Gastroparesis

What is it?
Gastroparesis, or delayed stomach emptying, is a disorder in which, the stomach takes too long to empty its contents. Normally, muscles in the wall of the stomach work to grind food into smaller pieces and push its contents into the first part of the small intestine, the duodenum. In gastroparesis, these stomach muscles work poorly, or not at all, preventing your stomach from emptying properly. This can delay digestion, which can lead to a number of gastrointestinal symptoms.

Who gets it?
This disorder is more common in females. 50-65% of patient with diabetes and with upper abdominal complaints have gastroparesis.

Why does it happen?
About half the time, no specific cause can be found for the delayed stomach emptying. This is called idiopathic. There are several known causes:

  • Diabetes Mellitus, both types 1 and 2. It is thought the association is due to dysfunction of the nervous symptom in the stomach. Because the delayed emptying of food from the stomach, glucose (blood sugar) control can be more difficult.
  • Viral. There is evidence that possibly an infection with certain viruses like Norwalk virus and rotavirus can lead to slower stomach emptying. Usually this resolves with time.
  • Medications. Calcium channel blockers and narcotics are known to weaken stomach muscle contractions.
  • Previous gastric or chest surgeries. Sometimes, the vagus nerve can be damaged in surgical procedures; this nerve provides important signals for emptying.
  • Neurologic conditions. Parkinson’s, multiple sclerosis, stroke, brain injury and other nervous system disorders can cause gastroparesis.
  • Metabolic disorders such as adrenal or thyroid gland problems (hypothyroidism).
  • Autoimmune. The body’s immune system can incorrectly attacks itself; this can happen by itself or associated with a cancer, most often small cell lung cancer.
  • Psychiatric disease
  • Anorexia nervosa or bulemia


What are the symptoms?
Possible symptoms include:

  • Nausea
  • Vomiting
  • Bloating
  • Early satiety, a sense of feeling full with only several bites of food.
  • Excessive belching
  • Heartburn/indigestion
  • Upper abdominal pain. It may get worse after eating·
  • Weight loss
  • Lack of appetite

How is it diagnosed?
Several tests are available to help diagnose gastroparesis. Some of the tests are preformed to rule out other conditions that can cause similar symptoms.

Gastric Emptying Study is usually considered the most accurate way to diagnosis gastroparesis. It is a test which measures the amount of time it takes your stomach to move food to the small intestine. For the test, a small amount of food, which contains a small amount of a radioactive tracer, is eaten. A scanner is placed over the stomach to measure the amount of food moved out of the stomach over a period of time, typically 90 minutes.

Upper endoscopy (an exam with a lighted tube with a camera examining the esophagus, stomach and the first part of the small intestine, the duodenum) to rule out an obstruction or disease of the tissue of the stomach as a cause of the symptoms.

Laboratory testing may be ordered depending on your symptoms. While this would not actually document the speed of stomach emptying, it can help uncover diseases linked with gastroparesis or rule out other disorders.

How is it treated?
Once diagnosed with this disorder, changing your diet is important. If you are diabetic, it is thought that if your blood sugar is better controlled this may help improve the motor function of your stomach.

Dietary changes include:

  • Smaller, more frequent meals. Eat six small meals per day instead of three larger meals.
  • Avoid high fiber food. High fiber foods tend to stay in the stomach longer.
  • Avoid red meats, raw vegetables and raw fruits, especially when symptoms are bad.
  • Avoid high-fat foods.
  • Nutritional supplements may be consumed to supplement any missing nutrients in the diet
  • Liquids and pureed foods are helpful if symptoms are severe

Medications called prokinetics can be used to help the stomach empty more effectively. All of the following drugs are given 10-30 minutes before meals and potentially before bedtime.

  • Erythromycin. This is an antibiotic that causes the stomach to contract and squeeze out any material to the small intestine. There are serious side effects that can be linked with the medicine such as, worsening GI problems, damage to your ears, and changes in the electrical activity of the heart (prolongation of the QT interval, especially if taking certain medications).
  • Metoclopramide. Is a prokenetic which increases the strength and frequency of muscle contractions and relaxes the valve that controls the release of food from your stomach to your small intestine. Side effects are common including drowsiness, depression and muscle spasms.
  • Domperidone. This medicine is not approved for use in the United States by the Food and Drug Administration (FDA). It works by blocking dopamine and increases movement in the stomach. The most common side effects are headache, dry mouth and dizziness.

Complications

  • Weight loss and malnutrition. Problems can occur when slow emptying of the stomach affects your body’s ability to digest and absorb nutrients.
     
  • Blood sugar fluctuations. Gastroparesis doesn’t cause diabetes, but inconsistent food absorption can cause fluctuations in blood sugar, making the diabetes harder to control.
     
  • Bezoars. Undigested food in the stomach can harden into a bezoar. This can cause nausea and vomiting and may prevent food from passing into the small intestine.

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