If you are feeling nausea and vomiting persistently, having stomach discomfort, and feeling full after eating a little, probably you are suffering from gastroparesis.
The word gastroparesis means paralysis of the stomach. It is a chronic disorder in which the stomach’s ability to pass food to the small intestine is reduced or lost. It is also called delayed gastric emptying.
Stomach is supplied by the vagus nerve, which contracts stomach muscles to pass food from it to the small intestine. The vagus nerve is affected by a number of reasons, including diabetes, autoimmunity, drugs, infections, etc.
It is a chronic disorder affecting the quality of your life. Understanding it is the first step towards its management.
This blog post describes in detail the symptoms, causes, diagnosis, treatment options, and complications it causes if not treated properly.
NERVE AFFECTED
Stomach is supplied by vagus nerve. The role of it in the stomach is to contract stomach muscle to push food forward from it to the small intestine, and makes your gut motility and life easy.
When it is damaged or lost due to any causes mentioned below, your stomach no longer able to push food forward.
This lack of ability to push food forward resulting in gastroparesis or delayed gastric emptying.
Causes of gastroparesis
Gastroparesis is caused by a number of diseases. Some are known, that is, diabetes, post-surgery, and some causes are unknown, called idiopathic.
Some causes of gastroparesis are
Diabetes: Diabetes is the number one known cause of gastroparesis. Long-standing uncontrolled blood sugar damage nerves of the stomach. It results in delayed contraction of muscle to push food forward.
Neurological Disorders: Some neurological disorders like Parkinson disease, multiple sclerosis, and scleroderma damage nerves, including the vagus nerve, and thus cause gastroparesis or delayed gastric emptying.
IDIOPATHETIC: When there is no known cause to the disorder, we call it idiopathic. Sometimes the patient is not diabetic, having no history of surgery, infection, or any autoimmune disease.
AUTOIMMUNE: Sometimes a person’s own immune system is activated and produces agents called antibodies. They attack its own body cells, considering them foreign invaders. Autoimmune disease also causes gastroparesis.
Infection: Viral infections caused by rotavirus and norovirus also cause gastroparesis. Sometimes bacterial infections also cause it.
Drugs: medicines used for high blood pressure, psychiatric or psychotic disorders, and as pain relievers can also slow stomach and intestinal motility. Although this may not cause gastroparesis in patients already having the disorder, these drugs can worsen it.
Common drugs causing slow stomach and intestinal motility are clonidine (blood pressure medicine), lithium (used for treatment of bipolar disorder), opiod (pain relievers), etc.
Symptoms of gastroparesis
Patients feel a number of symptoms
· Nausea and vomiting
· Abdominal pain and discomfort
· Bloating and gas
· Loss of appetite
· Sensation of fullness and satisfaction
· Acid reflux and burning
· Blood sugar changes
· Weight loss
· constipation
Diagnosis of gastroparesis
Gastroparesis is diagnosed clinically from a detailed history and proper examination. Some investigations are required to exclude other causes of persistent vomiting and stomach discomfort.
· SCINTIGRAPY: It is performed to measure the rate of stomach emptying. The patient takes a small portion of food with radioactive material.
A scanner goes through your belly to measure the amount of time the radioactive material, food, takes to pass from stomach to small intestine.
It is helpful to find out if your stomach emptying time is short or long to label your condition as less severe or more severe, respectively.
· BREATHE TEST: Eating food having substances that are absorbed by the body. When it is absorbed and appears in your breath. This test is also used to label the disease as mild, moderate, or severe.
The one taking less time to appear in breath is mild, and taking a long time is severe.
· UPPER GI ENDOSCOPY: Upper gastrointestinal endoscopy is done to rule out other possible causes of stomach delayed emptying that is obstruction, GI Ulcers, gastritis, etc.
· UTRASOUOGRAPHY: This is also performed to rule out other possible causes of delayed gastric emptying, that is, problems of the kidneys, liver, or pancreas, etc.
It is a non-invasive test using high-energy sound waves to detect abnormalities in the body, specifically soft tissue.
Treatment options
Treatment of gastroparesis is to find and treat the underlying cause. Identifying the specific cause of gastroparesis and correcting it improves the symptoms a lot.
Treatment options include lifestyle modifications, medical therapy, and surgery correction.
It depends upon the individual severity of the disorder. Here is the brief discussion of each one
- LIFE STYLE MODIFICATION
The first treatment for patients with gastroparesis is lifestyle modification. Doing all the activities that improve your symptoms and avoiding all those things that worsen the symptoms. Some lifestyle modifications are
· Eating small portions of food more often than taking heavy meals two or three times a day.
· Avoid using foods with too much fat and fiber, which are difficult to digest and pushed forward by the stomach to the small intestine.
· Having a light exercise like walks after taking meals to improve your gut motility
- MEDICATION THERAPY
Medications used are
· To correct the underlying cause
Addressing the underlying cause of gastroparesis is the main focus, along with treating the symptoms.
· To improve gut motility
Metoclopramide is the only drug approved by the Food and Drug Administration (FDA) to improve gut motility.
Some healthcare professionals also use azithromycin and erythromycin for this purpose.
Domperidone, a dopamine agonist, is also used to enhance gut motility and
· To avoid the adverse effects of this disorder
Gastroparesis causes nausea, vomiting, stomach discomfort and malnutrition
Medicines used are
For nausea and vomiting
Pain relievers
Proton pump inhibitors
- SURGERY
When lifestyle modifications and medical therapy are applied for a long duration without any improvement in the symptoms, surgery is performed as a last resort.
There are a number of surgical producers available for gastroparesis, that is
· Pyloroplasty: A portion of muscle at the end point of the stomach (Pylorus) is surgically removed.
· Gastrojejunostomy: the stomach is directly connected to jejunum instead of duodenum.
· Gastrectomy: In this procedure, part of the stomach is surgically removed. This procedure is normally performed for weight loss in obese patients.
· Gastric electrical stimulation: An electrical device is implanted in the stomach to stimulate it to push food forward.
COMPLICATIONS
· DEHUYDRATION: Due to persistent vomiting, continuous fluid loss from the body causes dehydration.
· MALNUTRITION: due to early satiety, not taking enough food and nutrients causes malnutrition. Also become worse by persistent vomiting.
· FOOD NOT DIAGESTED: Food not digested properly accumulates in the form of balls in the stomach called bezoars. Which causes persistent nausea, vomiting, and weight loss.
· BLOOD SUGAR LEVEL: Patients with gastroparesis cannot pass food (sugar) from stomach to small intestine. When food stays longer than normal in the stomach, blood sugar drops, causing hypoglycemia.
When after a long time food (sugar) passes to the intestine, it suddenly increases blood sugar. These actions are very bad for people with diabetes. Grastroparesis worsens diabetes, while diabetes worsens gastroparesis.
· AFFECT QUALITY OF LIFE: Persistent nausea, vomiting, and abdominal pain affect the quality of life, both personal and professional.