Gastroparesis is a medical condition characterized by a delay in the stomach’s emptying process. The term literally translates to “stomach paralysis,” though it refers to weakened or slowed muscle contractions rather than a complete lack of movement. This disorder disrupts normal digestive flow, causing various uncomfortable symptoms.
What is Gastroparesis?
The stomach normally functions through coordinated muscle contractions, known as peristalsis, to propel food into the small intestine for digestion and nutrient absorption. This process is regulated by the vagus nerve, which transmits signals between the brain and the digestive tract, along with various hormones.
In gastroparesis, this neuromuscular control is impaired, leading to ineffective contractions of the stomach muscles. The vagus nerve may be damaged, or the stomach muscles themselves might be dysfunctional. This can lead to disorganized or reduced frequency of contractions, causing food to linger in the stomach.
Common Causes and Symptoms
Gastroparesis can stem from various underlying factors, with a significant number of cases being idiopathic. Diabetes is the most frequently identified cause, as prolonged high blood sugar levels can damage the vagus nerve over time, impairing its ability to signal stomach muscles. Post-surgical complications can also lead to gastroparesis due to injury to the vagus nerve. Certain medications, including opioids, anticholinergics, and some antidepressants, are known to slow gastric emptying and can either induce or worsen symptoms. Viral infections have also been implicated, damaging stomach nerves or triggering an immune response.
The symptoms of gastroparesis often manifest after eating and can vary in intensity. Nausea is a common complaint, and it can be accompanied by vomiting. Individuals frequently experience early satiety, feeling full quickly, or postprandial fullness. Bloating and abdominal pain are also prevalent symptoms. Unintentional weight loss can occur in more severe cases.
Diagnosing Gastroparesis
Diagnosing gastroparesis begins with a thorough medical history and a physical examination to assess symptoms. While a physical exam might reveal abdominal distention or tenderness, these findings are not specific to gastroparesis. The primary diagnostic test for confirming gastroparesis is the Gastric Emptying Scintigraphy (GES).
This test involves consuming a standardized meal containing a small amount of radioactive material. A scanner then tracks the movement of this material, measuring the rate at which food leaves the stomach over several hours, up to four hours. A diagnosis of gastroparesis is confirmed if a significant percentage, 10% or more, of the meal remains in the stomach after four hours.
Before a GES, patients are advised to stop taking medications that can slow gastric emptying to ensure accurate results. Other tests, such as an upper gastrointestinal (GI) endoscopy or imaging like ultrasound or CT scans, may be performed. These procedures are primarily used to rule out other conditions that can cause similar symptoms, such as mechanical obstructions, ulcers, or structural abnormalities, rather than directly diagnosing gastroparesis itself. An endoscopy can visualize the esophagus, stomach, and small intestine to check for blockages or other issues.
Treatment and Management Strategies
Managing gastroparesis involves a multi-faceted approach, starting with dietary modifications to ease the burden on the stomach. Eating smaller, more frequent meals can help prevent the stomach from becoming overly full. Reducing the intake of high-fat and high-fiber foods is also recommended, as these can slow digestion; low-fat and low-fiber options are easier to digest. In severe instances, liquid nutrition may be necessary to ensure adequate caloric intake.
Medications play a role in symptom management. Prokinetic drugs, such as metoclopramide or erythromycin, are prescribed to stimulate stomach contractions and improve gastric emptying. However, these medications can have side effects, and their long-term use requires careful monitoring. Antiemetic medications are used to reduce nausea and vomiting, providing symptomatic relief without directly affecting stomach emptying. Lifestyle adjustments, such as staying well-hydrated, avoiding carbonated beverages, and chewing food thoroughly, can also contribute to symptom control.
For individuals with severe gastroparesis that does not respond to dietary changes or medications, more advanced therapies may be considered. Gastric electrical stimulation involves surgically implanting a small device that sends mild electrical impulses to the stomach muscles, which can help reduce chronic nausea and vomiting, though it may not improve gastric emptying itself. Feeding tubes, such as a gastrostomy-jejunostomy (G/J) tube, can be placed to deliver liquid nutrition directly into the small intestine, bypassing the stomach entirely when oral feeding is insufficient. In rare and severe cases, surgical interventions like pyloroplasty, which widens the opening between the stomach and small intestine, or even a partial gastrectomy, where part of the stomach is removed, might be considered, though these are typically reserved as last resorts.