Gastroparesis is a condition in which the spontaneous movement of the muscles (motility) in your stomach does not function normally.
Ordinarily, strong muscular contractions propel food through your digestive tract. But in gastroparesis, your stomach's motility works poorly or not at all. This prevents your stomach from emptying properly. Gastroparesis can interfere with normal digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition.
The cause of gastroparesis is usually unknown. When this is the case, it's called idiopathic gastroparesis (IG). When people who have diabetes develop gastroparesis, it's called diabetic gastroparesis (DG). Some people develop gastroparesis after surgery.
There is no cure for gastroparesis, but changes to your diet, along with medication, can offer some relief.
Signs and symptoms of gastroparesis include:
- A feeling of fullness after eating just a few bites
- Abdominal bloating
- Abdominal pain
- Changes in blood sugar levels
- Lack of appetite
- Weight loss and malnutrition
When to see a doctor
Make an appointment with your doctor if you have any signs or symptoms that worry you.
It's not always clear what leads to gastroparesis. But in many cases, gastroparesis is believed to be caused by damage to a nerve that controls the stomach muscles (vagus nerve).
The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals normally to your stomach muscles. This may cause food to remain in your stomach longer, rather than move normally into your small intestine to be digested.
The vagus nerve can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine.
Factors that can make it difficult for your stomach to empty properly include:
- Abdominal or esophageal surgery
- Infection, usually a virus
- Certain medications that slow the rate of stomach emptying, such as narcotic pain medications
- Certain cancer treatments, such as radiation therapy
- Scleroderma (a connective tissue disease)
- Nervous system diseases, such as Parkinson's or multiple sclerosis
- Hypothyroidism (low thyroid)
Young and middle-aged women are most likely to develop idiopathic gastroparesis.
Gastroparesis can cause several complications, such as:
- Severe dehydration. Ongoing vomiting can cause dehydration.
- Malnutrition. Poor appetite can mean you don't take in enough calories, or you may be unable absorb enough nutrients due to vomiting.
- Undigested food that hardens and remains in your stomach. Undigested food in your stomach can harden into a solid mass called a bezoar. Bezoars can cause nausea and vomiting and may be life-threatening if they prevent food from passing into your small intestine.
- Blood sugar fluctuations. Although gastroparesis doesn't cause diabetes, inconsistent passage of food into the small bowel can cause erratic changes in blood sugar levels, which make diabetes worse. In turn, poor control of blood sugar levels makes gastroparesis worse.
- Decreased quality of life. Acute flare-up of symptoms can make it difficult to work.
You're likely to start by first seeing your family doctor or a general practitioner if you have signs and symptoms of gastroparesis. If your doctor suspects you may have gastroparesis, you may be referred to a doctor who specializes in digestive diseases (gastroenterologist). You may also be referred to a dietitian who can help you choose foods that are easier to process.
What you can do
Because appointments can be brief, it's a good idea to be well-prepared. To prepare, try to:
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Your doctor's office might recommend that you stop using certain pain medications, such as narcotics, prior to coming for an appointment.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
Questions to ask
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For gastroparesis, some basic questions to ask your doctor include:
- What is likely causing my gastroparesis?
- Could any of my medications be causing my signs and symptoms?
- What kinds of tests do I need?
- Is my gastroparesis likely temporary or chronic?
- Do I need treatment for my gastroparesis?
- What are my treatment options?
- What are the potential side effects of each treatment option?
- Are there certain foods I can eat that are easier to process?
- I have other health conditions. How can I best manage them together?
- I have diabetes. How might gastroparesis be affecting my diabetes control?
- Are there any restrictions that I need to follow?
- Should I see a dietitian?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
In addition to the questions that you've prepared, don't hesitate to ask other questions during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask:
- When did you first begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- Did your symptoms start suddenly, such as after an episode of food poisoning?
- What surgeries have you had?
Doctors use several tests to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include:
- Upper gastrointestinal (GI) endoscopy. This procedure is used to visually examine your upper digestive system — your esophagus, stomach and beginning of the small intestine (duodenum) — with a tiny camera on the end of a long, flexible tube.
- Computerized tomography (CT) enterography and magnetic resonance (MR) enterography. These are noninvasive tests that are more sensitive than conventional imaging for finding inflammation or blockage in the intestines. MR enterography is a radiation-free alternative.
- Upper gastrointestinal (GI) series. This is a series of X-rays in which you drink a white, chalky liquid (barium) that coats the digestive system to help abnormalities show up.
- Gastric emptying study. This test involves eating a light meal, such as eggs and toast, that contains a small amount of radioactive material. A scanner that detects the movement of the radioactive material is placed over your abdomen to monitor the rate at which food leaves your stomach. This is the most important test used in making a diagnosis of gastroparesis.
- Breath test. This test involves drinking a small amount of sugar water and then measuring the amount of gas processed by your body (metabolized) in the breath.
Treating gastroparesis begins with identifying and treating the underlying condition. If diabetes is causing your gastroparesis, your doctor can work with you to help you control it. Beyond this, other gastroparesis treatments may include the following.
Changes to your diet
Your doctor may refer you to a dietitian who can work with you to find foods that are easier for you to digest, so that you're more likely to get enough calories and nutrients from the food you eat. A dietitian might suggest that you try to:
- Eat smaller meals more frequently
- Chew food thoroughly
- Eat well-cooked fruits and vegetables rather than raw fruits and vegetables
- Avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars
- Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet
- If liquids are easier for you to swallow, try soups and pureed foods
- Drink water throughout each meal
- Exercise gently after you eat, such as going for a walk
- Avoid carbonated drinks, alcohol and smoking
Medications to treat gastroparesis may include:
- Medications to stimulate the stomach muscles. These medications include metoclopramide (Reglan) and erythromycin (Eryc, E.E.S). Metoclopramide has a risk of serious side effects. People tend to become tolerant to erythromycin. A newer medication, domperidone, with fewer side effects, is also available with restricted access. Cisapride also is used but is available only in certain settings.
Medications to control nausea and vomiting. Anti-emetic medications include prochlorperazine (Compro), thiethylperazine and diphenhydramine (Benadryl, Unisom). A class of medications that includes ondansetron (Zofran) is sometimes used to help nausea and vomiting.
Researchers continue to investigate new medications to treat gastroparesis.
Some people with gastroparesis may be unable to tolerate any food or liquids. In these situations, doctors may recommend a feeding tube (jejunostomy tube) be placed in the small intestine. Or doctors may recommend a gastric venting tube to help relieve pressure from gastric contents.
Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. The tube is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can't be controlled by any other method. Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest.
There is some evidence that acupuncture can be helpful to people with gastroparesis, although more studies are needed. Various treatments that are used for nausea in other conditions may be helpful in treating nausea in gastroparesis, such as ginger and the use of a skin patch (transdermal drug delivery of anti-emetics). Acupressure, biofeedback and hypnotherapy may be helpful as well.
Jan. 15, 2014
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