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Understanding gastroparesis

This disorder, which is often caused by diabetes, keeps food from moving properly through the stomach.

Gastroparesis is a disorder that causes food to stay in the stomach for too long. The condition happens when the vagus nerve, which helps control the muscles of the stomach and intestines, is damaged. As a result, food moves through the digestive tract too slowly (or not at all). This can lead to a variety of health problems, including malnutrition, weight loss and erratic blood sugar levels.

Causes of gastroparesis

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the American Academy of Family Physicians, causes of gastroparesis include:

  • Diabetes (both type 1 and type 2). Diabetes is the most common known cause of gastroparesis. Over time, high blood sugar levels can damage the vagus nerve.
  • Surgery on the esophagus, stomach or small intestine, which may injure the vagus nerve.
  • Disorders, including hypothyroidism, scleroderma, Parkinson's disease and some autoimmune disorders.
  • Viral infections of the stomach.

Some pain medicines, antidepressants and medications can slow muscle action in the intestine, making gastroparesis worse, but they don't cause it. In many cases, the cause of gastroparesis cannot be determined. This is called idiopathic gastroparesis. 

Symptoms

According to the NIDDK and other experts, signs and symptoms of gastroparesis can include:

  • Heartburn.
  • Pain in the upper abdomen.
  • Nausea.
  • Vomiting of undigested food.
  • Feeling full after only a few bites of food.
  • Bloating in the abdomen.
  • Lack of appetite.
  • Weight loss.
  • Erratic blood sugar levels.

If your doctor suspects gastroparesis, he or she may perform tests to rule out an obstruction or other conditions. Once other causes have been ruled out, a gastric emptying test may be done to confirm a diagnosis of gastroparesis. Gastric emptying tests include:

Gastric emptying scintigraphy. In this test, you'll eat a bland meal that contains a small (and safe) amount of a radioactive substance. This substance shows up on scans and shows how fast the stomach is emptying.

Breath test. This test involves eating a meal that contains a substance that is absorbed in your intestines and eventually passed into your breath. Breath samples are then taken over a period of a few hours. By measuring the amount of the substance in your breath, this test can show how fast your stomach empties.

SmartPill. This pill is swallowed and collects information as it passes through the digestive tract.

Complications

Gastroparesis can lead to several serious problems, including:

  • Malnutrition, dehydration or weight loss. These problems occur because a person can't absorb enough nutrients, doesn't consume enough calories, or vomits too much food and liquid.
  • Infection. Bacteria can grow in food that is not processed properly and remains in the stomach. This can lead to infection.
  • Bezoars. These are solid masses of food that the stomach is not able to digest. They can cause nausea and vomiting and can be life-threatening if they block food from entering the small intestine.
  • Poor blood sugar control. Because gastroparesis causes food to be absorbed more slowly and at different times, it's difficult to predict when blood sugar will go up or down.

Treatment

Gastroparesis usually can't be cured. Treatment focuses on controlling symptoms and addressing whatever caused the problem.

Treatments may include:

Medication. Some medicines can make the stomach empty more efficiently. Other medicines will ease nausea and vomiting. Still others may be used to treat infections or help break up bezoars.

Dietary changes. A doctor or dietitian may suggest:

  • Eating six small meals a day.
  • Avoiding high-fat foods, which slow digestion.
  • Avoiding high-fiber foods, which are difficult to digest. Some high-fiber foods contain material that can't be digested. This indigestible material could stay in the stomach for too long and possibly form bezoars.
  • Trying a liquid or pureed diet, especially when symptoms are severe or blood sugar is out of control.

A feeding tube. If a liquid or pureed diet doesn't work, a feeding tube—called a jejunostomy tube—may be used to bypass the stomach. This allows nutrients and medication to be placed directly into the small intestine, where they can be digested and quickly delivered to the bloodstream.  

Gastric electrical stimulation. If dietary changes or medication don't help, electrical gastric stimulation may be an alternative. For this treatment, a battery-operated neurostimulator is surgically implanted under the skin. This device sends mild electrical pulses to the stomach muscles which may help control nausea and vomiting.

Parenteral nutrition. This treatment uses a thin tube, called a catheter, to deliver nutrients directly into the bloodstream. According to the NIDDK, parenteral nutrition is an alternative to a feeding tube and is only used when gastroparesis is severe and other treatments don't work.

Blood sugar management. People with gastroparesis that is caused by diabetes might need to change the way they use insulin or other medications, or even the types of insulin or medication they use.

Reviewed 11/19/2020

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