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Gastroparesis

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Gastroparesis is a gastrointestinal condition that is characterized by a malfunction of the muscles in the stomach. This illness results in a partial paralysis of the stomach, causing it to retain food for much longer periods than the time it ordinarily takes to digest.

GASTROPARESIS SIGNS AND SYMPTOMS

The stomach is shaped into a hollow-like sac made up three layers of muscle. When food enters the stomach, it is churned around and mashed into smaller pieces by the constant grinding of the stomach muscles, aided by enzymes and acids. As soon as it has been converted into very small particles it will be ready for absorption in the small intestine.

In normal digestion, the stomach, controlled by its vagus nerve, propels food towards the small intestine in gradual portions using powerful muscle contractions. When Gastroparesis occurs, the vagus nerve is damage and the muscles in the stomach wall become weakened and fail to grind the food thoroughly. It also fails to empty the stomach of the consumed food in a timely manner. Because of this, digestion is impeded and the patient's nutrition and blood sugar levels are compromised.

During the long periods of time when food remains within the stomach, it continues to ferment in the gastric juices and becomes a breeding ground for bacteria. The food can also solidify into hard masses known as bezoars, which can block the path towards the small intestine. This dangerous stomach obstruction can cause nausea, vomiting.

GASTROPARESIS SIDE EFFECTS

Gastroparesis usually afflicts patients suffering from any acute illness, and is a common complication of diabetes mellitus, or type 1 diabetes. Twenty percent of type 1 diabetes patients also suffer from Gastroparesis. The high blood sugar of diabetes sufferers eventually damages the vagus nerve and leads to Gastroparesis. Having this complication makes it doubly difficult for diabetes sufferers because it makes it impossible to control the resulting erratic blood glucose levels.

GASTROPARESIS CAUSES

Gastroparesis also occurs when the vagus nerve is inadvertently damaged during surgery, or when a person suffers from scleroderma, a disease that damages the stomach muscles. In some cases, diseases like pancreatitis (an inflamation of the pancreas) will cause nervous reflexes which can lead to Gastroparesis. In these instances, the pancreas sends mixed messages to the stomach nerves which prevent it from performing its normal functions.

Other causes of Gastroparesis include eating disorders like anorexia nervosa or bulimia, postviral syndrome (fatigue from a viral infection), certain medications that retard stomach contractions, amyloidosis or scleroderma (a connective tissue disease), disorders of the nervous system (e.g., Parkinson's disease, abdominal migraine), hypothyrodism (a metabolic disorder), and blood mineral imbalances, like potassium, calcium or magnesium.

Although a clear reason hasn't been established, some people are afflicted with Gastroparesis after suffering from the flu or other viral infections. Cases of Gastroparesis that occur with no pinpointed cause are known as Idiopathic Gastroparesis.

People with Gastroparesis will experience nausea and vomiting, abdominal pain, and bloating. Because digestion takes place at a very slow pace, a person with Gastroparesis will immediately feel full after eating very little food (early satiety). This may result in a reduction of the food intake, nutritional deficiency, and eventual weight loss in the patient.

The symptoms of vomiting will most frequently occur after eating a meal. In the more advance stages of the disorder, vomiting can occur even without the person consuming anything.

Gastroparesis also causes gastroesophageal reflux disease, or GERD, leading to malnutrition. Other symptoms of the disorder include heartburn, a bloated abdomen, loss of appetite, and stomach spasms. These symptoms may be further aggravated when solid food, foods rich in fiber, fatty foods and carbonated drinks are consumed.

Symptoms range from mild to severe, and some people may exhibit more symptoms than most There are even cases when patients are afflicted with a broad range of symptoms making Gastroparesis difficult to diagnose.

GASTROPARESIS DIAGNOSIS

In diagnosing Gastroparesis, the doctor will evaluate the patient’s general health, medical history and current medicine intake, including any genetic predisposition towards gastrointestinal disease. The doctor will also ask the patient to describe the actual symptoms felt.

The doctor will also take note of any jaundice, bruising, edema and dry skin texture, including sunken eyes, the shape of a patient’s chest and abdomen, and abnormal breathing movements which may indicate an inflammation of the diaphragm.
gastroparesis
Image: Gastroparesis


Other characteristics the doctor will be searching for include the presence of blood in the vomit or stool, which will be determined using the gastroccult test, as well as any evidence of gastrointestinal bleeding, or liver disease.

