Gastroparesis - Symptoms, Causes, Diagnosis, Treatment, and Complications

Introduction:

Gastroparesis, also known as delayed gastric emptying, is a disorder in which the food stays in the stomach for a longer than normal. This slows down or stops the passage of food from the stomach into the intestine even though there is no blockage in the stomach or intestine. It means partial paralysis of the stomach. It has been a common condition in people with diabetes for a long time.

What Are the Symptoms of Gastroparesis?

The symptoms of gastroparesis include:

• Heartburn or gastroesophageal reflux disease (GERD).

• Stomach upset.

• Vomiting undigested food.

• Bloating.

• Feeling full even when eating a little food.

• Abdominal pain.

• Lack of appetite and weight loss.

• Poor blood sugar control.

What Are the Causes of Gastroparesis?

Gastroparesis can affect both men and women. The cause of gastroparesis is not known in many cases. Diabetes is the most common cause of gastroparesis. It damages the vagus nerve, which regulates the digestive system. The vagus nerve contracts the stomach muscles that help move the food through the digestive tract.

Other causes of gastroparesis include:

• Viral stomach infections (gastroenteritis).

• Injury to vagus nerve from surgery.

• Hypothyroidism (lack of thyroid hormone).

• Parkinson’s disease.

• Medications such as antidepressants and narcotics.

• Multiple sclerosis.

• Amyloidosis.

• Scleroderma.

How Can We Diagnose Gastroparesis?

Detailed medical history and symptoms are asked for; then, the doctor will do a physical examination.

The following tests are done to confirm the diagnosis, including:

• Radioisotope Gastric-Emptying Scan (Gastric Scintigraphy): This is the most important test in diagnosing gastroparesis. The patient eats food containing a minimal amount of radioactive substance, and a scan is done. If more than 10 % of food remains in the stomach four hours after eating, it confirms gastroparesis.

• Blood Tests: Blood tests identify malnutrition, infection, and blood sugar levels.

• Barium X-Ray: The patient drinks a liquid that coats the esophagus, stomach, and small intestine, which is viewed on an X-ray.

• Gastric Manometry: A thin tube is passed through the mouth and stomach to measure muscular activity and determine the timing of digestion.

• Electrogastrography: This test measures the electrical activity in the stomach using electrodes placed on the skin.

• Gastric Emptying Breath Tests: This test measures how fast the stomach empties after eating.

• Ultrasound: This imaging test uses sound waves to create images of the digestive system's organs and to rule out digestive problems.

• Upper Gastrointestinal Endoscopy: A thin tube called an endoscope is passed down the esophagus into the stomach to view the stomach's lining.

• Smart Pill: It is a capsule that contains a small electronic device. When the capsule is swallowed, it sends information to a receiver on how quickly food travels through the digestive tract.

What Is the Treatment of Gastroparesis?

Changes to diet are one of the best ways to control gastroparesis symptoms. Therefore, maintaining adequate nutrition is the most important goal in treating gastroparesis.

Some measures to improve the symptoms of gastroparesis include:

• Try to eat six small meals a day rather than three usual large meals.

• Drink more liquids like water, juices, soups, and sports drinks.

• Chew food thoroughly.

• Avoid carbonated beverages, smoking, and alcohol.

• Avoid high-fat foods and high-fiber foods, which are harder to digest.

• Do not lie down two hours after eating.

• Go for a walk after eating.

• Control blood sugar levels.

Medications for gastroparesis include:

• Metoclopramide: This drug is taken before eating, and it causes the stomach muscles to contract and helps move the food. It also helps in nausea and vomiting.

• Erythromycin: This antibiotic causes stomach contractions and helps in moving the food.

• Antiemetics: These drugs help in controlling nausea.

What Is the Surgical Treatment for Gastroparesis?

Even after taking medications, patients with nausea and vomiting are treated with surgery. One type of surgery is gastric electrical stimulation, in which mild electric shocks are sent to stomach muscles. The doctor inserts a small device called a gastric stimulator into the stomach during the procedure. The stimulator sends mild electric shocks which control vomiting.

Another type of surgery is gastric bypass, limiting the amount of food the patient eats. In this surgery, a small pouch is created from the top of the stomach. The small intestine is cut in half, and the lower end is attached to the small pouch. This surgery is more effective for obese patients. A per-oral pyloromyotomy is a non-surgical procedure in which the doctor uses an endoscope (a long, thin, flexible tube) to cut the pylorus valve, so it helps in easy stomach emptying.

In severe cases of gastroparesis, the doctor might give a feeding tube or jejunostomy tube, which is inserted through the belly into the small intestine. The patient puts the food into the tube, directly into the small intestine. The food skips the stomach and gets into the bloodstream faster. The jejunostomy tube is a temporary procedure. Another treatment option is feeding through an intravenous or parenteral route. In this method, the nutrients go directly into the bloodstream through a catheter placed in a vein in the chest. It is also a temporary procedure for severe cases of gastroparesis.

The doctor also injects botulinum toxin into the pylorus, the valve from the stomach to the small intestine. This relaxes the valve, keeping it open for a long time so that the stomach can empty quickly.

What Are the Complications of Gastroparesis?

• Dehydration.

• Malnourishment.

• If food stays in the stomach for a long time, it can ferment and lead to bacteria's growth.

• When food hardens, it turns into a solid lump called a bezoar. It can block food from passing through the small intestine.

• Blood sugar levels rise, and gastroparesis makes it harder to control blood sugar levels.

Conclusion:

Gastroparesis is a chronic condition. Treatment of the disease does not fully cure the disease but can manage it and keep it in control. Changes to the diet along with medication can provide some relief.