Gastroparesis

Gastroparesis is a condition in which your stomach cannot empty itself of food in a normal fashion. It can be caused by damage to the vagus nerve, which regulates the digestive system by controlling the muscles in the stomach responsible for moving food through the system.

Main causes of gastroparesis:

  • Idiopathic
  • Diabetes Mellitus
  • Surgeries
  • Medication Side Effects
  • Other illnesses
  • Cellular changes

There are a number of things that may contribute to or cause gastroparesis however the cause is unknown in a majority of individuals and is termed “idiopathic.” Some people with idiopathic gastroparesis report symptoms following a virus infection (post-infectious or post-viral gastroparesis) and the evaluation of gastroparesis seeks to confirm the diagnosis and identify treatable causes.

Diabetes Mellitus

Long-standing diabetes is the most common known cause of gastroparesis, although only a small percentage of people with diabetes will actually develop gastroparesis. The cause of symptoms is probably due to damage to nerves that supply the stomach.  The vagus nerve transmits impulses to the stomach and intestines and any injury to the vagus nerve can impair gastric emptying.

Surgeries

Gastroparesis can result as a complication from some surgical procedures typically involving the upper abdomen or esophagus. Nerve damage from surgery is rarely reversible.

Medications

Although relatively uncommon, gastroparesis can occur as a side effect from the use of certain medications. Medications know to impair gastric motility include but may not be limited to the following.

  • Narcotic pain relievers,
  • Anticholinergic/antispasmodic agents,
  • Calcium channel blockers,
  • Some antidepressants
  • Some medications for diabetes.

Other Illnesses

Sometimes gastroparesis is seen in association with other illnesses that impact the nervous system connective tissues. These may include multiple sclerosis, Parkinson’s disease, cerebral palsy, systemic lupus, and scleroderma.

Cellular Changes

Much remains to be learned about what causes gastroparesis. In both idiopathic and diabetic gastroparesis a great deal of interest is being paid to changes in the cells which help control muscular contractions (motility) in the stomach. These are known as the interstitial cells of Cajal (ICCs). These cells probably represent the essential pacemakers of the entire gastrointestinal (GI) tract. In addition to ICCs, scientists are looking at changes in the structure and the number of nerve cells and immune cells as possible contributors to the disease process in gastroparesis.

Symptoms of Gastroparesis

  • Feeling full quickly when eating
  • GERD-Heartburn
  • Nausea and vomiting partially digested food
  • Bloating
  • Poor appetite
  • Weight loss
  • Poor blood sugar control

Diagnosis of Gastroparesis

Diagnosing gastroparesis requires tests that can evaluate the ability of your stomach to empty digested food properly.

  • Radioisotope gastric-emptying scan (gastric scintigraphy): You eat food that contains a very small amount of radioisotope (a radioactive substance), then lie under a scanning machine; if the scan shows that more than 10% of food is still in your stomach 4 hours after eating, you are diagnosed with gastroparesis.
  • Gastric manometry: A thin tube that is passed through your mouth and into the stomach measures the stomach's electrical and muscular activity to determine the rate of digestion.
  • Barium X-ray or “swallow” You drink a liquid (barium), which coats the upper digestive system including the esophagus, stomach, and small intestine and shows up on X-ray.
  • Electrogastrography: This test measures electrical activity in the stomach using electrodes placed on the skin.
  • The smart pill: This is a small electronic device that is swallowed. It sends back information about how fast it is traveling as it moves through the your digestive system.

Treatment for Gastroparesis

Gastroparesis is a chronic condition and the best control is achieved whent the underlying condition that caused the gastroparesis can be effectively treated. The following medications can also help control the condition.

  • Reglan (metoclopramide): You take this drug before eating and it causes the stomach muscles to contract and move food along. Reglan also decreases the incidence of vomiting and nausea.
  • Erythromycin: This is an antibiotic that also causes stomach contractions and may help move food out of the stomach.
  • Antiemetics: to help control nausea and vomiting.

One of the best ways to help control the symptoms of gastroparesis is to modify your daily eating habits. Eat 6 smaller meals per day instead of 3.  In this way, there is less food in the stomach; you won't feel as full, and it will be easier for the food to leave your stomach. Another important factor is the consistency of food; liquids and low residue foods are encouraged (for example, applesauce should replace whole apples with intact skins).

You should also avoid foods that are high in fat (which can slow down digestion) and fiber (which is difficult to digest).

Jejunostomy or a feeding tube:

In a severe case of gastroparesis, a feeding tube, or jejunostomy tube, may be used to deliver nutrition. The tube is inserted through the abdomen via a small incision into the small intestine during surgery. Nutrition can then be directly delivered via tube into the small intestine.

Electrical stimulation for Gastroparesis

Electrical gastric stimulation for gastroparesis uses electrodes that are attached to the stomach wall and, when stimulated, trigger stomach contractions. Further studies are needed to help determine who will benefit most from this procedure.

CONDITIONS OF THE GI TRACT