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Gastroparesis : Causes, Signs and Symptoms, Diagnosis and Treatment

Symptoms & Causes, Diagnosing and Treating of Gastroparesis

Gastroparesis Causes, Signs and Symptoms, Diagnosis and Treatment

Gastroparesis is a long-term (chronic) condition where the stomach cannot empty in the normal way. Food passes through the stomach slower than usual.

Gastroparesis is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach’s motility is slowed down or doesn’t work at all, preventing your stomach from emptying properly.

The cause of gastroparesis is usually unknown. Sometimes it’s a complication of diabetes, and some people develop gastroparesis after surgery. Certain medications, such as opioid pain relievers, some antidepressants, and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. For people who already have gastroparesis, these medications may make their condition worse.

Gastroparesis is a disorder that occurs when the stomach takes too long to empty food. This disorder leads to a variety of symptoms that can include nausea, vomiting, feeling easily full, and a slow emptying of the stomach, known as delayed gastric emptying.

Gastroparesis can interfere with normal digestion, cause nausea, vomiting and abdominal pain. It can also cause problems with blood sugar levels and nutrition. Although there’s no cure for gastroparesis, changes to your diet, along with medication, can offer some relief.

It’s thought to be the result of a problem with the nerves and muscles that control how the stomach empties.

What Is Gastroparesis?

Gastroparesis (abbreviated as GP) represents a clinical syndrome characterized by sluggish emptying of solid food (and more rarely, liquid nutrients) from the stomach, which causes persistent digestive symptoms especially nausea and primarily affects young to middle-aged women, but is also known to affect younger children and males. Diagnosis is made based upon a radiographic gastric emptying test. Diabetics and those acquiring gastroparesis for unknown (or, idiopathic) causes represent the two largest groups of gastroparetic patients; however, numerous etiologies (both rare and common) can lead to a gastroparesis syndrome.

Gastroparesis is also known as delayed gastric emptying and is an old term that does not adequately describe all the motor impairments that may occur within the gastroparetic stomach. Furthermore, there is no expert agreement on the use of the term, gastroparesis. Some specialists will reserve the term, gastroparesis, for grossly impaired emptying of the stomach while retaining the label of delayed gastric emptying, or functional dyspepsia (non-ulcer dyspepsia), for less pronounced evidence of impaired emptying. These terms are all very subjective. There is no scientific basis by which to separate functional dyspepsia from classical gastroparesis except by symptom intensity. In both conditions, there is significant overlap in treatment, symptomatology and underlying physiological disturbances of stomach function.

For the most part, the finding of delayed emptying (gastric stasis) provides a “marker” for a gastric motility problem. Regardless, the symptoms generated by the stomach dysmotility greatly impair quality of life for the vast majority of patients and disable about 1 in 10 patients with the condition.

While delayed emptying of the stomach is the clinical feature of gastroparesis, the relationship between the degree of delay in emptying and the intensity of digestive symptoms does not always match. For instance, some diabetics may exhibit pronounced gastric stasis yet suffer very little from the classical gastroparetic symptoms of: nausea, vomiting, reflux, abdominal pain, bloating, fullness, and loss of appetite. Rather, erratic blood-glucose control and life-threatening hypoglycemic episodes may be the only indication of diabetic gastroparesis.

In another subset of patients (diabetic and non-diabetic) who suffer from disabling nausea that is to the degree that their ability to eat, sleep or carry out activities of daily living is disrupted gastric emptying may be normal, near normal, or intermittently delayed. In such cases, a gastric neuro-electrical dysfunction, or gastric dysrhythmia (commonly found associated with gastroparesis syndrome), may be at fault.

Therefore, these disorders of functional dyspepsia, gastric dysrhythms, and gastroparesis are all descriptive labels sharing similar symptoms and perhaps representing a similar entity of disordered gastric neuromuscular function. For this reason, a more encompassing term, gastropathy, can be used interchangeably with gastroparesis.
astroparesis.

What Are Gastroparesis Symptoms and Signs?

The most common symptoms of gastroparesis include feeling full from small amounts of food, nausea, vomiting, reduced appetite, abdominal pain, heartburn or gastroesophageal reflux disease (GERD), and regurgitation. These symptoms can lead to weight loss and nutrient deficiencies. Other symptoms include bloating, muscle weakness, and night sweats. Since the digestive system doesn’t work smoothly, those with the condition also experience periods of low blood sugar while the food remains in the stomach, and high blood sugar when it eventually reaches the intestines.

Sometimes, more severe complications can occur due to delayed gastric emptying. Individuals can experience obstructions caused by masses of solid hardened food (bezoars). Often, bezoars will pass on their own, but other times they require treatment in the form of oral solutions to help dissolve them or, in severe cases, surgery.

If excessive vomiting is a symptom, it can cause its own set of complications, including dehydration and malnutrition. In those who have diabetes and gastroparesis, controlling blood sugar can become very difficult due to the irregular release of food into the small intestine.

