Explore effective strategies for living with gastroparesis. Meri Sehat provides expert advice for your well-being

Gastroparesis

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

Gastroparesis is a functional disorder. Also known as delayed gastric emptying, it affects the spontaneous movement of the stomach muscles, slowing or stopping food traveling from the stomach to the small intestine even when there are no blockages in the stomach or intestines. 
&nbsp;

Gastroparesis is a medical condition characterized by delayed emptying of the stomach contents into the small intestine.

It is a relatively uncommon medical condition. Approximately, 10 men and 40 women out of 100,000 people of all ages have gastroparesis<a href="#accordion">[1]</a>. Women are more likely to be diagnosed than men<a href="#accordion">[3]</a>. 
&nbsp;

It is estimated that approximately 5 million people in the United States suffer from gastroparesis. The prevalence is higher among individuals with diabetes, with up to 30% of people with type 1 diabetes and 10% of people with type 2 <a href="https://merisehat.pk/disease/diabetes-a-complete-overview">diabetes</a> developing gastroparesis at some point. 
&nbsp;

Signs and Symptoms

Gastroparesis can cause a variety of signs and symptoms, the severity of which varies from person to person. The following are some common signs and symptoms of gastroparesis:

<ul>
	<li>Indigestion</li>
	<li><a href="https://merisehat.pk/disease/dehydration">Dehydration</a></li>
	<li>Heartburn and acid reflux</li>
	<li>Unintentional weight loss</li>
	<li>Upper abdominal pain</li>
	<li>Fluctuations in blood sugar levels</li>
	<li>Early satiety or feeling full quickly</li>
	<li>Reduced appetite or aversion to eating</li>
	<li>Malnutrition and nutritional deficiencies</li>
	<li>Feeling full for a long time after eating a meal</li>
	<li>Abdominal bloating, belching, and discomfort</li>
	<li>Inconsistent bowel movements, alternating between constipation and diarrhea</li>
	<li>Persistent or recurrent nausea and vomiting several hours after eating or drinking 
	&nbsp;</li>
</ul>

Important!

It&rsquo;s an emergency if you or someone you know presents with the following symptoms<a href="#accordion">[1]</a>:

<ul>
	<li>Fever</li>
	<li>Difficulty breathing</li>
	<li>Decreased skin turgor</li>
	<li>Red blood in your vomit</li>
	<li>Less or dark-colored urine</li>
	<li>Lightheadedness or dizziness</li>
	<li>Extreme thirst and dry mouth</li>
	<li>Severe pain or cramping in your abdomen</li>
	<li>Prolonged vomiting (for more than an hour) 
	&nbsp;</li>
</ul>

Causes

There are several potential causes of gastroparesis. One of the most common causes is damage to the vagus nerve, which controls the muscles of the stomach, nerves, and pacemaker cells in the stomach walls. 
&nbsp;

It can also result from:

<ul>
	<li>Diabetes</li>
</ul>

One of the most common causes of gastroparesis is diabetes mellitus, particularly type 1 diabetes and poorly-controlled type 2 diabetes. 
&nbsp;

<ul>
	<li>Idiopathic Gastroparesis</li>
</ul>

In some cases, the exact cause of gastroparesis remains unknown, and it is referred to as idiopathic gastroparesis. 
&nbsp;

<ul>
	<li>Neurological Disorders</li>
</ul>

Conditions affecting the nervous system, such as Parkinson&#39;s disease, multiple sclerosis, and certain neuropathies, can interfere with the nerve signals that regulate stomach motility. 
&nbsp;

<ul>
	<li>Viral Infections</li>
</ul>

Some viral infections, such as certain strains of the herpes virus, have been linked to the development of gastroparesis. 
&nbsp;

<ul>
	<li>Surgery</li>
</ul>

Surgeries that involve the stomach or nearby structures, such as gastric surgery for weight loss or esophageal surgery, can sometimes result in gastroparesis. 
&nbsp;

<ul>
	<li>Medications</li>
</ul>

Certain medications, especially those that affect the nervous system or interfere with stomach contractions, can contribute to gastroparesis. Examples include narcotics, some antidepressants, and some medications used for high blood pressure. 
&nbsp;

<ul>
	<li>Autoimmune Disorders</li>
</ul>

Autoimmune diseases that affect the nervous system or gastrointestinal tract, such as scleroderma, can lead to gastroparesis. 
&nbsp;

