Gastroparesis
Overview
What is gastroparesis?
Gastroparesis, which means partial paralysis of the stomach, is a disease in which your stomach cannot empty itself of food in a normal way. If you have this condition, damaged nerves and muscles don’t function with their normal strength and coordination — slowing the movement of contents through your digestive system.
This is a common condition in people who've had diabetes for a long time, but it may also occur in other situations. Gastroparesis can be misdiagnosed and is sometimes mistaken for an ulcer, heartburn or an allergic reaction. In people without diabetes, the condition may relate to acid reflux.
Symptoms and Causes
What causes gastroparesis?
Gastroparesis is caused by nerve injury, including damage to your vagus nerve. In its normal state, the vagus nerve contracts (tightens) your stomach muscles to help move food through your digestive tract. In cases of gastroparesis, diabetes damages your vagus nerve. This prevents the muscles of your stomach and intestine from working properly, which keeps food from moving from your stomach to your intestines.
Anatomy of the stomach
Other causes of gastroparesis include:
- Viral infections.
- Gastric (abdominal) surgery with injury to your vagus nerve.
- Medications such as narcotics and some antidepressants.
- 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).
What are the symptoms of gastroparesis?
The symptoms of gastroparesis include:
- Heartburn or gastroesophageal reflux (backup of stomach contents into your esophagus).
- Nausea.
- Vomiting undigested food.
- Early satiety (feeling full quickly when eating).
- Abdominal bloating (enlargement).
- Chronic abdominal pain.
- Poor appetite and weight loss.
- Mismanagement of blood sugar.
What are the complications of gastroparesis?
Gastroparesis can cause several problems:
- Food that stays in the stomach too long can ferment, which can lead to the growth of bacteria.
- Food in your stomach can harden into a solid mass called a bezoar. Bezoars can cause blockages in your stomach that keep food from passing into your small intestine.
- People who have both diabetes and gastroparesis may have other issues as well, because blood glucose levels rise quickly when food finally leaves your stomach and enters your small intestine.
- Dehydration (extreme thirst).
- Malnutrition (poor nutrition).
Diagnosis and Tests
How is gastroparesis diagnosed?
Your provider will go over your symptoms and medical history with you. They'll also give you a physical examination and may order certain blood tests, including blood sugar levels.
Other tests that are used to diagnose gastroparesis include:
- Four-hour solid gastric emptying study: This is a test to determine the time it takes a meal to move through your stomach. A technologist takes you to a room and gives you a meal to eat that's tagged with a radioactive isotope. After you eat this meal, they take a one-minute image of your stomach. You'll be allowed to leave the department, but you must return in one, two and four hours.
- SmartPill: This is a capsule that contains a small electronic device. You swallow the capsule, and as it moves through your digestive tract, it sends information to a receiver you're wearing on how quickly food travels through your digestive tract.
Management and Treatment
How is gastroparesis treated?
Gastroparesis is a chronic (long-lasting) condition. This means that treatment usually doesn’t cure the disease, but can help manage your symptoms. People who have diabetes should try to manage their blood glucose levels to reduce the problems of gastroparesis.
Some people may benefit from medications, including:
- Reglan: You take this drug before you eat, and it causes your stomach muscles to contract to help move food out of your stomach. Reglan also helps cut down on vomiting and nausea. Side effects include diarrhea and, rarely, a serious neurological (nerve) disorder.
- Erythromycin: This is an antibiotic that also causes stomach contractions and helps move food out. Side effects include diarrhea and development of resistant bacteria from taking the antibiotic for a long time.
- Antiemetics: These are drugs that help manage nausea.
Surgery for gastroparesis
People with gastroparesis who still have nausea and vomiting even after taking medications may benefit from surgery. One type of surgery for gastroparesis is gastric electrical stimulation, which is a treatment that sends mild electric shocks to your stomach muscles. In this procedure, your provider inserts a small device called a gastric stimulator into your abdomen. The stimulator has two leads that are attached to your stomach and provide mild electric shocks, which help manage vomiting. Your provider can adjust the strength of the electric shocks. The device runs on a battery that lasts up to 10 years.
Another surgery to relieve gastroparesis symptoms is gastric bypass, in which your care team creates a small pouch from the top part of your stomach. They divide the small intestine in half, and attach the lower end directly to the small stomach pouch. This limits the amount of food you can eat. This surgery is more effective for a person with obesity and diabetes than either medication or a gastric stimulator.
Are there any other treatments for gastroparesis?
A newer treatment for gastroparesis is called per oral pyloromyotomy (POP). This is a nonsurgical procedure in which your healthcare provider inserts an endoscope (a long, thin, flexible instrument) into your mouth and advances it to your stomach. Your provider then cuts the pylorus, the valve that empties your stomach, which allows food to move from your stomach to your small intestine more easily.
In a severe case of gastroparesis, your doctor may decide you would benefit from a feeding tube, or jejunostomy tube. The surgeon inserts the tube through your abdomen into your small intestine. To feed yourself, you put nutrients into the tube, and they go directly into your small intestine. This way, they go around the stomach and get into your bloodstream more quickly. The jejunostomy tube is usually a temporary measure.
Another treatment option is intravenous, or parenteral, nutrition. This is a feeding method in which nutrients go directly into your bloodstream through a catheter placed into a vein in your chest. Like a jejunostomy tube, parenteral nutrition is meant to be a temporary measure for a severe case of gastroparesis.
Should I change my diet if I have gastroparesis?
One of the best ways to help manage the symptoms of gastroparesis is to change your daily eating habits. For instance, instead of three meals a day, you can eat six small meals. In this way, there is less food in your stomach — you won’t feel as full, and it'll be easier for the food to leave your stomach.
Another important factor is the texture of food. Your provider may recommend liquids and low residue foods (for example, you should eat applesauce instead of whole apples with intact skins).
You should also avoid foods that are high in fat (which can slow down digestion) and fiber (which is difficult to digest).
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