Gastroparesis

Gastroparesis is a disease diagnosed and treated by the GI Division of Premier Medical Group.

What is gastroparesis?

Gastroparesis is also referred to as “delayed gastric emptying”. It is a disease of the muscles of the stomach, or the nerves which control those muscles, which results in the stomach muscles not working properly. The stomach no longer grinds the food which results in reduced passage of food into your intestines. Simply put, the stomach takes too long to empty.

What causes gastroparesis?

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The most common cause of gastroparesis is diabetes. People with diabetes have high blood glucose, also called blood sugar, which in turn causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. The high blood glucose can damage the vagus nerve over time, and a damaged vagus nerve stops the muscles in the stomach and intestine from working, preventing food from moving through the digestive system correctly. Not all patients with gastropparesis have diabetes. Other causes may include:

  • Viral infections
  • Narcotic medications and select antidepressants
  • Diabetes
  • Surgery that injured the vagus nerve
  • Anorexia or bulimia
  • Gastroesophageal reflux disease
  • Nervous system diseases such as Parkinson’s disease
  • Metabolic disorders, including hypothyroidism

Eating solid foods, high-fiber foods such as raw fruits and vegetables, fatty foods, or drinks high in fat or carbonation may add to these symptoms in susceptible individuals.

What are the symptons of gastroparesis?

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Signs and symptoms of gastroparesis are

  • heartburn
  • pain in the upper abdomen
  • nausea
  • vomiting of undigested food—sometimes several hours after a meal
  • early feeling of fullness after only a few bites of food
  • weight loss due to poor absorption of nutrients or low calorie intake
  • abdominal bloating
  • high and low blood glucose levels
  • lack of appetite
  • gastroesophageal reflux
  • spasms in the stomach area

Eating solid foods, high-fiber foods such as raw fruits and vegetables, fatty foods, or drinks high in fat or carbonation may contribute to these symptoms.

The symptoms of gastroparesis may be mild or severe, depending on the person. Symptoms can happen frequently in some people and less often in others. Many people with gastroparesis experience a wide range of symptoms, and sometimes the disorder is difficult for the physician to diagnose.

How is gastroparesis diagnosed?

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The first step in making the correct diagnosis is for the patient to have full physical exam and give their medical history to the doctor. A blood test will show chemical and electrolyte levels and your blood count.

The following is a list of other tests your doctor may order:

  • Upper endoscopy
  • Ultrasound
  • Barium X-ray — For this test, you will need to fast for 12 hours. The X-ray technician will give you thick liquid called barium to drink which will coat your stomach so it will show on the X-rays. The stomach generally empties in about 12 hours. If you have gastroparesis, this test will show food in your stomach.  Even if there is no food left, the doctor may want to repeat the procedure to be certain of the outcome. (People with diabetes will need special instructions for fasting.)
  • Gastric emptying scintigraphy — Your doctor will ask you to eat a very bland meal, such as eggs that will contain a small amount of radioactive substance (radioisotope) which will show up on a scan. The doctor is then able to measure the rate of your stomach emptying. If there is more than 10 percent of food left in your stomach, the diagnosis of gastroparesis will be positive.
  • Smart pill — This is a tiny pill you swallow which will track the movement of your digestive tract and collect the data in a cell phone-sized device worn around your neck. Once you pass the pill in your stool, you can take the device back for testing.

How is gastroparesis treated?

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The treatment for gastroparesis will depend on the severity of the symptoms. Gastoparesis is a chronic, long-lasting condition. Generally treatment does not cure gastroparesis, it just treats the symptoms so you are comfortable.

There are several medications that are commonly used for the treatment of gastroparesis, and they are listed below. (Your health care provider may also try a combination of medications.)

  • Metoclopramide (Reglan) — This is the most common drug used to treat gastroparesis because it stimulates your stomach muscle contractions to help the process of emptying. It also helps control any nausea and vomiting.
  • Erythromycin — A side effect of this antibiotic is that it increases the contractions that move food through the stomach. It can have some side effects including nausea, vomiting, and abdominal cramps.
  • Antiemetics — These are drugs that help control nausea.

What diet changes can I make to help with the symptoms of gastroparesis?

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Modifying your diet is the best way to help control the symptoms of gastroparesis.

Working with your doctor or a nutritionist may help. Here are some helpful tips:

  • Eat 6 small meals instead of 3 large meals
  • A liquid diet is vital to people who have gastroparesis. Try soups and pureed foods.
  • Juicing your vegetables and fruits instead of eating them whole with the skins
  • Avoid food with a lot of fat, which is harder to digest
  • Eat low-fiber forms of high-fiber foods, such as well-cooked fruits and vegetables rather than raw fruits and vegetables
  • Avoid fibrous fruits and vegetables such as oranges and broccoli
  • Drink water with every meal
  • Exercise after you eat; go for a walk

Other Treatment Options for Gastroparesis

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  • Feeding tube — For very severe cases of gastroparesis, your doctor may want to insert a feeding tube through your abdomen into your small intestine during endoscopy surgery. The nutrients bypass your stomach and go directly into your small intestine, so they go into your blood stream more quickly.
  • Parenteral Nutrition — Another feeding option is a catheter placed into a vein in your chest. The nutrients go directly into your bloodstream. This and the feeding tube are intended as a temporary measure when a patient has a severe case of gastropareses.
  • Electrical stimulation for Gastroparesis — This method uses electrical gastric stimulation. Small electrodes are connected to your stomach wall which triggers stomach contractions when they are stimulated (gastric pacemaker).

Diabetes and gastroparesis

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The most important goal for people who have gastroparesis related to diabetes is to increase stomach emptying and reclaim control of blood glucose levels This includes the use of insulin, oral medications, and dietary alterations. In more serious cases the feeding tube may become an option. Dietary changes would include eating 6 smaller meals a day instead of the regular 3 larger ones. You doctor may even suggest that you eat a liquid or pureed diet until your blood sugar levels become stable. If blood sugar levels are not being controlled with diet, your doctor may suggest using insulin until your levels are back to normal.

Some helpful tips about insulin:

  • Check with your primary physician or endocrinologist
  • Take insulin more often or change the type of insulin you take
  • Take your insulin after you eat
  • Make sure to check your levels often after you eat and give yourself insulin whenever you need it

For more information about gastroparesis or diabetes

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American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000
Internet: www.acg.gi.org

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1–800–342–2383
Email: AskADA@diabetes.org
Internet: www.diabetes.org

International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org