Gastroparesis

A normal, healthy digestive system has contractions in the stomach that cause ingested food to travel through the small intestine as part of the digestive process. Gastroparesis is the abnormality or absence of that stomach contraction. Its literal translation means “stomach paralysis”.  A patient with gastroparesis has a stomach with limited or no ability to contract, crush food and then move it along into the small intestine.

A damaged vagus nerve often causes gastroparesis. The vagus nerves control the stomach’s ability to contract. The most common way for the vagus nerve to become damaged is from diabetes, although it is not limited to that. Some medications (such as certain antidepressants and narcotics) cause limited motility in your stomach as a side effect. Traumatic injury or previous surgeries on the stomach, duodenum, or esophagus can damage your vagus nerve as well. However, there are numerous other possible causes, including connective tissue disorders, hypothyroidism, side effects of some forms of cancer treatment, eating disorders, infections, and many other possibilities.

Symptoms

The most notable symptom of gastroparesis is the feeling of being full even though you just started eating a meal. This is called “satiety”. Other symptoms include nausea and vomiting, a bloated feeling, heartburn, and pain in the upper region of the abdomen, all of which indicate what’s known as “dyspepsia”. All of these symptoms exist because your stomach is not properly digesting your food from your last meal. You may also experience malnutrition and weight loss as a result of poor nutrient absorption and fewer calories.

Diagnosis and Testing

Diagnosing the cause of your gastroparesis often requires further testing to find a proper diagnosis because it may be related to another health issue. Because some medications can cause gastroparesis as a side effect, we will analyze your current medications before proceeding further.

We may perform various tests, which may include an upper endoscopy, a gastric emptying study, or a small intestinal x-ray. We perform an upper endoscopy by inserting a thin, flexible tube with a camera at the end into your stomach so that we can visually look for hernias, ulcers, inflammation, or other challenges that might be causing the gastroparesis. A gastric emptying study examines how well your stomach is breaking down your ingested foods by determining the amount of solid vs. liquid matter that we find in there. A small intestinal x-ray is performed to determine if there is a blockage.

Treatment

Gastroparesis can be caused by many different things, so we will likely need to ask you some further questions and do some testing as part of your treatment. The first thing we will ask you to do is to change your diet because the things that you eat vary widely in how easy they are to digest. If you are eating foods that are difficult to digest, your symptoms will worsen. The undigested food can collect in your stomach, causing a painful blockage that will have to be broken apart through an endoscopy for it to continue in your digestion system. Your foods need to be easily digestible, soft, and you need to make sure you chew your food well. If you are living with gastroparesis, you can manage your nutrition by avoiding hard-to-digest foods, pureeing some foods in a blender, and supplementing your diet with healthy drinks or shakes. People with severe gastroparesis may have to use a feeding tube if the previous lifestyle changes are not working.

There are only a few medications available for gastroparesis. If they apply to your particular health challenges, we may prescribe medicine that acts on your dopamine receptors in the stomach, which stimulates the contraction of the stomach. These medications are called cisapride, domperidone, metoclopramide, and domperidone.

We may recommend surgery for very severe cases that have challenges that need to be immediately met. These operations place tubes in the stomach. The tubes help with nutritional supplementation, vent trapped air from the stomach to help the stomach to contract, and move food into the small intestine.