<ul>
	<li>Connective Tissue Disorders</li>
</ul>

Conditions like Ehlers-Danlos syndrome or systemic lupus erythematosus can affect the connective tissues and nerves, potentially causing gastroparesis. 
&nbsp;

<ul>
	<li>Hormonal Disorders</li>
</ul>

Hormonal imbalances, such as an underactive thyroid (hypothyroidism) or disorders affecting the adrenal glands, can impact stomach motility. 
&nbsp;

<ul>
	<li>Amyloidosis</li>
</ul>

This rare disorder involves the buildup of abnormal proteins in various tissues, including the stomach, which can disrupt normal function. 
&nbsp;

<ul>
	<li>Chemotherapy</li>
</ul>

Cancer treatments, particularly certain chemotherapy agents, can contribute to gastroparesis. 
&nbsp;

<ul>
	<li>Eating Disorders</li>
</ul>

Severe eating disorders, like anorexia nervosa or bulimia, can have an impact on stomach function.

Note: Sometimes multiple factors can contribute to the development of gastroparesis. The specific cause can impact the severity of the condition, the effectiveness of treatment approaches, and the overall prognosis. 
&nbsp;

Diagnosis

The diagnosis of gastroparesis involves a combination of medical history, physical examination, and various tests to assess stomach motility and rule out other conditions with similar symptoms.

The healthcare provider will begin by asking the individual about their medical history, including any existing medical conditions, any medications they&rsquo;re taking, and the symptoms they&rsquo;re experiencing. 
&nbsp;

A physical examination can allow the doctor to assess the patient&#39;s overall health and look for any signs or symptoms that may indicate gastroparesis. They may check blood pressure, heart rate, and temperature, and check the abdomen for unusual pain or tenderness.

They may also order blood tests to check for conditions like diabetes and thyroid disorders that can contribute to gastroparesis. Blood tests can also evaluate electrolyte levels and help rule out other potential causes of your symptoms. 
&nbsp;

<ul>
	<li>
	<h5>Gastric Emptying Studies</h5>
	</li>
</ul>

Gastric emptying studies are the primary tests used to diagnose gastroparesis. There are two main types of gastric emptying studies:

<ol>
	<li>Gastric Emptying Scan: In this test, the patient is instructed to eat a meal containing a small amount of radioactive material. The movement of the radioactive material through their digestive system is tracked using a special camera. The time it takes for the stomach to empty is measured.</li>
	<li>SmartPill Or Wireless Motility Capsule: The SmartPill is basically a tiny electronic device that the patient swallows. As the capsule moves through the digestive tract, it sends information to a recorder that&rsquo;s clipped to the patient&rsquo;s belt or hung around the neck, highlighting how fast or slow the food and liquid move through the stomach and intestines. The capsule passes out of the body through natural bowel movements. 
	&nbsp;</li>
</ol>

<ul>
	<li>
	<h5>Electrogastrography (EGG)</h5>
	</li>
</ul>

EGG is a non-invasive test that measures the electrical activity of the stomach muscles. It can provide information about the stomach&#39;s contractile activity and motility patterns. 
&nbsp;

<ul>
	<li>
	<h5>Upper Gastrointestinal Endoscopy</h5>
	</li>
</ul>

An endoscopy involves inserting a thin, flexible tube with a camera (endoscope) into the stomach to examine the lining and structures. While this test doesn&#39;t directly diagnose gastroparesis, it can help rule out other conditions with similar symptoms. 
&nbsp;

<ul>
	<li>
	<h5>Breath Tests</h5>
	</li>
</ul>

Breath tests can measure the amount of hydrogen in the patient&rsquo;s breath, which can be an indicator of bacterial overgrowth in the small intestine. 
&nbsp;

<ul>
	<li>
	<h5>Urine Tests</h5>
	</li>
</ul>

This can help identify diabetes, infections, dehydration, and kidney problems. 
&nbsp;

<ul>
	<li>
	<h5>Other Imaging Tests</h5>
	</li>
</ul>

Ultrasound and abdominal CT scans may be used to evaluate the stomach and surrounding structures, though they might not be as specific as gastric emptying studies. 
&nbsp;

Treatment

Treatment approaches for gastroparesis typically focus on managing symptoms, improving gastric emptying, and addressing underlying causes (if possible) to enhance the overall quality of life. 
&nbsp;

<ul>
	<li>Dietary Modifications</li>
</ul>

This includes eating smaller, more frequent meals. Consuming smaller portions can help reduce the workload on the stomach and ease digestion. Pureed and soft foods can also be preferred since they are easier to digest than solid foods.

