While gastroparesis is a relatively uncommon disorder, the degree that the condition disrupts a person’s life can be debilitating.
What is gastroparesis?
Gastroparesis is a disorder in which the motility of the stomach is delayed or absent,” says Ralph Wisniewski, MD, FACG, a gastroenterologist who treats patients with gastroparesis at Gastroenterology Associates of Central Virginia in Lynchburg. “When this occurs, the stomach cannot crush and move food into the small intestine properly.” Patients may experience symptoms differently, but they can include nausea, vomiting or regurgitation of undigested food, bloating, abdominal discomfort, and weight loss, and what physicians call early satiety—meaning, you feel full after only eating a small amount of food.
The reason why patients run into dead ends before being diagnosed is because symptoms can mimic those of other conditions. Often, other causes are ruled out first, like gallbladder disease, pancreatitis, irritable bowel syndrome (IBS) or tumors.
The path to diagnosis
Radiographic tests and endoscopic procedures are used to exclude bowel obstruction or other causes and lead a physician to the diagnosis. A patient may undergo a gastric emptying study, which is a common procedure that measures the rate that food empties from the stomach and enters the small intestine. In the study, a patient eats a meal that is mixed with a small amount of radioactive material. A scanner is placed over the patient’s stomach to monitor the amount of radioactivity in the stomach for several hours, which reveals the rate that the stomach empties. Other physicians might use a wireless motility capsule—a small, non-invasive pill-like device that is swallowed, and gathers information about your digestive system as you go about daily activities.
Dr. Wisniewski says the cause of gastroparesis varies by patient. One population that is vulnerable to developing gastroparesis is diabetics. In diabetics, elevated blood sugar over a period of years affects the nerve endings in the body (including the stomach) and makes them dysfunctional. The damage to the stomach nerves creates a ripple effect, and the stomach no longer functions and empties property. In diabetics, good blood sugar control does not guarantee that a patient won’t get gastroparesis—but could help prevent or delay its onset. Neuromuscular problems, infections, endocrine disorders, autoimmune conditions, and prior surgeries involving the vagus nerve can also be associated with gastroparesis. Medications prescribed for other conditions can cause delayed stomach emptying such as narcotics and certain antidepressants.
While diabetics are prone to it, the most common form of gastroparesis is idiopathic—meaning, the cause is unknown. The condition more commonly affects middle-aged women who were previously well and now have unexplained nausea and vomiting. Sometimes it follows a viral stomach illness or food poisoning.
A third, more rare cause of gastroparesis is previous gastrointestinal surgery—ulcer, reflux, stomach or esophageal surgery.
Treatment options for gastroparesis
“Treatment includes dietary modifications, medication, and treatment of the underlying cause such as improving diabetic control,” explains Dr. Wisniewski. “Diet is the primary course of action. Fatty foods and fibrous foods take longer to digest, thus, a low fat, low fiber diet is recommended.” Smaller, more frequent meals (four to six per day), cutting and chewing food well before swallowing, and drinking fluid with meals are effective. There are a few medications available to treat gastroparesis; however, they have limited effectiveness and unwanted side effects.
A common diet for gastroparesis is low fat, with limited caffeine and no raw fruits or vegetables, as the raw, fibrous material is difficult for the stomach to break down. Softer foods are easier on the stomach, such as pasta, cooked vegetables, oatmeal and low-fat yogurt. [End pull quote] A dietician is helpful in managing the condition and following diagnosis most patients are referred to one for guidance.
A very small percentage of patients are very symptomatic, and may require surgical intervention. These patients may be unable to tolerate any food or liquids, which, until recently, could require the placement of a feeding tube (jejunostomy tube) in the small intestine.
Now, there are two additional options that exist for these patients—one is a gastric stimulator, which has been FDA approved since 2000, and works much like a cardiac pacemaker, but for the stomach. It is wired to the stomach through a laparoscopic procedure, meaning incisions are tiny. It has proven helpful for diabetic gastroparesis.
The other, newer surgical intervention is called pyloroplasty which is helpful in about 75 percent of gastroparesis cases of unknown cause. This surgery is also done with less-invasive techniques. Pyloroplasty involves permanently opening the valve at the end of stomach, thus leaving it open helps food move to the small intestine more efficiently.
“Fortunately, and in most cases, gastroparesis is manageable with dietary interventions and treating or controlling the underlying cause”, says Dr. Wisniewski.
There are ongoing studies to find treatments for gastroparesis. The Mayo Clinic website, www.mayoclinic.org is an excellent resource for locating these national studies. Locally, the Blue Ridge Medical Research division of Gastroenterology Associates of Central Virginia will begin a study for new innovative medications and treatments for gastroparesis later this fall.