Gastroparesis is a medical condition in which the stomach's normally occurring contractions are not working properly. It is sometimes referred to as stomach paralysis.
During digestion, stomach contractions help move the partially digested food from the stomach to the small intestine. Here, further digestion and nutrient absorption occur. In people with gastroparesis, this does not occur properly.
This change interferes with how the stomach empties. The condition can lead to nausea, vomiting, and blood sugar and nutritional abnormalities.
Here are some key points about gastroparesis. More detail and supporting information is in the main article.
- The cause of gastroparesis is sometimes unknown, and such cases are referred to as idiopathic gastroparesis
- Those at highest risk for developing idiopathic gastroparesis include middle-aged women
- The treatment of gastroparesis relies on diagnosing and treating any underlying conditions
Causes of gastroparesis
As with most diseases, there are certain factors that can place a person at a higher risk for developing gastroparesis. These factors include:
The symptoms of gastroparesis can be mild or severe. The cause of the condition may be unknown in some cases.
- Vagus nerve damage
- Uncontrolled diabetes
- Certain drugs or medications such as tricyclic antidepressants, calcium channel blockers, clonidine, dopamine agonists, lithium, nicotine, and progesterone
- Conditions such as Parkinson's disease, multiple sclerosis, amyloidosis, and scleroderma
- Stomach surgery
- Viral infection
- Medical treatments such as radiation therapy
- Certain psychological disorders
- Eating disorders
At times, the cause of gastroparesis is unknown. These cases are referred to as idiopathic gastroparesis. Those at the highest risk for developing idiopathic gastroparesis include young and middle-aged women.
Symptoms of gastroparesis
The symptoms of gastroparesis include:
- Heartburn or reflux disease (GERD)
- Nausea or vomiting of undigested food
- Feeling full-up earlier than normal
- Stomach bloating or pain
- Reduced appetite
- Weight loss
The symptoms of gastroparesis are often worsened by eating solid foods, fatty foods, or foods high in fiber. They are also worsened by drinking high-fat or fizzy drinks.
Gastroparesis is not only an uncomfortable medical condition, but it can also cause a variety of complications. These complications include:
- Severe dehydration
- Blood sugar abnormalities
- Hardened, undigested food that can form a solid mass - this can sometimes be life-threatening
- Bacterial overgrowth in the stomach due to undigested food
- Reduced quality of life
Diagnosis and treatment
After a symptom review and physical exam, a healthcare provider may recommend certain tests and procedures. The aim of these is to evaluate further for the presence of gastroparesis.
Tests and procedures that can be used include:
- Upper gastrointestinal endoscopy (upper GI): A flexible tube with a lighted camera is used to examine the upper gastrointestinal system, looking for any abnormal areas.
- Radiologic imaging procedures: Such procedures include the use of CT scan, MRI, and ultrasound.
- Upper GI series: Also referred to as a barium X-ray or barium swallow, this test involves drinking liquid that coats the digestive tract and then having an X-ray. This allows doctors to see abnormal areas such as inflammation, infection, cancer, and hernias.
- Gastric emptying study: This nuclear medicine procedure allows for evaluation of the rate of stomach emptying in the presence of solid food or liquids.
- Breath test: After drinking some sugar water, the amount of gas metabolized by the body is measured in a sample of the breath.
- Gastric manometry: This test evaluates the electrical activity and smooth muscle movement of the stomach and small intestine. To do this, a thin tube is passed through the mouth and into the stomach.
- Electrogastrography: With the use of skin electrodes, an electrogastrography measures stomach electrical activity.
- The smart pill: A wireless capsule is consumed to test digestive speed. During the test, pH, temperature, and pressure changes are recorded as the pill passes through the gut.
- Scintigraphic gastric accommodation: Stomach volumes both before and after a meal are measured using radioactive material. The presence of more than 10 percent residual food within the stomach 4 hours after a meal meets the criteria for gastroparesis.
- Small intestine X-ray: This test is typically used to check for an intestinal blockage that could be causing symptoms of delayed stomach emptying. These symptoms could be confused for gastroparesis.
Treatment often involves tackling the underlying cause of gastroparesis. There are also certain treatments that can alleviate the symptoms:
Small changes in diet such as eating soups may help people with gastroparesis.
- Feeding tubes or intravenous forms of nutrition may be required
- Antinausea medications like prochlorperazine, diphenhydramine and thiethylperazine, or ondansetron
- Drugs to increase stomach contractions like metoclopramide
- Antibiotics such as erythromycin may be recommended
- Cisapride is rarely used due to its side effect profile of cardiac arrhythmias
- Domperidone is not available in the United States but is available in countries such as Mexico, Canada, and some European countries
- Injection with botulinum toxin
- Electrical gastric stimulation, a surgical procedure where electrodes are attached to the stomach to trigger contractions
Alternative therapies may provide relief to some people. Such therapies can include acupuncture, acupressure, biofeedback, hypnotherapy, the use of ginger, and skin application of antinausea medications.
Dietary modifications can also help people with gastroparesis. Steps to take can include:
- Small frequent meals
- Avoiding raw or uncooked fruits and vegetables
- Avoid fibrous fruits and vegetables
- Eating liquid foods such as soups or pureed foods
- Eating foods low in fat
- Drinking water during meals
- Gentle exercise following meals, such as walking
- Avoiding fizzy drinks, smoking, and alcohol
If someone thinks that they are experiencing symptoms of gastroparesis, they should speak with their healthcare provider for evaluation and treatment.