Gastroparesis

What is Gastroparesis?

Gastroparesis, or delayed gastric emptying, is a disruption in the movement of food through the stomach and lower parts of the GI tract (stomach, small intestine). Affecting the vagus nerve that connects the brainstem to the abdomen, the condition may progress to a point where food no longer passes through at all. Changes in eating habits sometimes help manage gastroparesis.

Causes

There is no definitive cause of gastroparesis. For patients with diabetes, consistently high blood sugar levels may damage the vagus nerve and affect how stomach and intestinal muscles function. Some medications can also contribute to the condition. It may also affect people with multiple sclerosis or Parkinson’s disease.

What are the Symptoms of Gastroparesis?

Symptoms of gastroparesis are similar to delayed gastric emptying making it difficult to diagnose.

Symptoms include

  • Nausea and vomiting
  • “Fullness” feeling after a few bites
  • Abdominal pain or discomfort
  • Sudden loss of appetite or weight loss
  • Fluctuating glucose levels

Gastroparesis Causes

The gastrointestinal system is partially regulated by the action of the nervous system. One nerve in particular, the vagus nerve, helps to stimulate the passage of food from the stomach into the small intestine. It also helps to move food efficiently through the gastrointestinal tract.

In those patients with gastroparesis, the vagus nerve fails to stimulate the stomach to empty into the small intestine. This is usually the result of damage to part of the vagus nerve.

There are a number of diseases and conditions that can cause vagus nerve damage. Most often, diabetes is the cause of vagus nerve damage. If the blood glucose level remains high for a long period of time, damage to various areas of the nervous system may result.

Nervous system disorders may also lead to damage or malfunction of the vagus nerve. Patients with advanced Parkinson’s disease and multiple sclerosis often report gastroparesis.

Those who take certain types of pain medications may develop a temporary form of gastroparesis. Opioid pain medicines may cause a slow down along the entire gastrointestinal tract.

How is Gastroparesis Treated?

Diagnosis can involve an upper GI endoscopy, a gastric emptying breath test, or the use of a SmartPill, an ingestible device that transmits images to a receiver worn by the patient. Initially treated with the replenishment of fluids if severe dehydration is experienced, gastroparesis is sometimes managed with metoclopramide (Reglan), the only FDA-approved medication for gastroparesis.

Treatment includes

  • Insertion of a feeding tube if rapid weight-loss is experienced
  • Nutritional and dietary adjustments
  • Liquid or pureed diet for severe symptoms
  • Insulin adjustments and frequent glucose monitoring (for diabetics)

Some patients find relief by eating smaller meals to make digestion easier rather than three daily meals to avoid bezoars, or clusters of undigested food in the stomach. Staying away from foods that are high in fiber and fat may also be helpful since such foods can make digestion more difficult. Symptoms tend to be intermittent, so the focus is often on management of the condition.

Gastroparesis Prevention

There is little that can be done to prevent some cases of gastroparesis. However, there are ways to prevent some of the underlying conditions that lead to gastroparesis. There are also ways to prevent episodes of gastroparesis in those prone to the problem.

Damage from diabetes is one of the primary causes of gastroparesis. Some cases of diabetes may be prevented by adopting a healthy lifestyle. Weight reduction and a proper diet are important. Eating a low fat and low sugar diet will also help to prevent diabetes. Moderate exercise will also help to reduce excess weight that leads to diabetes development.

For those prone to episodes of gastroparesis, dietary changes may help prevent episodes. Divide meals into six meal times instead of three. Eat smaller portions at these meal times. This aids in stomach emptying. Also, do not eat foods that are high in fiber as these take longer to digest, even in the absence of disease or disorder.