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Gastroparesis, a condition characterized by stomach paralysis, results from disturbances in the nerves and muscles of the stomach. Typically, the digestive process relies on strong muscular contractions to propel food through the digestive tract. However, in the case of gastroparesis, there is a significant slowdown or complete dysfunction in the stomach’s motility, leading to improper emptying.
The exact cause of gastroparesis is often unknown, although it can sometimes develop as a complication of diabetes or post-surgery. Additionally, specific medications, such as opioid pain relievers, certain antidepressants, high blood pressure drugs, and allergy medications, can hinder gastric emptying, resulting in similar symptoms. For individuals already afflicted with gastroparesis, these medications may exacerbate their condition.
Gastroparesis can disrupt normal digestion, giving rise to symptoms like nausea, vomiting, and abdominal pain. It can also create complications related to blood sugar levels and nutritional deficiencies. While there is no definitive cure for gastroparesis, dietary adjustments combined with medication can provide some relief.
Symptoms
Gastroparesis can often be asymptomatic in many individuals. However, when signs and symptoms do occur, they can include:
- Indigestion.
- Abdominal bloating.
- Vomiting.
- Nausea.
- A sensation of feeling full quickly and for an extended duration.
- Upper abdominal pain.
- Repeated episodes of nausea and vomiting.
- Regurgitation, characterized by spitting up undigested food particles.
- Loss of appetite.
- Acid reflux and heartburn.
- Fluctuations in blood sugar levels.
- Constipation.
- Unintentional weight loss and malnutrition.
Causes
Gastroparesis can be attributed to various factors, with one potential cause being damage to the vagus nerve, responsible for regulating stomach muscle contractions and the movement of food into the small intestine. When the vagus nerve is compromised, it loses its ability to transmit signals effectively to the stomach muscles, leading to delayed food transit from the stomach to the small intestine. Such nerve damage may result from conditions like diabetes or surgical procedures involving the stomach or small intestine.
Risk factors
Risk factors for developing gastroparesis include:
- Gender: Women have a higher likelihood of developing gastroparesis compared to men.
- Diabetes: Individuals with diabetes are at an increased risk of developing gastroparesis.
- Previous Abdominal or Esophageal Surgery: History of abdominal or esophageal surgeries can elevate the risk of gastroparesis.
- Infection: Gastroparesis can be triggered by infections, typically viral in nature.
- Medications: Certain drugs, particularly narcotic pain medications, can slow down stomach emptying and contribute to the development of gastroparesis.
- Scleroderma: People with scleroderma, a connective tissue disease, are more susceptible to gastroparesis.
- Nervous System Disorders: Conditions like Parkinson’s disease or multiple sclerosis, which affect the nervous system, can increase the risk of gastroparesis.
- Hypothyroidism: Underactive thyroid (hypothyroidism) is another factor that can raise the risk of gastroparesis.
Diagnosis
Medical professionals employ various tests to aid in the diagnosis of gastroparesis while also excluding other conditions that may exhibit similar symptoms. These tests can include:
- Gastric emptying tests: To see how fast your stomach empties its contents, one or more of these tests may be recommended:
- Scintigraphy. The primary diagnostic test for gastroparesis involves consuming a light meal, often consisting of items like eggs and toast, which incorporates a trace amount of radioactive material. A specialized scanner is then positioned over your abdominal area to track the movement of this radioactive material, assessing the pace at which food exits the stomach. It’s crucial to discontinue any medications that could potentially impede gastric emptying before undergoing this test, and it’s advisable to consult your doctor to determine if any of your prescribed medications might have such an effect on your digestion.
- Breath tests. For breath tests, you consume a solid or liquid food that contains a substance that your body absorbs. Eventually, the substance can be detected in your breath. Samples of your breath are collected over a few hours and the amount of the substance in your breath is measured. The test can show how fast your stomach empties after consuming food by measuring the amount of the substance in your breath.
- Imaging:
- Upper gastrointestinal (GI) endoscopy: This procedure is used to visually examine your upper digestive system — your esophagus, stomach and beginning of the small intestine (duodenum). It uses a tiny camera on the end of a long, flexible tube. This test can also be used to diagnose other conditions, such as peptic ulcer disease or pyloric stenosis, which can have symptoms similar to those of gastroparesis.
