We tend to take our body for granted when it is functioning properly. Every day our bodies perform tiny miracles, like taking food and turning it into energy that powers everything we do, from kicking a ball to growing fingernails. But what happens when one simple function breaks down? What happens when involuntary, reflexive actions just stop? Gastroparesis is a condition that occurs when one vital process stops. Learning more about this mysterious disease and what is gastroparesis can help spot the early signs for a better treatment outcome.
What is gastroparesis?
The digestive system is largely reflexive. Food enters this system when we swallow. Stomach muscles work together with digestive enzymes to break larger pieces of food into small bits to move through the stomach to the small intestine. The digestive contractions of the stomach muscles allow the body to utilize the nutrition in the food and provide energy.
The vagus nerve controls this action of contraction. This involuntary contraction is referred to as stomach motility. When stomach motility slows or stops, the movement of food into the small intestine is slowed or stopped as well. Digestion is delayed, and food simply sits in the stomach, partially digested.
Gastroparesis is also referred to as delayed gastric emptying. This condition is not caused by any blockages in the intestinal tract. The stomach simply stops or slows the act of emptying.
There are two main types of gastroparesis.
- Idiopathic gastroparesis: Gastroparesis without an identifiable cause
- Diabetic gastroparesis: Gastroparesis caused by diabetes
What causes gastroparesis?
Most cases of gastroparesis are idiopathic in that an exact cause cannot be identified. Because the vagus nerve is responsible for stomach motility, any damage to that nerve may compromise stomach motility and cause delayed emptying.
Poorly controlled diabetes is the most common known cause of gastroparesis. Other conditions that can lead to gastroparesis include:
- An inflamed pancreas (pancreatitis)
- Thyroid disease
- Imbalance of minerals in the body (i.e., imbalance of potassium, magnesium, or prescription medications)
- Side effect of surgery in the small intestine
- Diseases of the connective tissue, such as multiple sclerosis or muscular dystrophy
What is gastroparesis risk factors?
Patients with any of the above conditions are more susceptible to developing gastroparesis, but young and middle-aged women are more likely to develop gastroparesis than any other demographic. There is no evidence that there is a genetic link.
Hypothyroidism, viral infections, nervous system diseases, and some cancer treatments (e.g., radiation therapy) are also risk factors for gastroparesis.
Symptoms of gastroparesis
Gastroparesis has some symptoms similar to acid reflux and is often misdiagnosed because of that. There are many other symptoms that can help lead to a diagnosis.
Abdominal pain can be severe and unresponsive to treatment. This can be caused by the partially digested food essentially fermenting in the stomach, causing extreme pain.
Gas and bloating
The stomach may be distended and bloated. Bloating may also occur without stomach distension. In this case, the stomach feels very full and gas may still be present.
Nausea and vomiting
Other than pain, nausea and vomiting may be the most uncomfortable part of gastroparesis.
Early satiety and malnutrition
When eating, the stomach may feel very full after a small amount of food. While this type of portion control may seem like a welcome side effect, as gastroparesis progresses, the amount of food that can be eaten is not enough to provide adequate nutrition. For this reason, malnutrition can result in later stages of gastroparesis.
Many who suffer from acid reflux also have gastroparesis. This is one reason that gastroparesis is often underdiagnosed or misdiagnosed as an ulcer.
Other symptoms of gastroparesis include lack of appetite and low blood sugar.
How is gastroparesis diagnosed?
Gastroparesis shares many symptoms with other stomach conditions, so deciding what is gastroparesis and what is something else can be tricky. In general, doctors will begin with a thorough medical history, including a family history and a conversation about general overall health.
After that, several different tests are used, both to eliminate other possible conditions and to verify a diagnosis of gastroparesis. These include:
- Gastric emptying study: A light meal is taken with a small amount of radioactive material. The stomach is then scanned for the radioactive material to monitor how fast the food moves through the stomach.
- Upper gastrointestinal endoscopy: The upper digestive system is examined using a tiny camera on the end of a small, thin tube. This checks for any visible signs of damage.
- Computerized tomography (CT) enterography and magnetic resonance (MR) enterography: These two tests are more sensitive than endoscopy and may be able to detect more subtle signs of damage. MR enterography does not use radiation.
- Upper gastrointestinal series: Patients drink a chalky substance called barium to coat the upper gastrointestinal tract to see if anything abnormal shows up.
- Breath test: The patient drinks sugar water, and the breath is analyzed to see how much gas is produced.
All of these tests together can help come up with a diagnosis.
Treatments for gastroparesis
What is gastroparesis treatment and what does it target? Gastroparesis treatments actually have many different goals.
Nausea, vomiting, and abdominal pain are often the first things to be addressed. These can be addressed not only through medications but also with changes in diet. Soft, liquid foods are recommended in the early stages of treatment to allow the stomach to work less and empty more easily.
Medications to control vomiting and abdominal pain are prescribed to keep patients comfortable.
Address underlying conditions
For diabetic gastroparesis, getting blood sugar under control is necessary to truly begin to heal the stomach.
Stimulating the gut
The stomach muscles may not be receiving emptying signals. Stimulating these signals is an important part of treatment for gastroparesis. Patients can be prescribed a variety of oral or intravenous medications.
Another newer technology is the use of electrical signals to stimulate the vagus nerve. This is similar to the way a pacemaker works for the heart.
Ensuring proper nutrition
In extreme cases, patients may need to receive food through a feeding tube or fluids intravenously to maintain proper nutrition and hydration. This will help control symptoms and help the body to maintain adequate nutrition during treatment. Patients may also receive crucial vitamins and minerals intravenously.
Long term outcomes for gastroparesis depend on the underlying cause of the condition. If the cause is treatable, symptoms generally subside and the prognosis is good. For idiopathic gastroparesis, the outlook is not so simple, but treatments can help.
If you are experiencing any of the above symptoms and have risk factors for gastroparesis, talk to your doctor today.