Strategies to Lower Gastroparesis Associated Mortality

Introduction

Gastroparesis is a gastrointestinal condition where the stomach muscles have very slow motility. This slow motility inhibits the gastric emptying of food, which, in turn, causes the food to stay in the stomach for more time. The Vagus nerve is responsible for managing the muscles of the stomach. Gastroparesis is caused when the vagus nerve gets injured. The nerve usually gets damaged by high blood glucose levels from diabetes, abdominal surgery, or surgery to small intestines. Other causes of gastroparesis include infections or the use of medications like antidepressants or narcotics.

What Symptoms Are Seen in Gastroparesis?

Gastroparesis is usually asymptomatic; however, at times, certain symptoms occur, including nausea, vomiting, abdominal pain, bloating, weight loss, acid reflux, and feeling full even after eating very low amounts of food. In some people, gastroparesis affects the quality of life by causing flare-ups affecting certain activities or their work but does not cause any life-threatening complications. However, in others, gastroparesis can cause deadly complications. Some include:

• Malnutrition and Dehydration - Persistent vomiting in gastroparesis can cause dehydration. Dehydration hinders the absorption process of nutrients in the body, leading to malnutrition, which is life-threatening.

• Blockages in the Stomach - When undigested food is left back, people with gastroparesis develop masses in the stomach. These masses, called bezoars, cause small intestine blockages. If left untreated, the blockages will cause infections which can be deadly.

• Diabetes - The blood sugar level becomes low when food stays in the stomach and increases when the food travels to the intestines. The slow movements of food from the stomach area into the intestine will also cause abnormal changes in the blood sugar level and worsen diabetes. The fluctuations in these blood sugar levels make it difficult to control the blood sugar, leading to serious problems like stroke, heart attack, and damage to the vital organs.

• Cancer Complications - Gastroparesis occurs as a complication of cancer. It is seen in people with pancreatic cancer and tumors in their upper gastrointestinal tract. Gastroparesis symptoms after cancer diagnosis mainly include chemotherapy-induced nausea, vomiting, and cancer cachexia. Cancer cachexia is the muscular and weight loss that occurs in people with advanced stages of cancer.

Is Gastroparesis a Reversible Condition?

Gastroparesis is a long-term chronic condition that cannot be reversed. A cure has not yet been developed for gastroparesis. However, the healthcare practitioner will develop a management plan to help with the symptoms and reduce the chances of complications.

How Is Gastroparesis Diagnosed?

To diagnose gastroparesis; the doctor will perform a physical examination, take a detailed history of symptoms, and do certain tests. The tests include

• Smart Pill - The patient will be asked to swallow a capsule that will track the food while it travels through the intestine area. The smart pill test helps determine the speed at which the stomach empties its contents. This capsule will then leave the body during bowel movements.

• Gastric Emptying Study - The patient will be asked to eat a light meal containing radioactive material. This will help the doctor track the food's speed as it travels from the stomach to the intestine.

• Upper Gastrointestinal Series - This test examines the upper gastrointestinal tract and checks for abnormalities. The patient will be asked to drink a white chalky substance. This substance coats the gastrointestinal tract walls, which will help highlight the problematic areas in an X-ray.

• Upper Gastrointestinal Endoscopy - In this procedure, the doctor will insert a long tube containing a camera into a patient's throat. This will capture pictures of the upper gastrointestinal tract area, including the esophagus, stomach, and the start of the small intestines. The doctor will then view these images to rule out conditions that cause similar symptoms of gastroparesis, like a peptic ulcer.

• Ultrasound - It is a technique where high-frequency sound waves create images inside the body. This test rules out conditions resembling gastroparesis symptoms in the gallbladder or kidney area.

• Symptoms-Based Tests - The doctor might also recommend more tests based on the patient's symptoms. For example, suppose a patient shows signs of diabetes like extreme thirst, frequent urination, or elevated blood sugar levels. In that case, the doctor will order an oral glucose test or a fasting blood sugar test.

How Is Gastroparesis Managed?

1. Managing gastroparesis efficiently improves the quality of life of a patient. The management mainly depends on its severity and its symptoms.

2. Symptoms like nausea and vomiting are treated with medications like Prochlorperazine and Diphenhydramine.

3. Medicines like Metoclopramide and Erythromycin stimulate the stomach muscles.

4. Suppose medication does not help improve symptoms of the condition. In that case, the doctor may recommend placing a feeding tube surgically from the abdomen to the small intestine to ensure that the patient receives enough nutrients.

5. The surgical intervention done is gastric electrical stimulation. In this procedure, the doctor uses an electric shock to stimulate the stomach muscles.

6. Another surgical procedure called gastric bypass is also recommended. This procedure involved the creation of a small pouch from the stomach area and connecting the pouch to the small intestine. This technique helps in faster stomach emptying. Gastric bypass is also a weight loss surgery; the doctor might recommend this procedure if a patient is obese.

Can Gastroparesis Be Prevented?

A low-fiber and low-fat diet will help improve the digestion and movements of food through the stomach area. If a person has diabetes, keeping the blood sugar level in a normal range is recommended to prevent damage to the vagus nerve. Exercise regularly. Increasing physical activity will help the stomach empty its content faster.

What Are the Dietary Recommendations for Gastroparesis?

• Dietary modification plays an important role in the management of gastroparesis.

• Some people could manage the condition effectively with just dietary changes.

• It is advised to avoid high-fiber foods, which slow digestion, and high-fat foods and alcohol, which slow stomach emptying.

• Some foods recommended for the condition include pancakes, potatoes, rice, pasta, beef, chicken, pork, cooked vegetables, seafood like lobster, shrimp, applesauce, vegetable juice, fruit juice, and baked French fries.

• People must avoid cauliflower, broccoli, apple, carrot, pears, oranges, alcohol, and fried food.

• It is also advised to eat small meals daily by thoroughly chewing the food and eating slowly.

• Try staying up for at least two hours and walking after eating.

Conclusion

Gastroparesis is a gastrointestinal condition where the low motility of the stomach muscles causes difficulty for the stomach to empty its contents. Some of the symptoms seen in this gastroparesis include abdominal pain, bloating, nausea, vomiting, weight loss, acid reflux, and a feeling of fullness even after eating small amounts of food. It can also cause certain deadly complications like blockages in the stomach and dehydration, leading to malnutrition. Gastroparesis can be diagnosed by endoscopies and ultrasound . Even though gastroparesis is a chronic condition, its symptoms can be effectively managed by medical and surgical intervention, dietary modification, and certain lifestyle changes.