On the other hand, high-fiber and fatty foods should be consumed in limited quantities only to minimize the risk of digestive discomfort. 
&nbsp;

<ul>
	<li>Medications</li>
</ul>

Prokinetic medications, such as metoclopramide and domperidone, help stimulate stomach contractions and improve motility<a href="#accordion">[1]</a>. However, these medications can have side effects and interactions, so they should be used under medical supervision.

Medications that control nausea and vomiting, such as ondansetron, may also be prescribed to manage symptoms<a href="#accordion">[1]</a>.

The healthcare provider may modify the patient&rsquo;s prescription if certain medications are contributing to gastroparesis symptoms. 
&nbsp;

<ul>
	<li>Nutritional Support</li>
</ul>

In severe cases of gastroparesis where oral intake is limited, IV fluids and nasal tube feeding may be necessary to maintain hydration and adequate nutrition. 
&nbsp;

<ul>
	<li>Glycemic Control (For Diabetic Gastroparesis)</li>
</ul>

Careful management of blood sugar levels in individuals with diabetic gastroparesis can help prevent fluctuations that worsen symptoms. 
&nbsp;

<ul>
	<li>Botulinum Toxin Injections</li>
</ul>

In some cases, Botox injections into the pylorus (the muscle between the stomach and small intestine) can help improve the condition. According to a study, women, patients younger than 50 years, and nondiabetics respond best to Botox<a href="#accordion">[2]</a>. 
&nbsp;

<ul>
	<li>Gastric Electrical Stimulation (GES)</li>
</ul>

GES involves surgically implanting a device that delivers electrical impulses to the stomach muscles, aiming to improve motility. 
&nbsp;

<ul>
	<li>Psychological Support</li>
</ul>

Chronic gastrointestinal conditions like gastroparesis can have a significant impact on mental health. Psychological support, counseling, and stress management techniques can help improve overall well-being. 
&nbsp;

<ul>
	<li>Lifestyle Modifications</li>
</ul>

Gentle exercise can promote digestion and improve overall health. Practices such as yoga, meditation, and relaxation techniques also help manage stress and potentially ease symptoms. 
&nbsp;

<ul>
	<li>Surgical Interventions</li>
</ul>

Surgery might be considered for severe cases that do not respond to other treatments. Options include gastric bypass surgery or a procedure called pyloroplasty, which widens the opening between the stomach and small intestine.

It&#39;s important to note that treatment plans for gastroparesis are individualized based on the patient&#39;s specific condition, symptoms, and underlying causes. 
&nbsp;

Left untreated, gastroparesis lowers the patient&rsquo;s quality of life. Complications include<a href="#accordion">[1]</a>: 
&nbsp;

<ul>
	<li>Unintentional Weight Loss, Dehydration And Malnutrition</li>
</ul>

Constant nausea and vomiting, or even just reduced appetite, can cause unintentional and excessive weight loss and malnutrition. Frequent vomiting can also result in dehydration and a lack of essential electrolytes. Poor absorption of nutrients can lead to malnutrition. 
&nbsp;

<ul>
	<li>Acid Reflux Complications</li>
</ul>

Gastroparesis leads to a swollen abdomen, allowing stomach acid to flow more easily from your stomach into your esophagus. Long-term acid reflux can create problems for the esophagus, causing issues such as heartburn and inflammation. 
&nbsp;

<ul>
	<li>Blood Sugar Complications</li>
</ul>

Gastroparesis also disrupts the normal, controlled release of glucose into the blood. When food remains in the stomach for an extended period, it causes blood sugar to decrease drastically. Later, when the food is eventually released, it can cause a sharp rise in blood sugar. These ups and downs are particularly challenging for individuals with diabetes and can worsen the effects of gastroparesis. 
&nbsp;

<ul>
	<li>Bezoar</li>
</ul>

A bezoar is a dense, solid clump of undigested food that becomes trapped in the stomach. If a bezoar grows too large, it might get stuck at the stomach&#39;s exit, obstructing the passage for other foods. Doctors may prescribe medicines or, if needed, surgery to break them down. 
&nbsp;

