a range of situations, including from various mineral deficiencies, eating disorders, opioid medications, certain antidepressants, and surgeries in the upper gastrointestinal tract, such as gastrectomy or bariatric surgery.

Other causes of gastroparesis, although very rare, include connective tissue diseases such as scleroderma and Ehlers-Danlos Syndrome, and neurological conditions such as Parkinson’s disease. In about a third of cases, the cause of gastroparesis is unknown (idiopathic). In some cases, such as those caused by certain medications or eating disorders, the gastroparesis can be temporary, with normal digestive function returning upon medication adjustment or adapting to healthy eating habits.

Management of Gastroparesis

The management of gastroparesis can include simple dietary changes, medications, and even surgery depending on the disease severity.

Lifestyle and Dietary Changes

In individuals with mild gastroparesis, a few changes to dietary habits can largely reduce symptoms. Most of these changes focus on reducing the amount of food you eat at once, because overeating makes it even more difficult for your stomach to empty. Consuming smaller meals more frequently, rather than two or three large meals, can help. You may also find relief by eating mostly soft or liquid foods, such as soups and smoothies. Chewing each bite very well and consuming non-fizzy liquids with meals can also make digestion easier. Avoiding or limiting high fibre and high fat foods can reduce discomfort, since these foods typically take longer to digest. For some individuals, supplemental nutrition beverages can help ensure adequate nutrient intake.

If you have diabetes, make sure to keep glucose tablets or hard candies on hand. You can use them to raise your blood sugar, because they are easily absorbed, if gastroparesis is causing low blood sugar. A registered dietitian can offer advice if you are unsure what to eat so that you meet your nutrition requirements when you have gastroparesis.

Medications

The medications available for gastroparesis don’t treat the underlying disease, but they help to alleviate symptoms. There are two primary medication types available:

Motility agents increase the speed of peristalsis, causing the stomach to empty more quickly, and include metoclopramide (Reglan®, Maxeran®) and domperidone (Motilium®). NOTE: Health Canada pulled a gastroprokinetic agent, cisapride, from the market at the turn of the century due to serious health concerns and deaths. However, some physicians still cautiously prescribe cisapride, which increases motility in the upper gastrointestinal tract, for severe cases of gastroparesis. Compounding pharmacies can acquire the drug under special circumstance.

Antiemetics reduce nausea and vomiting, and include medicines such as prochlorperazine and promethazine.

Surgery

For those who are unable to get symptoms under control through dietary changes and medications, there are a few surgical options that may offer relief.

A gastric electric stimulator is an implanted device that uses mild, controlled electrical pulses to stimulate the smooth muscles in the digestive tract and speed up gastric emptying. However, this treatment does not work for everyone, and is not available in all areas.

Botox (botulism toxin) injected in the sphincter that connects the stomach to the small intestine (pylorus) can help relax the sphincter so that it more easily allows food passage into the small intestine. Botox injections don’t work for everyone, they are only a temporary solution, and can become less effective in subsequent injections.

A feeding tube surgically attached at the entry to the small intestine can offer a last resort for those who are completely unable to take nutrients into the stomach in either solid or liquid form.