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Gastroparesis

Definition

Gastroparesis is a disorder that affects the digestive system. During normal digestion, the stomach breaks down food and then contracts to push food down to the small intestine. With gastroparesis, there is delayed emptying of the stomach. Food either moves slowly through the digestive tract or does not move at all. This can pose problems since the food can harden causing blockage, nausea, and vomiting. Bacteria can also start to grow. Gastroparesis is a potentially serious condition. It requires care from your doctor.

The Stomach and Intestines
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Causes

Movement of food in the digestive system is controlled by the vagus nerve. Gastroparesis occurs when this nerve is damaged and the muscles of the stomach do not work properly.

Risk Factors

The main risk factor is diabetes . Diabetes can damage the vagus nerve, which may lead to gastroparesis. High blood sugar can also damage blood vessels that carry nutrients and oxygen to the vagus nerve, preventing it from working properly. Other risk factors include:

  • Gastroesophageal reflux disease (GERD)
  • Surgery that involves the stomach or vagus nerve
  • Taking certain medicines (eg, anticholinergics or narcotics)
  • Infection from a virus
  • Diseases affecting the nerves, muscles, or hormones
  • Diseases affecting metabolism (body’s ability to make and use energy)
  • Chronic disease
  • Anorexia or bulimia
  • Radiation or chemotherapy
  • Tobacco
  • Alcohol

Symptoms

If you have any of these symptoms, do not assume it is due to gastroparesis. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:

  • Feeling full early during a meal
  • No appetite
  • Nausea and vomiting
  • Bloating
  • Pain in your abdomen or esophagus (the muscular tube that carries food from your mouth to your stomach)
  • Heartburn
  • Weight loss

The following may worsen symptoms:

  • High-fiber foods, like raw vegetables and fruits
  • Fatty foods
  • Carbonated drinks

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will also be done. The doctor may do:

  • Blood tests
  • Tests to measure:
    • Stomach volume before and after a meal
    • The rate at which the stomach empties
    • The ability of the muscles in the stomach and small intestine to contract and relax
  • Imaging tests:
    • Ultrasound —to observe movement of food out of the stomach
    • Barium x-ray or CT scan —uses a milky fluid to coat the lining of the stomach intestines to look for blockage
    • Gastric emptying study—uses radioactive meal to measure stomach emptying directly with an x-ray
    • Gastric emptying study may also be done by MRI
  • Other procedures
    • Upper endoscopy —a thin, lighted tube inserted down the throat to examine the esophagus, stomach, and small intestine
    • SmartPill—a pill-sized device that is swallowed to capture information on the digestive system

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Diet

Managing what you eat can help control gastroparesis. You may work with your doctor or a registered dietician to create a meal plan that is right for you. This may include:

  • Eating small meals several times throughout the day
  • Following a liquid diet
  • Limiting high-fat and high-fiber foods

Alternative Nutrition

In severe cases, you may need to have nutrients delivered directly to your intestines (skipping the stomach) or directly to your bloodstream. Feeding tubes may be inserted down your throat or through your abdomen and into your intestines to help deliver food. Nutrients may also be given through a thin tube that is placed in one of your veins.

Medications

You may be given medicines that treat your symptoms and help your stomach empty. These medicines work by stimulating the stomach muscles to contract. Examples include:

  • Metoclopramide (Reglan)
  • Erythromycin

Other medicines may be prescribed to reduce nausea.

Surgery

In severe cases, your doctor may consider surgery. This may include removing part of the stomach .

Prevention

To help reduce your chances of getting gastroparesis, take the following steps:

  • Control diabetes. Since diabetes is a common risk factor for gastroparesis, it is important that you follow treatment plans from your doctor if you have diabetes.
  • Avoid medicines that delay gastric emptying. Some medicines may keep your stomach from emptying properly. These include narcotic pain medicines, calcium channel blockers, and some antidepressants. Keep a list of all the medicines you are taking and share this list with your doctor. Make sure you talk to your doctor before stopping any medicines.

Revision Information

  • American College of Gastroenterology

    http://www.acg.gi.org/

  • American Gastroenterological Association

    http://www.gastro.org/

  • Canadian Institute for Health Information

    http://www.cihi.ca/

  • Health Canada

    http://www.hc-sc.gc.ca/

  • DynaMed Editors. Gastroparesis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 29, 2010. Accessed April 4, 2011.

  • Fox J, Foxx-Orenstein A. Gastroparesis. The American College of Gastroenterology website. Available at: http://www.acg.gi.org/patients/gihealth/gastroparesis.asp . Accessed April 4, 2011.

  • Gastroparesis. The National Digestive Diseases Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/ . Updated July 2007. Accessed April 4, 2011.

  • Shakil A, Church RJ, Rao SS. Gastrointestinal complications of diabetes. Am Fam Physician . 2008;77(12):1697-1702.

  • Soykan I, Sivri B, Sarosiek I, Kiernan B, McCallum RW. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci . 1998;43(11):2398-2404.