GASTROPARESIS TEST

The doctor will also order the patient to go through several tests like a Barium x-ray, a thick liquid ingested after a 12-hour fast. The substance coats the inside walls of the stomach and if the subsequent x-ray shows food, then the patient is likely to have Gastroparesis. A Barium beefsteak meal test involves the patient eating food containing barium, allowing a radiologist to observe the patient’s stomach while the meal is digesting.

A radioisotope gastric-emptying scan is another test where the patient consumes food containing a small amount of radioisotope, and lies under a machine which will determine how long it will take for the food to be digested. A gastric manometry can measure the stomach’s electrical and muscular motions, and blood tests will be able to check a patient’s chemical and electrolyte levels.

Other diagnostic tests include an upper endoscopy and an ultrasound to take pictures and images of the stomach lining, gallbladder and pancreas. In 2006, the U.S. Food and Drug Administration (FDA) approved of a small device called the SmartPill which is swallowed in capsule form and travels throughout the digestive tract to gather information on a patient’s digestive process. It then sends signals to a small receiver worn around a patient’s neck. After the SmartPill is expelled during through defecation, the receiver is given to the doctor who retrieves information from it.

GASTROPARESIS TREATMENT

There is no specific cure for Gastroparesis, but the doctor can recommend drugs and a change of diet to alleviate the symptoms, and to control any underlying causes of this chronic disorder. These remedies are aimed at relieving the primary symptoms of Gastroparesis, like stomach pain, nausea and vomiting, and to encourage the muscles of the stomach to digest food more effectively, and to maintain proper nutrition.

The doctor will prescribe medications like metoclopramide (Raglan) to help the stomach muscles contract; erythromycin, an antibiotic to aid stomach emptying; Domperidone to also help the stomach empty and to reduce nausea and vomiting; antiemetics for vomiting and nausea, and antibiotics to rid the body of any bacterial infection that may have developed. Octreotide (Sandostatin) hormone injections stimulate stomach muscle contractions, as well.

To rid the stomach of the existence of bezoars, the doctor may use an endoscopy procedure to inject dissolving medication directly into the blockage. Parenteral nutrition, on the other hand, is when the doctor inserts a catheter into a vein in the chest to allow liquid nutrients to enter the bloodstreatm. Another type of treatment requires the implantation of a “gastric neurotransmitter” device to reduce nausea and vomiting.

As a last resort for more severe cases, the doctor may recommend jejunostomy, a surgical procedure involving the insertion of a feeding tube into the small intestine to allow nutrients into the body, or even to enlarge the opening of the stomach and small intestine to facilitate the emptying process. If these surgical methods do not work, the final option will be to undergo a stomach removal procedure.

To maintain nutrition, the doctor will recommend smaller and frequent feedings, especially soft or liquid food with lower fat and fiber content. Too much fat and fiber in the diet causes will cause a slower and more difficult digestion. Dehydration and malnutrition can be remedied by intravenous fluids to replenish the body’s electrolytes.

GASTROPARESIS PREVENTION

To prevent Gastroparesis, patients with diabetes will need to maintain their blood sugar levels to prevent acquiring the disorder as a complication. Smaller meals 6 times a day will be recommended, and an avoidance of fatty and fibrous foods, those with partially hydrogenated vegetable oils (e.g., butter, chicken skin, whole milk), as well as junk food will be advised.


Because Gastroparesis is a chronic disorder, treatments will only help relieve symptoms and manage the problem. However, if it is caused by treatable underlying conditions like pancreatitis, curing the primary illness will remove the Gastroparesis complication. If it occurs secondary to diabetes, the patient will need to maintain normal levels of blood glucose.

In heartening news, new experiments have discovered that injecting Botulinum (a neurotoxin protein) into the pyloric sphincter, the sturdy ring of smooth muscle that allows food to travel from the stomach to the small intestine, can relieve the symptoms of Gastroparesis.

Researchers from the National Institute of Diabetes and Digestive and Kidney Diseases are currently studying experimental drugs to manage Gastroparesis symptoms, such as abdominal pain, bloating, nausea and vomiting, including medications that aid the stomach in emptying food into the small intestine at a much faster rate.
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