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Gastroparesis
Overview
What is gastroparesis?

Gastroparesis (say: "gast-roe-par-EE-sus") is a disorder that happens when your stomach muscles don't work properly. It is sometimes called "delayed gastric emptying." Normally, after you swallow food, your stomach muscles begin squeezing and tightening. (These movements are called contractions.) This crushes the food and moves it into the small intestine to continue the digestive process. If you have gastroparesis, your stomach muscles don't contract properly. This can delay or prevent the process of crushing the food and sending it to the small intestine.

Symptoms
What are the symptoms of gastroparesis?

Symptoms of gastroparesis can be mild or severe, and may include:

  • Heartburn or stomach pain
  • Nausea
  • Vomiting, especially vomiting pieces of undigested food
  • Feeling full after only a few bites of food
  • Bloating
  • Lack of appetite
  • Unintended weight loss
  • Unstable blood sugar levels (in people who have diabetes)

These symptoms can suggest a lot of different problems and disorders. This can make gastroparesis hard to diagnose.

Causes & Risk Factors
Who is at risk of gastroparesis?

People who have diabetes are most at risk for gastroparesis because high blood sugar levels can damage the vagus (say: "vay-gus") nerve. The vagus nerve tells your stomach muscles when to contract. Damage to this nerve is one of the most common causes of gastroparesis. Diabetes can also damage the blood vessels that carry oxygen and nutrients to the vagus nerve.Other things that can lead to gastroparesis include:

  • Some medicines, such as certain pain medicines, antidepressants and others
  • Surgery on the esophagus (the tube the runs from the mouth to the stomach), the stomach or the upper small intestine
  • Radiation of the chest or stomach area for cancer treatment
  • Eating disorders, such as anorexia nervosa and bulimia
  • Gastroesophageal reflux disease (GERD)
  • Other disorders, including hypothyroidism, scleroderma, Parkinson's disease and some autoimmune disorders
  • Rarely, viral infections such as the flu
Diagnosis & Tests
How do doctors diagnose gastroparesis?

Your doctor will start by examining you and asking you about your medical history. Be sure to tell your doctor about any prescription or over-the-counter medicines you are taking. You may have blood tests to check the quality of your blood and measure some chemical levels.Your doctor might want to do some other tests to make sure you don't have a blockage or another medical problem. These tests may include:

  • Upper endoscopy. Your doctor uses a flexible tube with a light at the end to look inside your throat, your esophagus and into your stomach. You will probably be given a sedative drug to make you more relaxed and comfortable during this test. Your throat will also be numbed, so you shouldn't feel any pain.
  • Gastric emptying ultrasound. This test uses sound waves to look at the organs in your abdomen (your gallbladder, liver and pancreas) so your doctor can check for signs of problems.
  • Barium X-ray. When your stomach is mostly empty, you drink a liquid that contains a small amount of barium. The doctor can watch the barium liquid travel through your body on an X-ray machine, in order to figure out where the problem is occurring.
  • Gastric emptying studies. For these studies, you'll eat or drink something that contains a small amount of radioactive material. A scanner is able to pick up signals from the radioactive material. This scanner keeps track of how long it takes your stomach to empty completely. Or, your breath may be tested for the radioactive material to measure how fast your stomach is emptying.
  • Gastrointestinal (GI) monitoring capsule. For this test, you swallow a small capsule (or "pill") that collects information as it moves through your digestive system. The pill sends this information to a small computer you wear around your waist or neck. After a few days, you will pass the capsule in your stool, and your doctor will study the information it collected.
Treatment
How is gastroparesis treated?

There is no cure for gastroparesis. Treatment will focus on treating any underlying problem that is causing the gastroparesis and controlling your symptoms. For example, your doctor may ask you to stop taking any drugs that can affect the digestive system. Don't stop any medicine without first talking to your doctor. Your doctor also may want to treat any eating disorders, infections or other issues that could be causing gastroparesis. Your doctor might also recommend one or more of the following: Dietary changes. Since you might not be able to eat normally, it's very important to make sure you're getting enough nutrients. You may need to:

  • Eat several smaller meals each day instead of 2 or 3 large ones.
  • Eat softer foods, such as vegetables or pasta that are cooked thoroughly.
  • Limit fat (which can slow digestion) and fiber (which can be hard to digest).
  • Supplement your diet with nutrition drinks (such as Ensure or Boost) or solid food that you've pureed in a blender.

Medicine. Anti-nausea medicines called antiemetics can help with nausea and vomiting. Some other medicines, such as metoclopramide and erythromycin, can stimulate stomach muscle contractions. Each of these drugs has some drawbacks, including potentially serious side effects. You and your doctor need to discuss whether the benefits of taking these medicines outweigh the risks. Feeding tube. If your gastroparesis is severe, you may need a feeding tube. This tube will be inserted through your skin into your small intestine. Or, it may be passed into your intestines through your nose or mouth. The tube allows nutrients to be delivered directly to your bloodstream. A feeding tube can also help when gastroparesis causes unstable blood sugar levels in people who have diabetes.

Complications
What are the complications of gastroparesis?
  • Weight loss, malnutrition and dehydration. If you're not able to eat enough food, or if you vomit up a lot of what you eat, you may not get enough nutrition. Following the suggestions listed above may help with this problem.
  • Bezoars. A bezoar (say: "bee-zore") is a solid mass of food that your stomach is not able to digest. Bezoars can cause nausea and vomiting. In severe cases, they may block other food from entering the small intestine. This situation can be life-threatening, and the bezoar may have to be removed by surgery.
  • Bacterial infections. When food stays too long in your stomach, bacteria can grow out of control, which can lead to infection.
  • Problems controlling blood sugar. When you have gastroparesis, your timing for digesting food doesn't follow normal patterns. For this reason, people who have diabetes and gastroparesis often have a lot of trouble controlling their blood sugar levels.
Questions to Ask Your Doctor
  • I have diabetes. Am I at risk of gastroparesis?
  • How can I prevent gastroparesis?
  • What should I do and when should I call if I think I have gastroparesis?
  • Are there lifestyle changes I can make that will ease or prevent gastroparesis?
  • Is gastroparesis dangerous?
References
  1. Gastrointestinal Complications of Diabetes by Amer Shakil, MD, Robert J. Church, MD, and Shobha S. Rao, MD(06/15/08, http://www.aafp.org/afp/20080615/1697.html)