Gastroparesis, or delayed gastric emptying, is a disorder where the stomach takes too long to push food into the small intestine, often leading to uncomfortable and disruptive symptoms. Probiotics are live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, primarily by influencing the gut environment. This discussion explores the science behind this potential connection, evaluating the function of the gut microbiome and the limited but emerging clinical evidence for using beneficial bacteria to support gastroparesis management.
Understanding Gastroparesis
Gastroparesis is a chronic condition characterized by ineffective muscular contractions of the stomach, which slows or stops the movement of food into the small intestine despite the absence of a physical blockage. This failure is often traced back to damage to the vagus nerve, which regulates the involuntary movements of the digestive tract. When the vagus nerve is compromised, the stomach muscles do not receive the necessary signals, resulting in delayed gastric emptying.
The most common cause is long-standing diabetes, where high blood glucose levels can damage the vagus nerve over time. The condition can also be idiopathic (having no known cause) or result from surgery or viral infections. Symptoms typically include nausea, vomiting of undigested food, abdominal bloating, and an uncomfortable feeling of fullness after eating only a small amount of food, known as early satiety. Stagnation of food can also lead to complications like poor nutrient absorption and the formation of solid masses, or bezoars, within the stomach.
The Role of the Gut Microbiome in Gastric Motility
The digestive system’s motility is regulated by the gut-brain axis, a bidirectional communication network linking the central nervous system to the enteric nervous system within the gut wall. The gut microbiome, the community of microorganisms inhabiting the digestive tract, actively participates in this communication, providing a theoretical foundation for probiotic use. Alterations in the gut flora, known as dysbiosis, can directly or indirectly affect gut motility and visceral sensation.
Microbial communities influence the nervous system through the production of signaling molecules, including short-chain fatty acids (SCFAs). These SCFAs can modulate the enteric nervous system, affecting both gastric emptying and inflammation. When gastric emptying is delayed, food sits in the upper digestive tract for an extended period, fostering the overgrowth of bacteria, known as Small Intestinal Bacterial Overgrowth (SIBO). This bacterial overgrowth exacerbates symptoms like bloating and abdominal discomfort, creating a cycle where gastroparesis complicates the microbiome and dysbiosis worsens the symptoms.
Current Scientific Evidence for Probiotics in Gastroparesis
The scientific evidence specifically linking probiotic use to definitive improvements in gastroparesis is still limited, as research has been characterized by small-scale trials and mixed results. However, some clinical studies have explored the effect of certain probiotic strains on gastric emptying time (GET), which is the objective measure of the condition. A few studies have suggested that the use of specific probiotics, particularly multi-strain Lactobacillus capsules, may correlate with a measurable improvement in GET in certain patient groups.
Probiotics are generally not considered a direct treatment for the underlying nerve damage of gastroparesis, but rather a supportive therapy for managing associated symptoms. Evidence is stronger for the ability of probiotics to alleviate secondary symptoms common in gastroparesis, such as bloating and abdominal discomfort. Certain strains of Lactobacillus and Bifidobacterium have been shown to improve these symptoms, possibly by reducing gas-producing bacteria and modulating the gut’s sensitivity.
Probiotics and SIBO Management
The management of SIBO, which frequently co-occurs with gastroparesis, is an area where probiotics show promise. Specific probiotic strains, such as the yeast Saccharomyces boulardii or certain Bacillus species, have demonstrated efficacy in reducing bacterial overgrowth and improving symptoms in SIBO patients. Because SIBO often contributes significantly to the most disruptive symptoms of gastroparesis, using targeted probiotics to address this secondary condition can lead to a noticeable improvement in overall patient well-being, even if the primary gastric motility issue is not fully corrected.
Practical Considerations and Usage
Individuals with gastroparesis must consult with a gastroenterologist or other healthcare professional before introducing any new supplement, including probiotics, into their regimen. This consultation is necessary because a delayed digestive system requires a careful, personalized approach to diet and medication. The selection of a probiotic should be based on specific strains that have demonstrated benefits in clinical trials for either motility or associated symptoms like SIBO and bloating.
For those with gastroparesis, the delivery mechanism of the probiotic is particularly important due to the extended exposure to stomach acid. Strains known for their hardiness, such as specific Lactobacillus or Bifidobacterium species, or spore-forming probiotics like Bacillus species, are often considered because they are more likely to survive the slower passage through the stomach. While probiotics are generally well-tolerated, they can initially cause or worsen gas and bloating. Starting with a lower dose and gradually increasing it under medical guidance allows the digestive system to adjust and helps mitigate these potential side effects.