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Gastric emptying disorder, also known as gastroparesis, is characterized by a weakened stomach muscle and this causes the stomach contents to take too long to empty into the small intestine. Vagus nerve damage is also present. Slowed digestive movement is most common, but for some patients no movement occurs at all.
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Diabetes is the most common cause. The excess blood sugar levels can cause nerve and blood vessel damage, including the vagus nerve. In some cases, the cause of this disorder is unknown, referred to as idiopathic gastroparesis. Other possible causes include:
- Surgery on the vagus nerve or stomach
- Bulimia or anorexia nervosa
- Gastroesophageal reflux disease
- Certain nervous system disorders, such as Parkinson's disease and abdominal migraine
- Viral infections
- Certain smooth muscle disorders, such as scleroderma and amyloidosis
- Certain metabolic disorders, such as hypothyroidism
- Certain medications that slow intestinal contractions, such as narcotics and anticholinergics
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Signs and Symptoms
Gastric emptying disorder can cause a variety of signs and symptoms. Solid, high-fiber foods, carbonated beverages, and high-fat foods often contribute to symptoms. Frequency and severity varies. Signs and symptoms may include:
- Feeling full with little food
- Abdominal bloating
- Loss of appetite
- Stomach area spasms
- Upper abdominal pain
- Vomiting undigested food
- Weight loss
- Low and high blood sugar
- Gastroesophageal reflux
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Testing and Diagnosis
Blood testing and a physical exam is typically done first. The patient's doctor will also get a medical history. To rule out other possible conditions, especially obstructive ones, patients may have upper endoscopy, barium X-ray, and ultrasound. Once the doctor has ruled out other possible causes, gastric emptying tests are done to confirm the diagnosis. These include a breath test, gastric emptying scintigraphy and a device known as SmartPill.
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There are a variety of medications that may be beneficial for alleviating gastric emptying disorder. Metoclopramide helps stomach emptying and helps in reducing nausea and vomiting. Side effects may include fatigue, depression, physical movement problems, sleepiness, and anxiety. Domperidone also helps stomach emptying and helps in reducing nausea and vomiting. Erythromycin helps stomach emptying. This antibiotic may cause abdominal cramping, nausea, and vomiting. Other medications may be used to control individual symptoms if needed.
Dietary changes are common. Patients should eat smaller meals more often. In some cases, a pureed or liquid diet may be necessary. Certain foods should be avoided and the patient's doctor will provide them with a list of these foods, but they are generally those high in fiber or fat.
Patients with a very difficult time eating may need to have a feeding tube. This will ensure they are getting adequate food. Parenteral nutrition may also be necessary. This involves getting nutrients directly into the bloodstream using a catheter.
Gastric electrical stimulation is done to help with nausea and vomiting in patients who fail to respond to medications. This is not a common treatment yet and it requires surgery for implantation.
While further medical studies are still needed, botulinum toxin may also prove helpful in improving symptoms.
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Dartmouth-Hitchcock Medical Center. (2011). Gastroparesis. Retrieved on March 14, 2011 from Dartmouth-Hitchcock Medical Center: http://www.dhmc.org/webpage.cfm?site_id=2&org_id=596&gsec_id=33835&sec_id=33835&item_id=34171
National Digestive Diseases Information Clearinghouse. (2007). Gastroparesis. Retrieved on March 14, 2011 from the National Digestive Diseases Information Clearinghouse: http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/