| Gastroparesis is a condition that occurs when the autonomous nervous system fails to send signals to the stomach to empty food contents into the small intestine. Normally, the stomach works in tangent with the vagus nerve. This nerve when damaged or fails to work, causes the intestines and stomach to not function properly and food digestion is slowed or stopped. The result is swings in the blood glucose levels, the most concerning complication. Gastroparesis is typically diagnosed in people with type 1 or type 2 diabetes.
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| Gastroparesis |
Symptoms
Nausea and vomiting are the most commons symptoms present in a patient with gastroparesis. The vomiting occurs when the stomach is full of undigested food and typical digestive juices, usually a few hours after a meal. Accumulated enzymes and acids can also produce vomiting without eating. Different stomach muscles respond to different foods. Some patients may only swallow solids, others may only swallow liquids and still others may have problems with both.
Other symptoms of gastroparesis are felling full after just a small amount of food, abdominal bloating, fluctuating blood sugar levels, loss of appetite, malnutrition, heartburn and GERD.
Diagnosis
There are several tests used to diagnose gastroparesis. These tests can specifically pinpoint indicators of gastroparesis and eliminate other possible conditions that may have the same symptoms. The tests used are gastric emptying studies, gastro duodenal manometry, upper gastrointestinal endoscopy (a.k.a. Upper GI), electrogastrogram and magnetic resonance imaging (MRI).
A gastric emptying study is considered to be one of the most accurate ways to diagnose gastroparesis. This test has many forms; the most common used involves the patient ingesting a solid food that contains a tracer. A tracer is a radioactive material. A scanner will monitor the rate in which the food leaves the stomach based on the location of the tracer. Other forms check the relaxation rate and degree of the stomach muscles after a meal.
A gastro duodenal manometry tests the strength, frequency and coordination of muscle contractions in the stomach. The contractions are measured before and after a meal. A pressure sensitive plastic tube that is connected to a monitor is inserted down the throat through the stomach and to the small intestine. This test can determine different motility conditions. Unfortunately the test is not available everywhere and is not used too often to detect gastroparesis.
An Upper GI endoscopy is used to rule out other conditions that cause delayed gastric emptying. The Upper GI endoscopy will allow the physician to see the contents of the stomach and intestine to check for blockages.
An electrogastrogram is much like an electrocardiogram, except through the stomach muscles. The electrogastrogram records the electrical signals of the stomach muscles before and after eating. A normal electrical signal speeds up after a meal. With gastroparesis, this signal is uneven – either not increasing or not present at all.
Magnetic resonance imaging (MRI) is a test that uses a powerful magnet and radio waves, producing cross section slices or images of the body. This test is primarily used to detect a large variety of cancers. Real-time MRI is being used to evaluate the motility of the stomach, which is how it moves food through digestion. This test does not involve radiation exposure and is noninvasive.
Treatment
The first step in treatment is controlling any underlying conditions that are causing the gastroparesis, which most likely is diabetes type 1 or type 2. Dietary changes and medications that increase stomach contractions are the next step in treatment. The drugs have serious side effects, though and doctors are experimenting with new procedures that are they typical approach to gastroparesis treatment.
Dietary approaches to gastroparesis treatment include smaller, frequent meals, low fiber foods, low fat foods, pureed and liquid foods, plenty of water, nutritional supplements (vitamins and minerals). In some cases a feeding tube may need to be inserted into the patient. This needs to be done when blood sugar levels are uncontrollable and gastroparesis is severe.
Medications
There are two types of drugs commonly used to treat gastroparesis, anti-emetics (anti-vomiting) and prokinetics (muscle contraction stimulators). These medications are usually an oral liquid or administered via injection.
Surgery to staple or bypass the lower part of the stomach can be performed to improve the rate of stomach emptying. There are serious risks with this treatment and it is usually a choice of last resort for severe, chronic gastroparesis.
Emerging therapies that are being tested are Botulinum (Botox) toxin injections and electrical gastric stimulation. Botox injections to the pyloric muscle can allow the stomach to release more food. The results are temporary and more studies need to be conducted. Electrical gastric stimulation uses an electric current to stimulate muscle contractions in the stomach, just like a pacemaker stimulates contractions in the heart. This procedure is experimental and is not widely available for gastroparesis patients.
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