Gastroparesis

Gastroparesis is a disorder that occurs when the stomach takes too long to empty the food inside. This disorder, also known as delayed gastric emptying, is a result of weak or abnormal muscles in the stomach. Right now there’s no cure for gastroparesis, but treatment can help you manage your symptoms.

The exact cause of gastroparesis isn’t known yet but it’s thought to have something to do with disrupted nerve signals in the stomach. It’s believed that the vagus nerve, which controls the movement of food through the digestive tract, becomes damaged and causes food to be digested slowly or not at all.

A common cause for damage to the vagus nerve is diabetes. High levels of blood sugar can change way the vagus nerve gets its nutrients. Surgeries that involve the stomach or other digestive organs can also damage the vagus nerve.

Certain health conditions can make it harder for your stomach to empty, increasing your chances of developing gastroparesis. The risk factors include:

• diabetes
• an infection
• some cancer treatments
• eating disorders like anorexia and bulimia
• hypothyroidism or an overactive thyroid
• Parkinson’s disease
• medications that make the stomach empty more slowly

Symptoms of gastroparesis can range from mild to severe. They occur more often in some people than others. Symptoms of gastroparesis can include:

• upper abdominal pain
• nausea and vomiting
• heartburn
• loss of appetite
• changes in your blood sugar levels
• feeling full after only eating a little
• malnutrition
• unintended weight loss
• swollen abdomen

Your doctor will perform a physical exam and ask you questions about your medical history. In order to rule out other possible causes of your symptoms your doctor will probably want to run some tests, which might include:

• an ultrasound, which uses sound waves to create an image of your organs, to rule out pancreatitis and gallbladder disease
• an X-ray taken after you drink a liquid containing barium that lets your doctor see if your stomach is emptying like it should
• an upper endoscopy, which uses a long, thin scope that your doctor guides down your throat to see the lining of your stomach

Once your doctor has ruled out possible causes of your symptoms, he or she will move on to performing tests that will confirm that you have gastroparesis. These tests can include:

• a gastric emptying scintigraphy test which involves eating a small amount of a radioactive substance, so your doctor can see how fast food is being digested
• a SmartPill, which is a capsule that contains a device that tracks how fast food moves through your digestive tract

If your gastroparesis is caused by a condition like diabetes, the first step is to improve control of that underlying condition. After that, your doctor may recommend medication, diet changes, and even surgery in some cases.

Medication

Your doctor may prescribe one or more medications to treat your gastroparesis. Medicines like prochlorperazine (Compro) and diphenhydramine (Benadryl) are often given to control nausea and vomiting caused by gastroparesis. Medicines like metoclopramide (Reglan) and erythromycin stimulate the stomach muscles and help with digestion. But these drugs can cause numerous side effects. Talk with your doctor about possible side effects to decide if a muscle stimulant medication is right for you.

Surgery

If your doctor can’t get your malnutrition or vomiting under control with the use of medicine, he or she may decide that surgery on your stomach is necessary. The goal of gastroparesis surgery is to help your stomach empty more effectively. Surgery could entail stomach stapling, or a stomach bypass procedure.

Diet Changes

Seeing a dietitian, an expert on food and nutrition, is a common part of treatment for gastroparesis. A dietitian can suggest foods that your body is able to digest more easily, allowing your body to absorb more nutrients. Your dietitian might make suggestions like:

• eating well-cooked vegetables and fruit to lower the amount of fiber they contain
• eating mostly low-fat foods
• drinking water during your meal
• avoiding foods that have a lot of fiber like broccoli and oranges
• eating smaller meals more often

If you have a severe case of gastroparesis, you might not be able to eat solid foods and drink liquids. In this case, you may require a feeding tube until your condition improves.

Uncommon and Experimental Treatment Options

Gastric Neurostimulator

In a few treatment centers across the United States, doctors are testing a device called a gastric neurostimulator. The device releases electrical signals that help control nausea and vomiting. This treatment is mainly used on those who have had great difficulty in eliminating their nausea and vomiting with medicine. The device is marketed under the name “Enterra Therapy.”

Botulinum Toxin Type A

Injections of botulinum toxin type A, a toxin that reduces muscle activity, has been shown to relax the pyloric muscle, which is the muscle that controls the flow of food from the stomach to the small intestine. Using botulinum toxin type A on the pyloric muscle allows the stomach to pass more food into the small intestine.

Gastroparesis can make it harder to manage blood glucose levels. Food that stays in the stomach for too long can cause an overgrowth of bacteria. The food can also harden into masses called bezoars that cause nausea, vomiting, and obstruction in the stomach.