Individuals are at greater risk if they<a href="#accordion">[1]</a>:

<ul>
	<li>Have diabetes</li>
	<li>Are women</li>
	<li>Live in areas where certain viral infections are endemic</li>
	<li>Have genetic disorders like Parkinson&rsquo;s disease and Ehlers-Danlos syndrome</li>
	<li>Have had cancer treatments, including chemotherapy to the stomach or chest</li>
	<li>Make poor lifestyle choices that contribute to hormonal imbalances or eating disorders</li>
	<li>Have a medical history that involves the use of certain medications to treat depression or manage high blood pressure</li>
	<li>Have had surgery on the esophagus, stomach, or small intestine 
	&nbsp;</li>
</ul>

These include:

<ul>
	<li>Control Blood Sugar Levels</li>
</ul>

Consistently monitoring and managing blood sugar levels can help reduce the risk of diabetic gastroparesis. Follow the healthcare provider&#39;s recommendations for diabetes management, including medications, insulin, diet, and exercise. 
&nbsp;

<ul>
	<li>Avoid Smoking</li>
</ul>

Smoking can negatively impact digestion and overall gastrointestinal health. Quitting can reduce the risk of gastroparesis. 
&nbsp;

<ul>
	<li>Healthy Lifestyle</li>
</ul>

Adopt a healthy lifestyle that includes a balanced diet, regular exercise, and stress management. These factors can improve overall gastrointestinal health. 
&nbsp;

<ul>
	<li>Medication Management</li>
</ul>

If certain medications are affecting stomach motility, doctors can provide alternatives or modify their use. 
&nbsp;

<ul>
	<li>Hygiene And Food Safety</li>
</ul>

Practicing good hygiene and safe food handling can help reduce the risk of infections that might lead to gastroparesis. 
&nbsp;

<ul>
	<li>Stay Hydrated</li>
</ul>

Adequate fluid intake is important for maintaining digestive health 
&nbsp;

<ul>
	<li>Nutritional Choices</li>
</ul>

Eat smaller, more frequent meals instead of large ones. Chew it thoroughly. This can help reduce stress on the stomach and improve digestion. Additionally, focus on easily digestible foods and avoid foods high in fiber and fat, which are difficult to digest. 
&nbsp;

<ul>
	<li>Manage Stress</li>
</ul>

High levels of stress can negatively impact digestion. Practice relaxation techniques, mindfulness, or meditation to help manage stress. 
&nbsp;

<ul>
	<li>Regular Checkups</li>
</ul>

Chronic conditions like diabetes require regular checkups with healthcare providers. Don&rsquo;t skip scheduled appointments.

Note: Idiopathic gastroparesis or gastroparesis without a known cause cannot be prevented. 
&nbsp;

Key Points

<ul>
	<li>Gastroparesis is a relatively rare condition that can significantly impact an individual&#39;s quality of life.</li>
	<li>It is characterized by delayed stomach emptying due to impaired motility (muscle movement) of the stomach. This leads to food and liquids remaining in the stomach for longer periods than normal.</li>
	<li>Common symptoms of gastroparesis include nausea, vomiting, bloating, early satiety (feeling full quickly), abdominal pain, and fluctuations in blood sugar levels, especially in individuals with diabetes.</li>
	<li>The condition is caused by various factors, including damage to the vagus nerve, diabetes, viral infections, neurological disorders, and certain medications.</li>
	<li>Diagnosis involves a combination of medical history, physical examination, blood tests, gastric emptying studies, and other tests to assess stomach motility and rule out other conditions.</li>
	<li>Treatment aims to alleviate symptoms and improve stomach emptying. Approaches may include dietary modifications (smaller, frequent meals), medications to stimulate stomach contractions, nutritional support, and surgical interventions in severe cases. It&rsquo;s also recommended to avoid smoking and alcohol.</li>
	<li>Risk factors for gastroparesis include being diabetic, gender, certain genetic disorders, and lifestyle choices.</li>
	<li>Complications of gastroparesis include malnutrition, dehydration, weight loss, and difficulties in managing blood sugar levels in diabetic individuals.</li>
</ul>

[1] Gastroparesis. National Institute of Diabetes and Digestive and Kidney Diseases.

[2] Myint AS, Rieders B, Tashkandi M, et al. Current and Emerging Therapeutic Options for Gastroparesis. Gastroenterol Hepatol (N Y). 2018;14(11):639-645.