The symptoms of gastroparesis may include

  • feeling full soon after starting a meal
  • feeling full long after eating a meal
  • nausea
  • vomiting
  • too much bloating
  • too much belching
  • pain in your upper abdomen
  • heartburn
  • poor appetite

Certain medicines may delay gastric emptying or affect motility, resulting in symptoms that are similar to those of gastroparesis. If you have been diagnosed with gastroparesis, these medicines may make your symptoms worse. Medicines that may delay gastric emptying or make symptoms worse include the following:

  • narcotic pain medicines, such as codeine NIH external link , hydrocodone NIH external link , morphine NIH external link , oxycodone NIH external link , and tapentadol NIH external link
  • some antidepressants NIH external link , such as amitriptyline NIH external link , nortriptyline NIH external link , and venlafaxine NIH external link
  • some anticholinergics —medicines that block certain nerve signals
  • some medicines used to treat overactive bladder
  • pramlintide NIH external link

What Causes Gastroparesis?

Gastroparesis is caused by nerve injury, including damage to the vagus nerve. In its normal state, the vagus nerve contracts (tightens) the stomach muscles to help move food through the digestive tract. In cases of gastroparesis, the vagus nerve is damaged by diabetes. This prevents the muscles of the stomach and intestine from working properly, which keeps food from moving from the stomach to the intestines.

While the exact cause of gastroparesis isn’t known, it’s thought to have something to do with disrupted nerve signals in the stomach. It’s believed that when the nerves to the stomach become affected by a variety of factors, food can move through it too slowly. Other problems such as the stomach being overly sensitive to signals from the nervous system and the stomach not being able to react to a meal are believed to also have a roleTrusted Source in this condition.

Most types of gastroparesis fit into one of these categories:

  • idiopathic, or unknown
  • diabetes-related
  • postsurgical

Nearly 36 percentTrusted Source of gastroparesis cases aren’t linked to an identifiable cause. This is known as idiopathic. Many times this condition occurs after a viral illness, but it’s not fully understood.

A common cause of damage to the nervous system that affects the digestion is diabetes, specifically diabetes that isn’t well-controlled. High blood sugar can damage nerves over time.

Surgeries that involve the stomach or other digestive organs can also change signals to the stomach. About 13 percentTrusted Source of people with gastroparesis have the type known as postsurgical.

How Is Gastroparesis Diagnosed?

The most common method for diagnosing gastroparesis is a nuclear medicine test called a gastric emptying study, which measures the emptying of food from the stomach. For this study, a patient eats a meal in which the solid food, liquid food, or both contain a small amount of radioactive material. A scanner (acting like a Geiger counter) is placed over the stomach for several hours to monitor the amount of radioactivity in the stomach. In patients with gastroparesis, the food takes longer than normal (usually more than several hours) to empty into the intestine.

The antro-duodenal motility study is a study that can be considered experimental and is reserved for selected patients. An antro-duodenal motility study measures the pressure that is generated by the contractions of the muscles of the stomach and intestine. This study is conducted by passing a thin tube through the nose, down the esophagus, through the stomach and into the small intestine.

With this tube, the strength of the contractions of the muscles of the stomach and small intestine can be measured at rest and following a meal. In most patients with gastroparesis, food (which normally causes the stomach to contract vigorously) causes either infrequent contractions (if the nerves are diseased) or only very weak contractions (if the muscle is diseased).

An electrogastrogram, another experimental study that sometimes is done in patients with suspected gastroparesis, is similar to an electrocardiogram (EKG) of the heart. The electrogastrogram is a recording of the electrical signals that travel through the stomach muscles and control the muscles’ contractions. An electrogastrogram is performed by taping several electrodes onto a patient’s abdomen over the stomach area in the same manner as electrodes are placed on the chest for an EKG.

The electrical signals coming from the stomach that reach the electrodes on the abdomen are recorded at rest and after a meal. In normal individuals, there is a regular electrical rhythm just as in the heart, and the power (voltage) of the electrical current increases after the meal. In most patients with gastroparesis, the rhythm is not normal or there is no increase in electrical power after the meal.

Although the gastric emptying study is the primary test for diagnosing gastroparesis, there are patients with gastroparesis who have a normal gastric emptying study but an abnormal electrogastrogram. Therefore, the electrogastrogram can be useful primarily when the suspicion for gastroparesis is high but the gastric emptying study is normal or borderline abnormal.

A physical obstruction to the emptying of the stomach, for example, a tumor that compresses the outlet from the stomach or scarring from an ulcer, may cause symptoms that are similar to gastroparesis. Therefore, an upper gastrointestinal (GI) endoscopy test usually is performed to exclude the possibility of an obstruction as the cause of a patient’s symptoms. (Upper GI endoscopy involves the swallowing of a tube with a camera on the end and can be used to visually examine the stomach and duodenum and take biopsies.)

