Gastroparesis

What is gastroparesis?

Normally, your stomach contracts in a coordinated and sequential motion to grind up the food you eat, mix it with acid, a digestive gastric juice and then propel it into the small intestine, which absorbs nutrients into the bloodstream. If the stomach contractions are weak or poorly coordinated, the stomach fails to empty properly, resulting in the retention of partially digested goods in the stomach. This condition is termed gastroparesis.

This can cause several symptoms and complications:

• Feeling full after eating very little
• Heartburn and gastroesophageal reflux disease (GERD)
• Vomiting undigested food
• Dehydration
• Malnutrition
• Difficulty regulating blood sugar
• Bacterial infections
• Blockages formed from hardened, undigested food

Gastroparesis can be intermittent or continuous, so symptoms may come and go, or they can occur daily.

How do we diagnose gastroparesis?

We suspect a diagnosis of gastroparesis based on your symptoms and medical history, but the diagnosis is established with a test that measures the emptying of the stomach. Typically, you consume a meal containing a radiolabel, and a special camera monitors the progress of the radiolabel through the stomach and into the small intestine. We may perform stomach endoscopy, pressure testing of the esophagus (manometry), or other imaging and blood tests as part of the evaluation.

What causes gastroparesis?

In many cases, gastroparesis is associated with diabetes due to the harmful impact of diabetes on the vagus nerve, which is important in activating stomach contractions and moving food out into your small intestine. An impaired nerve may not send signals properly to your stomach and intestine. Conversely, gastroparesis often worsens diabetes. Controlling your blood sugar is crucial to diabetes care, but gastroparesis causes unpredictable delivery of food to the small intestine and into the bloodstream, making control difficult.

In some cases, stomach surgery injures the vagus nerve, leading to gastroparesis. In addition, certain medications, including narcotics and antidepressants, can delay digestion and cause your stomach to empty slowly.

In some cases, gastroparesis can result from an acute infection. In these cases, fortunately, gastric motility often spontaneously returns to normal over time.

In many cases, we cannot ascertain an underlying cause for gastroparesis, but we can proceed with treatment without a cause.

How is gastroparesis treated?

Gastroparesis is a chronic condition, and the symptoms typically wax and wanes over time. The first step is dietary – you should consume frequent, smaller meals. We will often refer you to one of our dieticians to get advice regarding diet.

A variety of medications work to increase the strength of stomach contraction. These can be useful in gastroparesis. We will work with you to choose a drug that is effective and has minimal side effects. Other medications work to control nausea caused by the condition.

In some cases, the medication works best intravenously, and some patients with gastroparesis need occasional in-hospital care to receive hydration and medication treatment.

In the modern era, for more affected patients we are now on occasion recommending interventional treatments, including a gastric pacemaker. We implant this device into the abdomen, and it delivers sequential electrical impulses to the stomach as needed, much like a heart pacemaker, replacing your normal physiological electrical activity.

Treating Gastroparesis: A dietary approach

Managing gastroparesis can include eating a diet of easily digested foods, and that means reducing or eliminating high-fat and high-fiber foods. Eating smaller, more frequent meals is also often recommended.

If you have diabetes, keeping your blood sugar under control through insulin, medication, and/or diet can minimize your gastroparesis symptoms. Because gastroparesis affects your blood sugar levels, the dietary changes noted above may also be necessary to effectively manage your co-occurring diabetes.

Source:
Gastroparesis – NY Gastroenterology Associates (gastroenterologistnewyork.com)