What is gastroparesis?
Gastroparesis, which stands for partial paralysis of the stomach, is a disease in which the stomach cannot empty itself of food normally. If you have this condition, damaged nerves and muscles don’t function with their normal strength and coordination, slowing down the movement of contents through your digestive system.
This is a common condition in people who have had diabetes for a long time, but it can occur in other situations as well. Gastroparesis can be misdiagnosed and is occasionally mistaken for an ulcer, heartburn, or an allergic reaction. In non-diabetic people, the condition may be related to acid reflux.
Symptoms of gastroparesis
- Heartburn or gastroesophageal reflux disease (GERD)
- Stomach ache
- Vomiting undigested food
- A feeling of fullness quickly when eating
- Lack of appetite and weight loss
- Problems controlling blood sugar
Causes of gastroparesis
Gastroparesis can be caused by diseases of the stomach muscles or the nerves that control the muscles, although a specific cause is often not identified. The most common disease that causes gastroparesis is diabetes mellitus, which damages the nerves that control the stomach muscles.
Gastroparesis can also result from damage to the vagus nerve, the nerve that panels the stomach muscles, that occurs during surgery on the esophagus and stomach. Scleroderma is an example of a disease in which gastroparesis is due to damage to the stomach muscles. Sometimes gastroparesis is caused by reflexes within the nervous system, for example, when the pancreas is inflamed (pancreatitis). In such cases, neither the nerves nor the muscles of the stomach are diseased, but messages are sent through the nerves from the pancreas to the stomach, preventing the muscles from working normally.
Other causes of gastroparesis include inequities of minerals in the blood such as potassium, calcium, or magnesium, medications (such as narcotic pain relievers), and thyroid disease. For a substantial number of patients, the cause of gastroparesis, a condition called idiopathic gastroparesis, cannot be found. In fact, idiopathic gastroparesis is the second most common cause of gastroparesis after diabetes.
Gastroparesis can occur as an isolated difficulty or it can be related to weakness of the muscles in other parts of the intestine, including the small intestine, colon, and esophagus.
Factors that can increase your risk of gastroparesis:
- Abdominal or esophageal surgery
- Infection, usually from a virus
- Certain medications that slow stomach emptying, such as narcotic pain relievers
- Scleroderma – A connective tissue disease
- Nervous system diseases, such as Parkinson’s disease or numerous sclerosis
- An underactive thyroid (hypothyroidism)
- Women are more likely to develop gastroparesis than men.
Diagnosis of gastroparesis
To diagnose gastroparesis, a GP will ask about your symptoms and medical history and can arrange a blood test for you.
You may be referred to the hospital for some of the following tests:
Barium x-ray: In which you swallow a liquid that contains the chemical barium, which can be seen on an x-ray and highlights how the liquid passes through your digestive system.
Gastric emptying scan: You eat food (often eggs) that contains a very small amount of a radioactive substance that can be seen on the scan. Gastroparesis is diagnosed if more than 10% of the food is motionless in your stomach 4 hours after eating
Wireless capsule test: A small electronic device is swallowed that sends information about how fast it is moving through your digestive tract to a recording device.
Endoscopy: A thin, flexible tube (endoscope) is passed down the throat into the stomach to examine the lining of the stomach and rule out other possible causes
Treatment of gastroparesis
How doctors treat gastroparesis depends on the cause, the severity of your symptoms and complications, and your response to different treatments. Sometimes treating the cause can stop gastroparesis. If diabetes is causing your gastroparesis, your healthcare professional will work with you to help you control your blood glucose levels. When the cause of your gastroparesis is unidentified, your doctor will provide treatments to help relieve your symptoms and treat complications.
Change eating habits
Changing your eating habits can help control gastroparesis and ensure you are getting the right amount of nutrients, calories, and fluids. Getting the right amount of nutrients, calories, and fluids can also treat the two main complications of the disorder: Malnutrition and Dehydration.
Your doctor may recommend
- Eat foods low in fat and fibre
- Eat five or six small, nutritious meals a day in place of two or three large meals
- Chew your food well
- Eating soft, well-cooked food
- Avoid carbonated or carbonated drinks
- Avoid alcohol
- Drink plenty of water or fluids that contain glucose and electrolytes, such as
- low-fat broths or clear soups
- Low Fiber, Naturally Sweetened Fruit and Vegetable Juices
- Sport drinks
- Oral rehydration solutions
- Doing some mild physical activity after a meal, such as taking a walk
- Avoid lying down for 2 hours subsequently a meal
- Take a multivitamin every day
If your symptoms are moderate to severe, your doctor may recommend drinking only liquids or eating well-cooked solid foods that have been processed into very small pieces or stuck in a blender.
