Gastroparesis Symptoms & Treatment
Gastroparesis is a digestive disease in which the muscles of the stomach don’t work properly and food is not properly digested. When the stomach functions normally, its muscles contract to help pulverize food and move it into the small intestine (a process called gastric emptying), where food is further digested and nutrients are absorbed. This muscle movement is referred to as motility. With gastroparesis, stomach muscle contractions are either too slow or nonexistent, which prevents normal digestion.
Certain medications, such as opioid pain relievers, some antidepressants, and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. For people who already have gastroparesis, these medications may make their condition worse.
Gastroparesis can interfere with normal digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition. The cause of gastroparesis is usually unknown. Sometimes it's a complication of diabetes, and some people develop gastroparesis after surgery. Although there's no cure for gastroparesis, changes to your diet, along with medication, can offer some relief.
The vagus nerve controls the stomach muscles. Damage to this nerve can hinder its ability to send signals to the stomach muscles to contract and propel food into the small intestine. Certain diseases or surgery to the stomach or small intestine can damage the vagus nerve. Risk factors for gastroparesis may include:
- Diabetes (one of the most common causes)
- Surgery of the upper intestinal tract (esophagus, stomach, small intestine)
- Infections (usually viral)
- Hypothyroidism (endocrine disorders)
- Scleroderma (connective tissue disorder)
- Neuromuscular diseases such as Parkinson's disease or multiple sclerosis
- Psychological conditions
- Eating disorders such as anorexia nervosa or bulimia
In addition, some medications can slow the rate of stomach emptying, such as narcotic pain medications and certain antidepressants.
Symptoms of gastroparesis may include one or more of the following:
- Abdominal pain and bloating
- Nausea / vomiting
- Feeling full after eating only a few bites
- Vomiting undigested food eaten a few hours earlier
- Heartburn / acid reflux
- Weight loss and malnutrition
- Erratic changes in blood sugar levels
There are a number of tests that gastroenterologists can use to help diagnose gastroparesis and rule out other conditions that cause similar symptoms, such as inflammation, ulcers, or intestinal obstruction. Tests may include:
- Gastric emptying study, to evaluate the rate at which food leaves your stomach
- Upper GI endoscopy, to check for other conditions that cause similar symptoms
- Ultrasound, to determine if problems with your gallbladder or kidneys could be causing your symptoms
- Upper GI series (barium X-rays), to detect blockages in the small intestine
Your doctor will first identify any underlying condition that may be causing or exacerbating your gastroparesis, such as diabetes, and help you better manage it.
The optimal way to treat and manage gastroparesis is to change your diet. Some foods are more difficult than others for the stomach to digest, such as foods that are high in fat or fiber. It’s important to know what foods worsen the condition so you can avoid them. A dietician can help you identify healthy foods that are easier to digest and provide other diet-related tips and guidance for managing your condition.
A bezoar is a common complication of gastroparesis. This is a mass of undigested food that collects in the stomach and causes a blockage, which leads to nausea and pain. If this happens, your gastroenterologist may need to remove the bezoar by way of endoscopy.
Other treatments for gastroparesis may include:
- Medications to stimulate the stomach muscles, such as metoclopramide (Reglan®) and erythromycin
- Feeding tube placed in the small intestine (jejunostomy) for those who are unable to tolerate any food or liquids
- Gastric electrical stimulation to enhance stomach muscle contractions and motility
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