Gastroparesis

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What is gastroparesis?

Gastroparesis is a stomach disorder in which the stomach takes too long in emptying its contents. If food remains in the stomach for too long, it can cause problems such as bacterial overgrowth from the fermentation of the food. The food can also harden into solid masses, called bezoars, that may cause nausea, vomiting, and, sometimes, obstruction in the stomach. This can be dangerous if they block the passage of food into the small intestine.

What causes gastroparesis?

Most often, this condition is a complication of type 1 diabetes. It can also occur in persons with type 2 diabetes, although not as frequently. Gastroparesis is caused when the vagus nerve, which controls the movement of food through the digestive tract, is damaged or stops working. When this happens, the movement of food is slowed down or stopped.

The vagus nerve becomes damaged in persons with diabetes when blood glucose (sugar) levels remain high over a long period of time.

Other causes of gastroparesis include the following:

• Anorexia nervosa

• Surgery on the stomach or vagus nerve

• Postviral syndromes

• Certain medications, particularly those that slow contractions in the intestine

• Disorders involving smooth muscle, such as amyloidosis and scleroderma

• Diseases of the nervous system, such as abdominal migraine and Parkinson's disease

• Metabolic disorders, including hypothyroidism

What are the symptoms of gastroparesis?

The following are the most common symptoms of gastroparesis. However, each individual may experience symptoms differently. Symptoms may include:

• Nausea

• Vomiting

• Weight loss

• Feeling full early when eating

• Abdominal bloating and/or discomfort (epigastric pain)

• Heartburn

The symptoms of gastroparesis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is gastroparesis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for gastroparesis may include the following:

• Blood tests.  These tests check blood counts and measure chemical and electrolyte levels.

• Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

• Barium beefsteak meal. During this test, the patient eats a meal containing barium, allowing the radiologist to watch the stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working and helps to detect emptying problems that may not show up on the liquid barium X-ray.

• Radioisotope gastric-emptying scan. During this test, the patient eats food containing a radioisotope, which is a slightly radioactive substance that will show up on a scan. The dosage of radiation from the radioisotope is very small and not harmful, but allows the radiologist to see the food in the stomach and how quickly it leaves the stomach, while the patient lies under a machine.

• Gastric manometry. This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the patient's throat into the stomach. This tube contains a wire that takes measurements of the electrical and muscular activity of the stomach as it digests foods and liquids. This helps show how the stomach is working, and if there is any delay in digestion.

• Esophagogastroduodenoscopy (also called EGD or upper endoscopy). This is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to allow instruments through the scope for the removal of a sample of tissue for biopsy (if necessary).

• Scintigraphic gastric accommodation. During this test, the volume of stomach contents before and after a meal are measured, and how well the stomach relaxes in response to food intake.

Sometimes, in an effort to rule out other digestive conditions, an endoscopy and ultrasound may be performed.

Treatment for gastroparesis

Specific treatment for gastroparesis will be determined by your doctor based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance of specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

Gastroparesis is usually a chronic condition, so treatment does not cure it, but rather helps the patient manage the condition. In gastroparesis related to diabetes, the primary goal is to regain control of the blood glucose levels.

Treatment may include:

• Medications. Several medications are used to treat gastroparesis. Your physician may prescribe combinations of medications or different medications to determine which is the most effective. Botulinum toxin has also been shown to improve symptoms when injected directly into the pyloric sphincter.

• Dietary modifications. Changing eating habits can also help control gastroparesis. Sometimes, eating six smaller meals a day is more effective than eating three larger ones. Some doctors recommend several liquid meals a day until blood glucose levels are stable and gastroparesis is stable. Your doctor may also recommend avoiding fatty and high-fiber foods, as these can slow digestion and be difficult to digest. It is important to consult your doctor or dietitian for the best eating plan for your condition. Botulinum toxin has also been shown to improve symptoms when injected directly into the pyloric sphincter.

• Surgery. Occasionally, when other approaches fail, it is necessary to perform a surgical procedure called jejunostomy, in which a feeding tube is inserted through the skin on the abdomen into the small intestine. This tube then allows nutrients to be put directly into the small intestine, bypassing the stomach. This is used only when gastroparesis is severe and prevents the nutrients and medications necessary to regulate blood glucose levels from reaching the bloodstream.

  A new surgically implanted device, known as a "gastric neurotransmitter," may also be used to control nausea and vomiting.

• Parenteral nutrition. An alternative to the jejunostomy tube is parenteral nutrition, in which nutrients are delivered directly into the bloodstream, bypassing the digestive system. The doctor places a catheter in a chest vein, leaving an opening on the outside of the skin. A bag with liquid nutrients or medication can be attached to the catheter, allowing the fluid to enter the bloodstream through the vein.