The peculiar stomach condition called gastroparesis

Gastroparesis, also known as delayed gastric emptying, is a condition in which the movement of food from the stomach to the small intestine is slowed or stops completely.  The word gastroparesis means stomach (gastro) paralysis (paresis).  This condition is fairly common – The National Institutes of Health has declared that 5 million American are afflicted with gastroparesis. 

What is gastroparesis?

Under normal conditions, the stomach is a flexible sac that can stretch and shrink, mix and churn and will eventually empty food into the small intestine. 

In people without gastroparesis, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and to move it along through the gastrointestinal (GI) tract.  When we eat food, our food is moved and digested through the GI tract by the movement of muscles, along with the release of hormones and enzymes.  The vagus nerve helps manage the complex processes of digestion which includes telling the muscles in the stomach to contract and push food into the small intestine.  If this nerve is damaged, it can’t send signals normally to those muscles.  This results in food remaining in the stomach longer than usual with the food moving very slowly from the stomach to the small intestine or even stopping movement altogether.  

The vagus nerve can be damaged by diseases such as diabetes, or by surgery to the stomach or small intestine. 

Causes of gastroparesis

The two largest groups of people who make up gastroparesis sufferers are people with diabetes or those who have idiopathic gastroparesis.  Idiopathic gastroparesis means there is no known or identifiable cause for the condition.  For reasons that are not known, women are more likely than men to develop gastroparesis.

The reason why people with diabetes are susceptible to gastroparesis is the fact of their high levels of blood glucose.  Over time, high blood glucose levels can damage the vagus nerve. 

Other possible causes of gastroparesis include intestinal surgery along with nervous system disorders such as Parkinson’s disease or multiple sclerosis. 

Idiopathic reasons that may increase the likelihood of gastroparesis include infections from a virus, scleroderma (a connective tissue disease), hypothyroidism (low thyroid), and certain medications that slow the rate of stomach emptying such as narcotic pain medications like morphine.

Symptoms of gastroparesis

The following signs and symptoms are most commonly seen in someone with gastroparesis:

·      Nausea and vomiting

·      A feeling of fullness after eating just a few bites

·      Vomiting undigested food eaten a few hours earlier

·      Acid reflux

·      Abdominal bloating and/or pain

·      Changes in blood sugar levels – become more erratic

·      Lack of appetite

·      Weight loss and malnutrition

The symptoms can be aggravated by eating greasy or fried foods, large quantities of foods with fiber such as raw fruits and vegetables, or drinking beverages high in fat or carbonation.  The symptoms can be mild or severe with some people experiencing frequent bouts while others have only a few.  Because the symptoms of gastroparesis are similar to other disease, diagnosing this illness can be difficult. 

Complications of gastroparesis

Complications that can be attributed to gastroparesis are:

·      Severe dehydration – Frequent vomiting can contribute to dehydration.

·      Malnutrition – Lack of appetite leads to low caloric intake, and results in an inability to absorb enough nutrients.

·      Undigested food that hardens and remains in your stomach – Foods that remain undigested in the stomach can solidify into a hardened mass called a bezoar. These solid masses cause nausea and vomiting and can be life-threatening due to the prevention of digestion.

·      Unpredictable blood sugar changes – Gastroparesis does not directly cause diabetes, however it can lead to irregular changes in blood sugar levels. This can aggravate an existing case of diabetes and make it more difficult to manage.

·      Decreased quality of life – Gastroparesis flare ups can cause discomfort and affect an individual’s ability to perform normal day to day activities.

Diagnosing gastroparesis

Any person who is noticing symptoms associated with gastroparesis should make an appointment to see their doctor.  To diagnosis gastroparesis, a thorough medical exam will be done which includes going over medical history, a physical exam, blood tests, and tests to rule out a blockage or structural problem in the GI tract, along with gastric emptying tests.  Tests a doctor may order could include an upper gastrointestinal endoscopy, upper GI series, ultrasound, gastric emptying scintigraphy and gastric emptying breath test.

Treatment of gastroparesis

Depending on the severity of this condition, determines how to treat it.  Unfortunately, gastroparesis treatment generally does not cure it as this illness is usually considered to be a chronic, long-term condition.  Gastroparesis is also a relapsing condition in that the symptoms can come and go over time.  The treatments that are used are meant to help people better manage the condition so they can be as comfortable as possible.

 One of the primary means of treating gastroparesis is through dietary changes.  These changes can include the following:

·      Eating six small meals a day instead of three.  If less food enters the stomach each time a person eats, the stomach does not become overly full making it easier to empty.

·      Avoid foods high in fat

·      Eat nutritious foods first before filling up on “empty calories”

·      Chew foods well

·      Sit up while eating and for 2 hours after finishing. 

·      To assist with gastric emptying, consider taking a casual walk after a meal instead of lying down

·      Drink noncarbonated beverages such as water with a meal

·      Avoid foods high in fiber such as raw fruits and vegetables since the fibrous parts don’t digest as well

·      For those with diabetes, keep blood sugar well controlled

·      On days when symptoms are worse, avoid eating solid foods as they make the stomach have to work harder.  Instead, consume just liquids to let the stomach rest.  Or consume foods that are liquefied, thinned, blenderized or strained.

Other ways of controlling gastroparesis is with medications such as Reglan or Erythromycin, gastric electrical stimulation, botulinum toxin, jejunostomy, and parenteral nutrition.