Gastroparesis

What is Gastroparesis?

Gastroparesis refers to a delay in emptying of stomach contents into the small intestine.  This can be caused by a change in the ability of the nerves to pick up information in the stomach, or the nerves that send information to the stomach telling it to contract or empty.  Another cause includes the stomach muscles not being able to contract.  This loss of function can be limited to the stomach or can include the esophagus and small intestine.

What causes Gastroparesis?

Gastroparesis can occur spontaneously, or as a result of:

 

    • Thyroid abnormalities
  • Diabetes Mellitus,

 

  • An infection,

 

  • Gastro-intestinal surgery,

 

  • Neurological diseases,

 

  • Pregnancy,

 

  • Motion sickness,

 

  • Medications that have side-effects of delayed stomach emptying.

 

Other causes include: Alcohol, tobacco, marijuana, Total Parenteral Nutrition (TPN), certain muscle disorders, eating disorders (anorexia nervosa, or bulimia nervosa).  Symptoms may last a few hours, a few days or be chronic.

What are the Symptoms?

Symptoms of gastroparesis include nausea, vomiting, full feeling after eating only a few bites or a small amount of what you normally eat.  Other symptoms include weight loss, bloating, heartburn and abdominal pain after eating.

How do you know if you have gastroparesis?

The evaluation for gastroparesis includes:

 

  • Blood tests that look at thyroid function, tests that evaluate for Diabetes (blood sugar, hemoglobin A1C) kidney function, electrolytes, and blood tests that look at nutritional status including a blood count, and comprehensive metabolic profile.

Radiological Tests include:

 

    • An Upper GI x-ray.  This involves drinking barium that coats the stomach, to evaluate the lining and structure.  It can also show if there is something blocking the stomach from emptying.
  • Gastric Emptying Study.  This is a Nuclear Medicine test that can show how the stomach empties liquid and solid material into the small intestine, and how long it takes to empty.  This is then compared to the normal emptying rates to give a result.   This test involves eating food that is labeled with a tiny amount of radioactivity that can be seen on the scanner.

 

How is gastroparesis treated?

Treatment of gastroparesis includes:

 

    • Dietary changes. Eating smaller, more frequent meals is encouraged, as opposed to the 3 meals a day type of diet.  A low fat diet is encouraged, as meals higher in dietary fat may cause delay of stomach emptying. A diet low in dietary fiber has also been shown to decrease the symptoms of gastroparesis. Liquids empty more easily from the stomach, so the use of supplements like Boost or Ensure is encouraged.
  • Medications that promote gastric emptying called “Prokinetics” are used. There currently are not very many drugs available. These drugs include metoclopramide (Reglan) and erythromycin.  Medications that cause delayed gastric emptying should be discontinued if possible. This should be done at the direction of your doctor.

 

  • Feeding Tubes are also used in the treatment of gastroparesis.  The tubes can be placed through the nose into the esophagus, stomach and into the small intestine.  They may also be placed through the abdominal wall and into the small intestine.  The latter procedure would be used for more long-term feeding and is usually placed by a surgeon or radiologist. The type of feeding is based on individual calorie and nutritional needs, as well as the expected duration of the feeding used.

 

  • Enterra therapy is a newer therapy that involves the placement of a generator beneath the skin of the abdomen. Electrodes (coated wires with sensors) are then placed with one end in the muscle of the stomach and the other into the generator.  The Enterra generator is similar in size and function to a cardiac pacemaker. It works by stimulating the stomach muscles to empty the stomach, and often lessens symptoms.

 

Are there any complications to gastroparesis?

The main complications of gastroparesis involve alteration in nutrition which can lead to weight loss and malnutrition. Discomfort is a major problem for some people. Inability to eat normally may cause emotional and social distress.

What kind of follow up will I need?

Once an appropriate treatment plan is made for you, follow-up will be determined by your response to it.  Some individuals have symptoms lasting only a few weeks or months, while others have symptoms for years.  Some have success with medication and need only yearly follow-up.  Others with feeding tubes can be followed by their primary physician.  The Gastroenterologists who specialize in the Enterra device follow individuals with Enterra on a regular basis.