August is Gastroparesis Month

What is Gastroparesis? Gastroparesis means paralyzed stomach. It is one of the most severe and complicated gastric motility disorders as it affects the normal spontaneous movement of the muscles (motility) in the stomach. Ordinarily, strong muscular contractions propel food through the digestive tract. But with gastroparesis, the stomach's motility is slowed down or doesn't work at all, preventing the stomach from emptying properly. Approximately 1 in 25 Americans, including children, suffers from gastroparesis. It is more prominent among females than males, and it is more common among individuals who are long-term diabetics. Several symptoms and indicators of gastroparesis include:

• Heartburn or gastroesophageal reflux (the backup of stomach contents into the esophagus).
• Persistent nausea.
• Vomiting of undigested food.
• Feeling full very quickly when eating.
• Abdominal bloating.
• Chronic abdominal pain.
• Poor appetite and weight loss.
• Poor blood sugar control.

Many people with gastroparesis don't have any noticeable signs and symptoms. In some instances, it appears for a brief time and goes away on its own or improves with treatment. However, some cases are refractory and do not respond well to treatment. What Causes Gastroparesis? Unfortunately, the primary cause of the disease is not always clear. However, doctors have identified several contributing causes of gastroparesis that include:

• Damage to the vagus nerve. Diabetes, viral infection, surgery to the stomach or small intestine can cause damage to the vagus nerve. The vagus nerve helps manage the digestive tract, including signaling the muscles in the gut to contract and push food into the small intestine. A damaged vagus nerve can't send normal signals to the stomach muscles. As a result, food can remain in the stomach longer rather than move into the small intestine to digest.
• Medications such as narcotics, opioid pain relievers, some antidepressants, high blood pressure, and allergy medications can lead to slow gastric emptying and cause symptoms similar to gastroparesis. For people already diagnosed with the disease, these medications make their condition worse.
• Amyloidosis - deposits of protein fibers in tissues and organs
• Scleroderma - a connective tissue disorder that affects the skin, blood vessels, skeletal muscles, and internal organs

Complications associated with gastroparesis:

1. Severe dehydration. Ongoing vomiting can cause dehydration.
2. Poor appetite and persistent vomiting can cause insufficient caloric intake and the inability to absorb sufficient nutrients.
3. Undigested food that hardens and remains in the stomach. Undigested food in the stomach can harden into a solid mass called a bezoar. Bezoars can cause nausea and vomiting and may be life-threatening if they prevent food from passing into the small intestine.
4. Unpredictable blood sugar changes. Although gastroparesis doesn't cause diabetes, frequent changes in the rate and amount of food passing into the small bowel can cause erratic blood sugar levels. These variations in blood sugar make diabetes worse. In turn, poor control of blood sugar levels makes gastroparesis worse.
5. Decreased quality of life. Symptoms associated with gastroparesis can make it challenging to work and keep up with other responsibilities.

How is gastroparesis diagnosed? A gastroenterologist specializes in digestive disorders and diseases and is the best option to consult if gastroparesis symptoms appear. In addition to reviewing symptoms and medical history, a gastroenterologist will provide a physical exam and likely order specific blood tests, including blood sugar/glucose levels. Other tests used to diagnose gastroparesis include:

• Four-hour solid gastric emptying study: This test determines the time it takes a meal to move through the stomach. Patients receive a meal that contains a radioactive isotope. An image of the stomach is taken one minute after eating the meal. Subsequent images are taken at the one, two, and four-hour marks after consumption to view how the food passes through the stomach and intestines.
• SmartPill: This is a small, digestible capsule that contains a small electronic device. After the capsule is swallowed and moves through the digestive tract, it sends information to a receiver attached to the patient. This test monitors and records how quickly food travels through the digestive tract.

How is gastroparesis treated?

Gastroparesis is a chronic (long-lasting) condition. Treatment usually doesn't cure the disease, but it can be managed and kept under control. People who have diabetes should consciously monitor and control their blood glucose levels to reduce the problems of gastroparesis. Some patients may benefit from medications, including:

• Reglan, which causes the stomach muscles to contract to help move food out of the stomach. Reglan also helps reduce vomiting and nausea. Side effects include diarrhea and, rarely, a serious neurological (nerve) disorder.
• Erythromycin: This is an antibiotic that also causes stomach contractions and helps move food out. Side effects include diarrhea and the development of resistant bacteria from taking the antibiotic for a long time.
• Antiemetics: These are drugs that help control nausea.

Some patients may benefit from surgical procedures such as:

Gastric Electrical Stimulation: Gastroparesis patients who still have nausea and vomiting even after taking medications may benefit from surgery. One type of surgery for gastroparesis is gastric electrical stimulation, which is a treatment that sends mild electric shocks to the stomach muscles. In this procedure, the doctor inserts a small device called a gastric stimulator into the abdomen. The stimulator has two leads attached to the stomach that provide mild electric shocks, which help control vomiting. In addition, the doctor can adjust the strength of the electric shocks. The device runs on a battery that lasts up to 10 years. Gastric Bypass: Another surgery to relieve gastroparesis symptoms is gastric bypass. Gastric bypass creates a small pouch from the top part of the stomach. The small intestine is divided in half and attached directly to the small stomach pouch. This procedure significantly limits the amount of food the patient can eat. This surgery is more effective for an obese diabetic patient than either medication or a gastric stimulator.

Alternative Treatments for Gastroparesis include:

POP: A newer treatment for gastroparesis is called peroral pyloromyotomy (POP). POP is a non-surgical procedure in which the doctor inserts an endoscope (a long, thin, flexible instrument) into the patient's mouth and advances it to the stomach. The doctor then cuts the pylorus, the valve that empties the stomach, allowing food to move from the stomach to the small intestine more easily. Feeding/Jejunostomy Tube: In a severe case of gastroparesis, a feeding tube or jejunostomy tube may be appropriate. Through a surgical procedure, a tube gets inserted through the abdomen into the small intestine. Typically liquid nutrients are put into the tube, which goes directly into the small intestine; this way, they go around the stomach and get into the bloodstream more quickly. The jejunostomy tube is usually a temporary measure. IV Nutrition: Another treatment option is intravenous, or parenteral, nutrition. With this feeding method, nutrients go directly into the bloodstream through a catheter placed into a vein in your chest. Like a jejunostomy tube, parenteral nutrition is a temporary measure for a severe case of gastroparesis.

Dietary Considerations for Gastroparesis

According to the American College of Gastroenterology, diet is a mainstay of gastroparesis treatment, and it's a natural treatment to boot. In addition, doctors can prescribe medication and perform medical procedures to improve gastroparesis symptoms. However, these interventions work best if patients also follow a gastroparesis diet that focuses on reducing the amount of hard to digest foods like fatty and fibrous foods will help ease digestion and avoid complications resulting from gastroparesis. If you are experiencing symptoms of gastroparesis or complications related to a diagnosis of gastroparesis, we encourage you to schedule an appointment with a gastroenterologist near you immediately. GI Alliance has over 1000 providers throughout nine states to serve your needs and support your GI health. Find a GI Alliance physician near you.

Patient Resources:

• https://staywell.mydigitalpublication.com/publication/?m=61769&i=630984&p=22&ver=html5
• https://g-pact.org/gastroparesis/

Article Sources: https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787 https://my.clevelandclinic.org/health/diseases/15522-gastroparesis