Gastroparesis

What is gastroparesis?

Gastroparesis is a disorder involving your stomach muscles. It is sometimes called delayed gastric emptying. Normally, after you swallow food, your stomach muscles begin squeezing and tightening. These movements are called contractions. This crushes the food and moves it into the small intestine to continue the digestive process. If you have gastroparesis, your stomach muscles don’t contract properly. This can delay or prevent the process of crushing the food and sending it to the small intestine.

Symptoms of gastroparesis

Symptoms of gastroparesis can be mild or severe, and may include:

• Heartburn or stomach pain
• Nausea
• Vomiting, especially vomiting pieces of undigested food
• Feeling full after only a few bites of food
• Bloating
• Lack of appetite
• Unintended weight loss
• Unstable blood sugar levels (in people who have diabetes)

These symptoms are related to a lot of different problems and disorders. This makes gastroparesis hard to diagnose.

What causes gastroparesis?

People who have diabetes are most at risk for gastroparesis. That’s because high blood sugar levels damage your nerves. In this case, it’s your vagus nerve. The vagus nerve tells your stomach muscles when to contract. Damage to this nerve is one of the most common causes of gastroparesis. Diabetes also can damage the blood vessels that carry oxygen and nutrients to the vagus nerve. Other things that cause gastroparesis include:

• Certain medicines. This includes certain pain medicines, antidepressants, and others.
• Surgery on the esophagus (the tube that runs from the mouth to the stomach), the stomach or the upper small intestine.
• Radiation of the chest or stomach for cancer treatment.
• Eating disorders, such as anorexia nervosa and bulimia.
• Gastroesophageal reflux disease (GERD).
• Other disorders, including hypothyroidism, scleroderma, Parkinson’s disease and some autoimmune disorders.
• Viral infections such as the flu (this is rare).

How is gastroparesis diagnosed?

Your doctor will examine you and ask about your medical history. Tell your doctor about any prescription or over-the-counter medicines you are taking. Your doctor may order blood tests to check the quality of your blood and measure chemical levels. They might want to do additional tests to make sure you don’t have a blockage or another medical problem. These tests may include:

• Upper endoscopy (EGD). Your doctor uses a flexible tube with a light at the end to look inside your throat, your esophagus and into your stomach. You will probably be given medicine to make you sleep during the test. Your throat also will be numbed so that you don’t feel pain.
• Gastric emptying ultrasound. This test uses sound waves to look at the organs in your abdomen (your gallbladder, liver, and pancreas) so your doctor can check for signs of problems.
• Barium X-ray. When your stomach is mostly empty, you drink a liquid that contains a small, safe amount of the chemical barium. The doctor can watch the barium travel through your body during an X-ray. This helps your doctor figure out where the problem is occurring.
• Gastric emptying studies. For these studies, you’ll eat or drink something that contains a small, safe amount of radioactive material. A scanner can pick up signals from the radioactive material. This scanner tracks how long it takes your stomach to empty. Your breath may be tested for the radioactive material to measure how fast your stomach is emptying.
• Gastrointestinal (GI) monitoring capsule. For this test, you swallow a small capsule (or pill) that collects information as it moves through your digestive system. The pill sends this information to a small computer you wear around your waist or neck. After a few days, you will pass the capsule in your stool, and your doctor will study the information it collected.

Can gastroparesis be prevented or avoided?

Change your eating habits. Changing your eating habits can help control gastroparesis.  However, make sure you get the proper nutrition and liquids.

Your doctor may recommend that you:

• Eat foods low in fat and fiber.
• Eat several small, healthy meals a day instead of two or three big meals.
• Chew your food completely.
• Eat soft, well-cooked foods.
• Avoid carbonated beverages.
• Avoid alcohol.
• Drink plenty of water or liquids (including low fat broths and clear soups, naturally sweetened fruit and vegetable juices, sports drinks, and oral rehydration products).
• Get some gentle physical activity after a meal, such as taking a walk.
• Avoid lying down for 2 hours after a meal.
• Take a daily multivitamin.

If your symptoms are moderate to severe, your doctor may recommend drinking only liquids. He or she may recommend eating well-cooked foods that have been chopped into small bites or processed in a blender.

Controlling blood glucose levels. If you have gastroparesis and diabetes, you will need to control your blood glucose levels. This includes hyperglycemia. Hyperglycemia, or high blood sugar levels, can delay the emptying of food from your stomach. Your doctor will work with you to keep your blood glucose levels stable.

Your doctor may also recommend:

• Taking insulin more often. You may need to change the type of insulin you take.
• Taking insulin after meals instead of before.
• Checking your blood glucose levels more frequently after eating and only taking insulin when you need it.

Your doctor will give you instructions for taking insulin based on your needs and the severity of your gastroparesis.

Gastroparesis treatment

There is no cure for gastroparesis. Treatment will focus on treating any underlying problem that is causing it and controlling your symptoms. For example, your doctor may ask you to stop taking any drugs that can affect the digestive system. Don’t stop any medicine without first talking to your doctor. Your doctor also may want to treat any eating disorders, infections or other issues that could be causing gastroparesis. Your doctor might also recommend one or more of the following:

Dietary changes. Since you might not be able to eat normally, it’s important to get enough nutrients. You may need to:

• Eat several smaller meals each day instead of 2 or 3 large ones.
• Eat softer foods, such as vegetables or pasta that are cooked thoroughly.
• Limit fat (which can slow digestion) and fiber (which can be hard to digest).
• Supplement your diet with nutrition drinks (such as Ensure or Boost). You may need to eat solid food you can puree in a blender.

Medicine. Anti-nausea medicines called antiemetics can help with nausea and vomiting. Other medicines, such as metoclopramide and erythromycin, can stimulate stomach muscle contractions. Each of these drugs has some drawbacks, including potentially serious side effects. You and your doctor need to discuss whether the benefits of taking these medicines outweigh the risks.

Feeding tube. If your gastroparesis is severe, you may need a feeding tube. This tube will be inserted through your skin into your small intestine. Or it may be passed into your intestines through your nose or mouth. The tube allows nutrients to be delivered directly to your small intestine where digestion and absorption of nutrients can occur. A feeding tube can also help when gastroparesis causes unstable blood sugar levels in people who have diabetes.

Questions to ask your doctor

• I have diabetes. Am I at risk of gastroparesis?
• How can I prevent gastroparesis?
• When should I see my doctor if I think I have gastroparesis?
• Are there lifestyle changes I can make that will ease or prevent gastroparesis?
• Is gastroparesis fatal?