Upper GI endoscopy also may be useful for diagnosing one of the complications of gastroparesis, a bezoar (a clump or wad of swallowed food or hair). Because of the poor emptying of the stomach, hard to digest components of the diet, usually from vegetables, are retained and accumulate in the stomach. A ball of undigested, plant-derived material can accumulate in the stomach and give rise to symptoms of fullness or can further obstruct the emptying of food from the stomach. Removing the bezoar may improve symptoms and emptying.

A computerized tomographic (CT) scan of the abdomen and upper gastrointestinal X-ray series also may be necessary to exclude cancer of the pancreas or other conditions that can obstruct the emptying of the stomach.

An alternative method of looking at gastric emptying is a large capsule (SmartPill) that is swallowed. The capsule measures pressure, acidity and temperature, and then transmits the measurements wirelessly to a recorder. By analyzing the measurements it can be determined how long it takes the capsule to empty from the stomach, and the amount of time necessary for emptying correlates well with other measures of gastric emptying.

Treating Gastroparesis

Gastroparesis cannot usually be cured, but dietary changes and medical treatment can help you control the condition.

Dietary Changes

You may find these tips helpful:

  • instead of 3 meals a day, try smaller, more frequent meals – this means there’s less food in your stomach and it will be easier to pass through your system
  • try soft and liquid foods – these are easier to digest
  • chew food well before swallowing
  • drink non-fizzy liquids with each meal

It may also help to avoid certain foods that are hard to digest, such as apples with their skin on or high-fibre foods like oranges and broccoli, plus foods that are high in fat, which can also slow down digestion.

Medicines

The following medicines may be prescribed to help improve your symptoms:

  • domperidone – which is taken before eating to contract your stomach muscles and help move food along
  • erythromycin – an antibiotic that also helps contract the stomach and may help move food along
  • anti-emetics – medicines that can help to stop you from feeling or being sick

However, the evidence that these medicines relieve the symptoms of gastroparesis is relatively limited and they can cause side effects. Your doctor should discuss the potential risks and benefits with you.

Domperidone should only be taken at the lowest effective dose for the shortest possible time because of the small risk of potentially serious heart-related side effects.

Electrical Stimulation

If dietary changes and medicine do not help your symptoms, a relatively new treatment called gastroelectrical stimulation may be recommended. However, this is currently not routinely funded by many NHS authorities.

Gastroelectrical stimulation involves surgically implanting a battery-operated device under the skin of your tummy.

Two leads attached to this device are fixed to the muscles of your lower stomach. They send electrical impulses to help stimulate the muscles involved in controlling the passage of food through your stomach. The device is turned on using a handheld external control.

The effectiveness of this treatment can vary considerably. Not everyone will respond to it, and for many people who do respond, the effect will largely wear off within 12 months. This means electrical stimulation is not suitable for everyone with gastroparesis.

There’s also a small chance of this procedure leading to complications that would require removing the device, such as:

  • infection
  • the device dislodging and moving
  • a hole forming in your stomach wall

Speak to your surgeon about the possible risks. You can also read the National Institute for Health and Care Excellence (NICE) guidelines on gastroelectrical stimulation for gastroparesis.

Botulinum toxin injections

More severe cases of gastroparesis may occasionally be treated by injecting botulinum toxin into the valve between your stomach and small intestine.

This relaxes the valve and keeps it open for a longer period of time so food can pass through.

The injection is given through a thin, flexible tube (endoscope) which is passed down your throat and into your stomach.

This is a fairly new treatment and some studies have found it may not be very effective, so it’s not recommended by all doctors.

A Feeding Tube

If you have extremely severe gastroparesis that is not improved with dietary changes or medicine, a feeding tube may be recommended.

Many different types of temporary and permanent feeding tube are available.

A temporary feeding tube, called a nasojejunal tube, may be offered to you first. This is inserted into your digestive tract through your nose and delivers nutrients directly into your small intestine.

A feeding tube can also be inserted into your bowel through a cut (incision) made in your tummy. This is known as a jejunostomy.

Liquid food can be delivered through the tube, which goes straight to your bowel to be absorbed, bypassing your stomach.

Speak to your doctor about the risks and benefits of each type of feeding tube.

An alternative feeding method for severe gastroparesis is intravenous (parenteral) nutrition. This is where liquid nutrients are delivered into your bloodstream through a catheter inserted into a large vein.

Surgery

Some people may benefit from having an operation to insert a tube into the stomach through the tummy (abdomen). This tube can be periodically opened to release gas and relieve bloating.

A surgical procedure may be recommended as a last resort to either:

  • create a new opening between your stomach and small intestine (gastroenterostomy)
  • connect your stomach directly to the second part of your small intestine, called the jejunum (gastrojejunostomy)

These operations may reduce your symptoms by allowing food to move through your stomach more easily.

Your doctor can explain whether any procedures are suitable for you, and can discuss the possible risks involved.

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