Gastroparesis is a medical condition where the stomach’s muscular contractions slow down, preventing it from emptying food normally. This delay is not caused by a physical blockage but is a functional issue where the stomach’s nerves and muscles fail to work in coordination. The term gastroparesis translates to “stomach paralysis,” and it results in food remaining in the stomach for prolonged periods, leading to various uncomfortable symptoms.
Causes and Risk Factors
The cause of gastroparesis is often damage to the vagus nerve, which controls the stomach muscles. Diabetes is the most common known cause, as high blood sugar can damage this nerve, leading to diabetic gastroparesis. This form is more prevalent in individuals with type 1 diabetes but can also affect those with type 2. When a specific cause cannot be found, the condition is termed idiopathic gastroparesis.
Surgeries on the esophagus or stomach can damage the vagus nerve, leading to postsurgical gastroparesis. Viral infections are another potential trigger. Certain medications, including opioid painkillers, some antidepressants, and high blood pressure drugs, can also slow gastric emptying. Other underlying causes include conditions like Parkinson’s disease or multiple sclerosis.
Common Symptoms
Common symptoms of gastroparesis include chronic nausea and vomiting, which may involve regurgitating undigested food hours after eating. Another primary symptom is early satiety, or feeling full after eating only a small amount. This makes it difficult to consume enough food for adequate nutrition.
Other symptoms include abdominal bloating, upper abdominal pain, heartburn, and acid reflux. For people with diabetes, the unpredictable stomach emptying can cause dangerous blood sugar fluctuations. The combination of these symptoms often leads to unintended weight loss and malnutrition.
The Diagnostic Process
Diagnosing gastroparesis begins with a review of a patient’s medical history and a physical exam to rule out other causes for the symptoms, like a physical obstruction. The main goal is to confirm that the stomach is emptying too slowly.
The primary test for diagnosis is the gastric emptying scan (gastric scintigraphy). For this procedure, a patient eats a light meal containing a small, safe amount of a radioactive substance. A special camera then tracks the meal’s movement out of the stomach over several hours. By measuring how much food remains at specific intervals, doctors can determine the rate of gastric emptying.
A physician might also perform an upper endoscopy, passing a thin tube with a camera down the throat to inspect the upper digestive tract. This is done to rule out any physical blockages causing the symptoms. Another tool is the wireless motility capsule, an ingestible device that measures pressure, pH, and temperature to provide detailed information on digestive motility.
Management and Treatment Strategies
Dietary Modification
Managing gastroparesis starts with changes to diet and eating habits. Patients are advised to eat smaller, more frequent meals instead of three large ones to reduce the volume of food in the stomach. Meals should be low in fat and fiber, as high-fat foods slow digestion and high-fiber foods, especially from raw vegetables, are difficult for a slow-moving stomach to break down.
Altering food texture can also provide relief. Softer or liquefied foods like soups, purees, and smoothies pass through the stomach more easily than solids. Vegetables should be cooked thoroughly, and tough meats should be avoided. Nutrient-rich shakes or broths can help supplement calorie intake and prevent malnutrition.
Medications
If dietary changes are not enough, medications may be prescribed. Prokinetics are drugs that stimulate stomach muscles to improve gastric emptying. Common options include metoclopramide and low-dose erythromycin, both of which cause stomach contractions.
Antiemetics are another class of medication used to manage nausea and vomiting. While these drugs do not speed up digestion, they can provide symptom relief. Finding the right medication or combination often requires a period of trial and error to balance effectiveness and side effects.
Medical Procedures
For severe gastroparesis unresponsive to other treatments, medical procedures are an option. Gastric electrical stimulation involves surgically implanting a device that sends mild electrical pulses to the stomach muscles. This can help control nausea and vomiting, though it may not improve the rate of stomach emptying.
Another procedure is the injection of botulinum toxin (Botox) into the pyloric sphincter, the valve between the stomach and small intestine. The injection is intended to relax this valve, allowing food to pass through more easily.
In severe cases with major malnutrition, a feeding tube may be required. A jejunostomy tube (J-tube), for instance, is surgically placed into the small intestine. This bypasses the stomach entirely to deliver liquid nutrition directly for absorption.