What is Gastroparesis?
Gastroparesis is a disorder where the stomach doesn’t empty food contents into the small intestine properly. This delayed gastric emptying may be due to nerve damage that prevents the stomach muscles from contracting, which inhibits movement of food through the stomach. The most common symptoms include early satiety, uncomfortable fullness after a meal, nausea, vomiting, burpring, and heartburn. Other symptoms can include abdominal pain, poor appetite, weight loss, and poor blood sugar control. A study in 2018 stated that gastroparesis affects up to 4% of the United States population.
The most common cause of gastroparesis is idiopathic, which means an unknown cause. Other common causes include diabetes, nerve damage from surgery or infection, medications, amyloidosis, and scleroderma. It can also be caused by eating disorders, but typically recovers as food intake and eating schedules normalize. In many cases, nerve damage, specifically damage to the vagus nerve, prevents stomach muscles from working properly. Normally, the vagus nerve causes stomach muscles to contract and move food through the gastrointestinal (GI) tract. WIth gastroparesis, the lack of muscle contractions prevents food from moving from the stomach to the small intestine.
Like irritable bowel syndrome (IBS), getting a diagnosis for gastroparesis can be tricky and take multiple visits to a gastroenterologist. In order to have a clear diagnosis, a test is needed to measure the delayed gastric emptying. The following tests may be used during this process:
Gastric scintigraphy: measures the volume of the stomach contents before and after a meal, and how well the stomach relaxes in response to food intake.
Breath testing:
Gastroduodenal manometry: measures how well the smooth muscle of the stomach and small intestine contracts and relaxes.
Upper endoscopy: a camera inserted through the mouth that can evaluate the upper GI tract for damage
4 hour solid gastric emptying study: determines the time it takes a meal to move through the stomach.
SmartPill: a capsule that contains a small electronic device that sends information on how quickly food is traveling through the GI tract.
What’s your poop personality? Find out here!
Once a diagnosis is confirmed, it’s important to start treating gastroparesis. If untreated, it can cause other complications, including bacterial overgrowth, blockages in the stomach, poor blood sugar management, dehydration, and malnutrition.
Treating gastroparesis is tricky, and typically requires both medical and nutrition management, which means both a gastroenterologist and registered dietitian should be involved. Below are some of the treatment options that are currently available.
Medication
Reglan (metoclopramide): a prokinetic that causes stomach muscles to contract and can reduce vomiting and nausea.
Erythromycin: an antibiotic that causes stomach muscles to contract.
Antiemetics: medications that help control nausea.
Cisapride: a prokinetic that binds to serotonin receptors to increase stomach contractions.
Many medications can cause diarrhea, so they should be monitored by healthcare providers to determine the appropriate dosages.
Surgery
In some cases, surgery may be necessary. Options include:
Gastric electrical stimulation: sends mild electrical shocks to stomach muscles.
Gastric bypass: limits amount of food someone can eat. Could result in malnutrition.
Non-surgical Treatment
Oral pyloromyotomy is a nonsurgical treatment where the pylorus, the valve that empties the stomach, is cut to allow food to move through more easily.
Nutrition
Nutrition recommendations will be individualized based on the severity of symptoms, and overlapping conditions. Some basic recommendations include:
Small, frequent meals, instead of larger meals.
Cooked, soft foods that are easier to chew and break down.
Liquids for those with more severe symptoms.
Lower fat and lower fiber foods because these are both harder to break down and slow down digestion.
Added electrolytes and optimal hydration to prevent dehydration.
Avoidance of alcohol and carbonation that may make symptoms worse.
In very severe cases, tube feeding or parenteral nutrition may be used.
Gastroparesis may be common among those with IBS, which could also be explained by misdiagnosis of IBS before gastroparesis is identified. If you think you may have gastroparesis, or you’re dealing with GI symptoms that you want answers for, speak with your doctor about getting a referral to a knowledgeable gastroenterologist. If you’re looking for help on the nutrition side, apply for a consult here to talk more!
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