Control blood glucose levels
If you have gastroparesis and diabetes, you will need to monitor your blood glucose levels, especially hyperglycemia. Hyperglycemia can further delay the emptying of food from the stomach. Your doctor will work with you to make sure that your blood glucose levels are not too high or too low and that they do not continue to rise or fall. Your doctor may recommend:
- Take insulin more often or change the type of insulin you use
- Taking insulin after meals, rather than before
- Check your blood glucose levels frequently after eating and take insulin when you need it
- Your doctor will give you specific instructions for taking insulin based on your needs and the severity of your gastroparesis.
Your doctor may prescribe medicines that help the muscles of the stomach wall work better. She may also prescribe medications to control nausea and vomiting and reduce pain.
Your doctor may prescribe one or more of the following medications:
- Metoclopramide NIH external link. This medicine increases the tension or contraction of the muscles of the stomach wall and can improve gastric emptying. Metoclopramide can also help relieve nausea and vomiting.
- This medicine also increases the contraction of the muscles of the stomach wall and can improve gastric emptying. However, this drug is available for use only under a special program. External link managed by the US Food and Drug Administration.
- Erythromycin NIH external link. This medicine also increases the contraction of the stomach muscles and can improve gastric emptying.
- Antiemetics are medications that help relieve nausea and vomiting. Prescription antiemetics include ondansetron NIH external link, prochlorperazine NIH external link, and promethazine NIH external link. Over-the-counter antiemetics include bismuth subsalicylate NIH exterior link and diphenhydramine NIH exterior link. Antiemetics does not improve gastric emptying.
- Antidepressants NIH external link. Certain antidepressants, such as mirtazapine NIH external link, can help relieve nausea and vomiting. These medications may not improve gastric emptying.
- Pain relievers that are not narcotic pain relievers can reduce pain in the abdomen due to gastroparesis.
Oral or nasal tube feeding
In some cases, your doctor may recommend oral or nasal tube feeding to make sure you are getting the correct amount of nutrients and calories. A healthcare professional will place a tube in your mouth or nose, through your esophagus and stomach, into your small intestine. Oral and nasal tube feeding bypasses the stomach and delivers a special liquid food directly into the small intestine.
Jejunostomy tube feeding
If you are not getting enough nutrients and calories from other treatments, your doctor may recommend jejunostomy tube feeding. Jejunostomy feeding is a longer-term method of feeding, compared to oral or nasal tube feeding.
Jejunostomy tube feeding is a way of feeding you through a tube that is placed in a part of your small intestine called the jejunum. To place the tube in the jejunum, a doctor creates an opening, called a jejunostomy, in the abdominal wall that leads to the jejunum. The feeding tube bypasses the stomach and delivers liquid food directly into the jejunum.
Your physician may recommend parenteral or intravenous (IV) nourishment if your gastroparesis is so severe that other treatments are not helping. Parenteral nutrition provides liquid nutrients directly into the bloodstream. Parenteral nutrition can be short-term until you can eat again. Parenteral nutrition can also be used until a tube can be placed for oral, nasal, or jejunostomy feeding. In some cases, the nutrition of the parents can be long-term.
Your doctor may recommend a ventilating gastrostomy to relieve pressure inside your stomach. A doctor creates an opening, called a gastrostomy, in the abdominal wall and in the stomach. The doctor then places a tube through the gastrostomy into the stomach. The stomach contents can flow out of the tube and relieve pressure inside your stomach.
Gastric electrical stimulation
Gastric electrical stimulation (GES) uses a small, battery-operated device to send mild electrical pulses to the nerves and muscles in the lower stomach. A surgeon places the device under the skin in the lower abdomen and connects the wires from the device to the muscles in the stomach wall. GES can help decrease nausea and vomiting in the long term.
GES is used to treat people with gastroparesis due to diabetes or unidentified causes only, and only in people whose symptoms cannot be skilful with medication.
Gastroparesis deprived of a known cause, called idiopathic gastroparesis, cannot be prevented.
If you have diabetes, you can prevent or delay the nerve damage that gastroparesis can cause by keeping your blood glucose levels within the target range that your doctor thinks is best for you. Meal planning, physical activity, and medications, if needed, can help you keep your blood glucose levels within your target range.
Gastroparesis can cause several complications, such as:
Severe dehydration Continual vomiting can cause dehydration.
- Malnutrition. Lack of appetite can mean that you are not eating enough calories or that you cannot absorb enough nutrients due to vomiting.
- Undigested food that hardens and remains in the stomach. Undigested food in your stomach can harden into a hard mass called a bezoar. Bezoars can cause nausea and vomiting and can be life-threatening if they prevent food from transient into the small intestine.
- Unpredictable changes in blood sugar. Though gastroparesis does not cause diabetes, frequent changes in the speed and quantity of food that pass into the small intestine can cause erratic changes in blood sugar levels. These swings in blood sugar make diabetes worse. In turn, poor control of blood sugar levels worsens gastroparesis.
- Decreased quality of life. Symptoms can make work difficult and fulfil other responsibilities.