Diseases & Conditions

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Gastroparesis Overview

Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. It often occurs in people with type 1 diabetes or type 2 diabetes.

Gastroparesis happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.

Symptoms

Signs and symptoms of gastroparesis are:

  • heartburn
  • nausea
  • vomiting of undigested food
  • an early feeling of fullness when eating
  • weight loss
  • abdominal bloating
  • erratic blood glucose levels
  • lack of appetite
  • gastroesophageal reflux
  • spasms of the stomach wall

These symptoms may be mild or severe, depending on the person.

Causes

Gastroparesis is most often caused by:

  • diabetes
  • postviral syndromes
  • anorexia nervosa
  • surgery on the stomach or vagus nerve
  • medications, particularly anticholinergics and narcotics (drugs that slow contractions in the intestine)
  • gastroesophageal reflux disease (rarely)
  • smooth muscle disorders such as amyloidosis and scleroderma
  • nervous system diseases, including abdominal migraine and Parkinsons disease
  • metabolic disorders, including hypothyroidism

Diagnosis

Because blockage of the stomach or small bowel can produce the same symptoms as gastroparesis, an endoscopy or x-ray study must be performed initially. If there is no blockage, the following tests can be conducted:

  • Gastric emptying study: measures how quickly an egg sandwich is emptied from the stomach
  • Manometry: measures the strength of stomach contractions
  • Electrogastrogram: a diagnostic test for patients with unexplained nausea and vomiting. The test consists of placement of electrodes on the skin of the abdomen, and recording the electrical activity of the stomach, much like an EKG. The test is done on an empty stomach followed by a liquid meal and lasts approximately 1 hour

Treatment

  • Special diet, avoiding those foods that are difficult for the stomach to empty.
  • Drugs that make the stomach muscle contract more strongly.
  • Tubes inserted into the small bowel so that liquid food can be given, and sometimes inserting tubes in the stomach to help empty secretions and air.
  • Gastric Neurostimulator (“Pacemaker”): The latest treatment involves implantation of a device in the abdominal wall, with electrodes sutured to the stomach. This new treatment is offered at the Cleveland Clinic and the “pacemaker” can be inserted laparoscopically. The Cleveland Clinic is among the few centers in the United States to implant this device laparoscopically. For additional information on this therapy, please visit the manufacturers Web site.
  • Surgery: In selective situations, surgery with removal of most of the stomach may need to be performed.

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