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

Introduction:

Gastroparesis, also known as delayed gastric emptying, is a disorder in which food stays in the stomach for 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 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 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.

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.

How Can We Diagnose Gastroparesis?

A detailed medical history and symptoms are requested, and 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, 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 in 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 the usual three 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 for 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 with 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 gastroparesis surgery. One type of surgery is gastric electrical stimulation, in which mild electric shocks are sent to stomach muscles. The doctor inserts a small gastric stimulator into the stomach during the procedure. The stimulator sends mild electric shocks, which control vomiting. Another type of gastroparesis surgery is gastric bypass, which limits the amount of food the patient eats. In this surgery, a small pouch is created at 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 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 the stomach can empty quickly.

What Are the Risk Factors of Gastroparesis?

The following variables may raise the risk of gastroparesis:

• Diabetes.

• Oesophagus or abdominal surgery.

• A virus often brings on infection.

• Certain drugs, such as opioid painkillers, slow the rate at which the stomach empties.

• One connective tissue disorder is scleroderma.

• Illnesses of the nervous system, including multiple sclerosis and Parkinson's disease.

Compared to men, women are more likely to develop gastroparesis.

What Are the Complications of Gastroparesis?

• Extreme dehydration. Continued vomiting may result in dehydration.

• Starvation. A lackluster appetite may indicate that the patients are not consuming enough calories, or vomiting may be prevented from absorbing adequate nutrition.

• Food that is not fully digested gets stuck in the stomach. Food that has not been fully digested in the stomach might solidify into a mass known as a bezoar. If a bezoar stops food from entering the small intestine, it can be fatal and induce nausea and vomiting.

• erratic swings in blood sugar. Diabetes is not caused by gastroparesis, but irregular fluctuations in the amount and rate of food that enters the small bowel can lead to unpredictable swings in blood sugar levels. These fluctuations in blood sugar exacerbate diabetes. Thus, inadequate management of blood glucose exacerbates the symptoms of gastroparesis.

• Reduced standard of living. It may be challenging to work and fulfill other obligations when experiencing symptoms.

Conclusion:

Gastroparesis is a chronic condition. It is the medical term for stomach paralysis. The stomach's muscles and nerves are affected by this functional condition. It causes the stomach's muscular contractions to become weaker and slower than they should be to break down and properly transfer food into the intestines. Food ends up remaining in the stomach for too long as a result. Treatment 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.