- Ultrasound: This test uses high-frequency sound waves to produce images of structures within your body. Ultrasound can help diagnose whether problems with your gallbladder or your kidneys could be causing your symptoms.
Treatment
Healthcare providers are unable to directly repair the underlying damage responsible for gastroparesis. However, they can provide treatments aimed at promoting stomach muscle contractions and facilitating stomach emptying. Medications are typically the initial treatment approach, while surgery is considered for individuals who do not respond to medications or are unable to tolerate them. It’s important to note that each treatment option may have potential side effects, and effectiveness can vary from person to person.
The primary objectives of treatment are as follows:
- Enhance stomach muscle function and promote stomach emptying.
- Ensure that the body receives adequate nutrition and hydration.
- Alleviate symptoms and manage any treatment-related side effects.
- Address the underlying cause, when possible, to prevent further deterioration of the condition.
Nutrition
The most important thing when dealing with gastroparesis is to make sure you get the right nutrition. Many people with this condition can manage it by changing their diet. Your doctor might send you to a dietitian who can help you find foods that are easier for your stomach to handle. This way, you can still get the calories and nutrients you need from your meals.
There are some simple dietary tips a dietitian might suggest:
- Eat smaller meals more often throughout the day.
- Chew your food thoroughly before swallowing.
- Choose cooked fruits and veggies over raw ones.
- Avoid tough fruits and veggies like oranges and broccoli, as they can be hard to digest.
- Pick mostly low-fat foods, but you can have a bit of fatty food if you can handle it.
- Consider soups and pureed foods, especially if liquids are easier for you to eat.
- Make sure you drink about 34 to 51 ounces (1 to 1.5 liters) of water every day.
- Do some light exercise, like taking a short walk, after you eat.
- Stay away from fizzy drinks, alcohol, and smoking.
- Try not to lie down for at least two hours after a meal.
- Take a daily multivitamin to make sure you’re getting all the essential nutrients.
Medication
The primary treatment approach for gastroparesis involves the use of prokinetics, which are medications designed to enhance gastrointestinal motility. These prokinetic medications encompass various options:
- Metoclopramide: This is the sole FDA-approved drug for gastroparesis treatment. It operates by stimulating contractions in the stomach muscles and can also alleviate nausea. However, it carries a black-box warning due to potential neurological side effects such as tremors and muscle twitching.
- Motolin Agonists: Motolin agonists present an alternative class of prokinetic drugs that healthcare providers may recommend. Examples include erythromycin and azithromycin, which are typically used as antibiotics but are sometimes prescribed off-label to address gastroparesis.
- Serotonin Agonists: Two serotonin agonists, namely Tegaserod and prucalopride, are typically prescribed to promote bowel movements in individuals experiencing constipation. While their efficacy for gastroparesis treatment hasn’t been extensively studied, some healthcare providers may still consider them for this purpose.
- Dopamine Antagonists: Domperidone is a medication that enhances gastric motility and reduces nausea by blocking the action of dopamine, a neurotransmitter.
Additional medications that may be considered include:
- Antiemetics: These are prescribed to manage nausea and vomiting.
- Proton Pump Inhibitors: These drugs are used to address acid reflux.
- Analgesics: Pain relievers may be recommended for individuals experiencing significant stomach pain.
- Diabetes Medications: Some individuals with gastroparesis may require diabetes medications to regulate their blood sugar levels.
Surgery
When all other treatments fail in addressing gastroparesis, surgery becomes the last option. There are two main surgical procedures for gastroparesis:
- Pyloroplasty: This surgery modifies the pylorus, the valve at the bottom of the stomach responsible for food emptying. In a traditional pyloroplasty, the surgeon cuts into the pylorus muscle to widen the opening. A more recent variation, known as G-POEM (gastric peroral endoscopic myotomy), is performed endoscopically. Instead of abdominal incisions, the surgeon uses a long tube inserted through the mouth to access and modify the pylorus from within the stomach.
- Gastric Bypass: In some cases, individuals may require a gastric bypass procedure. This involves either removing or closing off a portion of the stomach and creating a new connection between the remaining stomach and the small intestine (gastrojejunostomy). Gastric bypass surgery is commonly used for weight loss, particularly for those with obesity-related Type 2 diabetes. It can also be recommended for severe diabetes-related gastroparesis.
