Have you been experiencing delay in gastric emptying these days and feels nauseated every morning? If yes, better have your gastrointestinal tract checked by a medical professional because you might be experiencing gastroparesis. What is gastroparesis and what is gastroparesis treatment?
Gastroparesis is a medical term that refers to the delay in gastric emptying. The term came from the words “Gastro” which means stomach and “paresis” which means paralysis. Normally, the stomach contracts to move the foods down the intestines for absorption of nutrients and further digestion. In this condition, the foods taken stay longer in the stomach than they usually should.
Causes of gastroparesis
Gastroparesis can be either transient or chronic. Transient gastroparesis usually occurs in acute illness of any kind, the use of certain drugs like chemotherapeutic drugs, and abnormal eating patterns. On the other hand, chronic gastroparesis is due to autonomic neuropathy which occurs to people with type 1 or type 2 diabetes. The vagus nerve is the one that controls the contraction of the stomach and any damage relating to it can cause gastroparesis. In diabetes, the vagus nerve is damaged because of long years of having high blood glucose level. High glucose level can decrease blood perfusion thus causes damages to the nerves and tissues in the body. Other conditions that can cause chronic gastroparesis are Sclerodera, Ehlers-Danlos Syndrome, and Parkinson’s disease. Abdominal surgery that results to vagus nerve damage can also result to chronic gastroparesis.
If the cause of gastroparesis is not fully known, the condition is called idiopathic gastroparesis. This accounts for a third of all chronic cases of gastroparesis. Medical professionals and researchers thought that this may be caused by an autoimmune response that is triggered by a viral infection. Other conditions that are thought to be related to it are stomach flu and mononucleosis.
Researchers have found out that gastroparesis occurs more often in women than in men. One reason for this is that women normally have slower stomach emptying than men. Another reason is that high level of progesterone (which occurs in the female body a week prior to menstruation) can cause this condition. It should be noted that the above reasons are not yet proven definitively.
Symptoms of gastroparesis
• Chronic nausea (usually in the morning)
• Vomiting (undigested foods)
• Early satiety
• Weight gain (due to starvation mode effect)
• Weight loss (due to early satiety)
• Abdominal bloating
• Abdominal pain
• Lack of appetite
• Erratic blood glucose level
• Spasms in the stomach wall
• GERD or gastroesophageal reflux
Gastroparesis can be diagnoses with tests such as manometry, xrays, gastric emptying scans and ultrasound. Physical assessment and symptoms may help in the diagnosis. However, it should be noed that severity of symptoms does not correlate with the severity of the condition. That means that there are people with few symptoms yet are experiencing serious complications of the condition already.
Treatment for gastroparesis
Treatment of gastroparesis begins with the knowledge of the cause of such condition. If the cause is determined, the treatment strategy is directed towards it for correction. Below are some of the known treatments for gastroparesis.
1. Diet modification. Your physician might refer you to a dietician that can help you plan meals that are easy to digest and at the same time provides you with enough calories for the day. Weight loss or weight gain may be experienced with gastroparesis. Prevention of which lies directly to proper food planning and intake. Your dietician may suggest you to try the following:
• Have small frequent feeding
• Consume low fiber forms of high fiber foods such as well cooked vegetables rather than raw ones
• Have low fat foods. Fatty foods can actually delay gastric emptying
• Try soft or liquid diet (soups and pureed foods).
• Increase water intake after each meal
• Engage in light exercise after a meal such as walking
2. Tube placement. For those who could not tolerate food intake by mouth, a feeding tube may be inserted in the nose down to the small intestine where osteorized foods are placed. This is only temporary and is applicable for those who are experiencing severe gastroparesis.
3. Medications. If the cause of gastroparesis is diabetes, your physician would sure recommend antidiabetic drugs that can help regulate the blood sugar level. Some of these are glimepiride and insulin. Other medications that may be prescribed to control symptoms associated with gastroparesis are metoclopramide (anti vomiting), domperidone (aids in stomach motility), Viagra (stimulates the GI tract), erythromycin (anti biotic), and miratazapine (an ntidepressant drug which is also proven to treat gastroparesis because of its anti-emetic and appetite stimulant properties).
4. Electrical pacing. This is a new way of managing severe gastroparesis. This is similar to cardiac pacemaker that sends electrical impulses to the heart. The difference is that it sends electrical impulses on the muscles surrounding the stomach. The impulses contract the stomach which then aids in the movement of the food inside it. The gastric pacemaker is inserted in the abdomen laparoscopically, which means that a large incision is not required. During placement, wire electrodes are attached on the muscles of the stomach and the wires are brought just under the skin. The wires are then attached to a battery operated pacemaker that is buried under the skin. The skin is then sutured to keep the pacemaker in place. It should be noted that the effectiveness and long term effect of this procedure is not yet fully known because it is relatively new in the medical-surgical field.
5. Surgery. This is more often done than electrical pacing. The goal of this procedure is to create a larger opening between the stomach and the small intestine to aid gastric emptying. There are also instances where in the stomach is removed. These procedures should only be considered when other options of treating gastroparesis are found ineffective because of the potential risks and complications of surgery. Surgical interventions should only be done by knowledgeable surgeons and gastroenterologists in order to lessen the numerous risks of surgery.
There are complications that are associated with gastroparesis and some of these are as follows:
• Fluctuation in blood glucose level due to unpredictable time of digestion and absorption of nutrients
• Malnutrition due to symptoms associated with the condition and dietary modifications accompanied by it
• Intestinal obstruction due to the formation of solid masses of undigested foods (referred to as “bezoars”)
• Bacterial infection due to proliferation of microorganisms in undigested foods