Gastroparesis
What is Gastroparesis?
Gastroparesis is a poorly understood disorder that disrupts the natural spontaneous movement (motility) of the stomach’s muscles. Strong muscle contractions normally drive food through the digestive tract. Patients with gastroparesis, however, have stomach’s with sluggish or non-existent motility preventing normal emptying of the stomach.
Typically, the cause of gastroparesis is unknown. Occasionally, it is a complication of diabetes, and some people get it after undergoing surgery. Certain drugs, including opioid pain relievers, some antidepressants, and treatments for high blood pressure and allergies, can produce sluggish stomach emptying and comparable symptoms. These drugs may worsen gastroparesis in those who already have the illness.
Gastroparesis can impede regular digestion and lead to nausea, vomiting, weight loss, bloating, regurgitation, severe reflux and abdominal pain.
Symptoms of Gastroparesis
- Weight Loss
- Malnutrition
- Severe acid reflux
- Abdominal Pain
- Nausea
- Vomiting
- Regurgitation of undigested food from hours earlier
- Severe Bloating
- Early Satiety or feeling full quickly
Diagnosis of Gastroparesis
There are likely many subtypes of gastroparesis that are yet to be understood, but currently testing is based on assessing stomach function.
- Gastric Emptying Study: This is the most useful test that is utilized while attempting to diagnose gastroparesis in a patient. It entails consuming a light meal that contains a limited amount of radioactive material. Some examples of such meals include eggs and toast or oatmeal. The rate at which food is expelled from the stomach is monitored by placing a scanner that detects movement of radioactive material over your abdomen. The study follows the stomachs activity for four hours.
- Upper Gastrointestinal Endoscopy: This is not a test that is ordered to diagnose gastroparesis, but often times when a patient is undergoing a workup for their symptoms, an endoscopy is performed. During this initial endoscopy if food is found to be present in the stomach, the diagnosis of gastroparesis is suspected because patients will have not eaten for over several hours prior to their endoscopy.
Treatments for Gastroparesis
It is common for patients with gastroparesis to remain misdiagnosed as GERD, IBS or other overlapping diseases. The treatments for gastroparesis similar to achalasia cannot cure the disease, but are aimed at improving the symptoms. Therapies are initiated and often escalated over time in order to achieve adequate symptom relief. Procedures and surgeries to address gastroparesis are directed at the pylorus, the muscle that is located between the stomach and the intestine. By loosening this muscle, the stomach emptying can be improved.
The most important goal in the therapy of gastroparesis is to ensure that patients continue to receive an adequate amount of nourishment. Alterations to diet are an effective treatment option for gastroparesis in many patients. We can recommend a dietician that can help identify foods that are more manageable for the digestive system. Smaller frequent meals, well chewed food, well cooked foods, low fat foods, avoiding carbonation, alcohol and smoking are some techniques that are employed. Quality foods that deliver adequate calories and nutrition can achieve significant improvement in many patients.
- Promotility Agents or medications that “speed up” the stomach
- Metoclopramide, often known as Reglan, and erythromycin are two of these drugs. Metoclopramide may cause severe adverse effects in some patients limiting its long-term use. Erythromycin loses its effectiveness after a period of time and can cause unpleasant side effects like diarrhea.
- Another medicine called domperidone has less adverse effects is also available, although access to it is difficult.
- Symptomatic medications to control nausea and vomiting: various anti-nausea medications can be used to improve the symptoms of nausea and vomiting which include Zofran (Ondansetron), Compazine (Prochlorperazine) and Benadryl (Diphenhydramine).