Gastroparesis is a condition where the muscles inside your stomach do not work properly, leading to inefficient emptying of your stomach into your small intestine. This disorder can lead to problems with nutrition, nausea, vomiting and poor blood glucose control for diabetics. Ironically, one cause of gastroparesis is diabetes. Read on to learn more about gastroparesis definition, symptoms, treatment and diagnosis.
Definition of Gastroparesis
Patients whose stomach muscles do not function normally are often diagnosed with gastroparesis, according to the Mayo Clinic. One cause of gastroparesis is damage to the vagus nerve which controls the muscles in your stomach and that are responsible for moving food into your intestine. When this nerve does not work correctly, food remains in your stomach longer than it is supposed to.
When food does not move into your small intestine as it is supposed to, you do not benefit from the nutrition it provides and you may experience other symptoms.
The vagus nerve can be damaged by high levels of blood sugar. High blood sugar leads to chemical changes in nerves throughout the body, including the vagus nerve. High levels of blood sugar also damage the blood vessels that take nutrients and oxygen to the nerves. Damage to the vagus nerve can develop over a long period of time, according to the National Digestive Diseases Information Clearinghouse.
Other causes of gastroparesis include viral infections, anorexia nervosa or bulimia, surgery performed on the vagus nerve or stomach, anticholinergic and narcotic drugs that work to slow stomach muscle contractions, nervous system diseases, smooth muscle disorders and metabolic disorders such as hypothyroidism, according to the NDDIC.
The symptoms of gastroparesis can be hard to diagnose since they are varied and not every person with this disorder has the same symptoms. These include heartburn, nausea, upper-abdomen pain, vomiting several hours after eating, feeling full after eating just a few bites, stomach and abdomenal bloating, weight loss after low-calorie intake or from poor nutrition, uncontrolled blood glucose control, poor appetite, stomach spasms and gastroesophageal reflux.
Certain kinds of foods – fatty foods, fruits and vegetables high in fiber, high-fat and highly-carbonated drinks – may make symptoms worse.
Depending on the person, symptoms can be severe or mild; they can occur frequently or not very often.
Complications and Diagnosis of Gastroparesis
Food that has not been emptied into the small intestine can develop bacterial overgrowth as the food ferments. Undigested food also hardens into bezoars or solid masses. These bezoars can cause obstruction in the stomach, nausea and vomiting; if they block passage of food into the small intestine, these masses can be dangerous, according to the NDDIC.
When the movement of food from the stomach into the small intestine is unpredictable, controlling blood sugar becomes difficult.
Doctors begin to make a diagnosis by ordering blood work to determine what your blood chemical and electrolyte levels are. An ultrasound may be ordered to rule out a stomach obstruction, pancreatitis and gallbladder disease, or an endoscopy to look for abnormalities in the lining of the stomach. A barium x-ray may also be completed. This is a fasting test, meaning you have to fast for 12 hours before the test is done. If you have gastroparesis, you are more likely to have food in your stomach even though it has been 12 hours since your last meal.
What is Gastroparesis? (cont’d)
After the doctor has ruled out other conditions, he may order a breath test to measure the level of isotope in the carbon dioxide in your exhaled breath. Before this test, you eat a meal that has had a small amount of isotope added. This test measure show quickly your stomach empties.
The gastric emptying scintigraphy measures the amount of a radioactive substance in your stomach after eating a bland meal. The doctor will have your system scanned at 1, 2, 3 and 4 hours. If more than 10 percent of the food is still in your stomach after four hours, your doctor will diagnose you with gastroparesis.
Your doctor may give you a SmartPill, which is a device in the form of a capsule that you swallow. This device collects information about its progress through your system as it moves through your digestive tract. During this test, you sear a small cell phone sized receiver, which collects the data being taken by the SmartPill. Once you have passed the SmartPill in a bowel movement, you return the receiver to your doctor so he can enter the collected information into a computer.
Your doctor will treat your gastroparesis depending on the severity of your symptoms. These range from medications and dietary changes to a feeding tube, parenteral nutrition, a gastric electrical stimulation or a botulinum toxin, according to the NDDIC.
Beginning with dietary changes, your doctor may tell you to eat six smaller meals a day rather than three large meals. If you have a more severe case, you may be put onto a pureed or liquid diet.
Medications your doctor could prescribe include metocloparmide (Reglan), which stimulates your stomach muscles to contract and move food into your small intestine. This medication also helps control nausea and vomiting. Possible side effects include sleepiness and fatigue, anxiety or depression and difficulty with physical movement. Erythromycin helps to increase the stomach contractions that aid food movement into your small intestine. Side effects can be stomach cramps, nausea and vomiting. Domperidone works like Reglan; its use in the United States is restricted, but the Food and Drug Administration is studying its use for treating gastroparesis. Other medications treat symptoms related to gastroparesis. These include medications that control nausea and vomiting and antibiotics to clear up bacterial infections. Your doctor will perform an endoscopy to inject medication into any bezoars you may have developed.
If a pureed or liquid diet isn’t helpful, your doctor may order a feeding tube, called a jejunostomy. The tube is inserted just under the skin on your abdomen and into your small intestine, completely bypassing your stomach. Medications and nutrients are injected directly into your small intestine, where they are digested and move into your bloodstream. This option is used to treat severe gastrparesis and to control blood sugar levels, according to the NDDIC.
Pareneral nutrition is used to inject nutrition directly into your bloodstream, completely bypassing your digestive system. A surgeon places a catheter into a chest vein and leaves the open end outside your skin so you can attach a bag of nutrition or medication to the catheter, where it will enter your bloodstream. This method is prescribed only in severe cases and to get you through a severe attack, according to the NDDIC.
Doctors surgically implant a gastric neurostimulator that releases small electrical impulses to control symptoms of nausea and vomiting. This option is used for patients who are not helped by medications.
Botulinum toxin is used because it has been “associated with improvement in symptoms of gastroparesis.” Further study is needed on this option, according to the NDDIC