How Is Gastroparesis Treated?

August is gastroparesis month. What is gastroparesis?

The term gastroparesis refers to nonmotile stomach. It's one of the most severe and concerning gastrointestinal (GI) motility problems as it prevents the natural mechanical movement of the stomach muscles. When functioning normally, forceful muscular contractions help food migrate through the gastrointestinal tract. When gastroparesis is present, however, the stomach's ability to digest food slows considerably or comes to a halt. This can block the proper emptying of the stomach and may lead to other medical issues. The seasoned gastrointestinal (GI) physicians at Arizona Digestive Health in Phoenix, AZ commonly provide treatment for gastroparesis.

What are the signs and symptoms of gastroparesis?

Nearly one out of every 25 people in the United States, including children, develops gastroparesis. The GI condition is more common among females. It's also more widespread in patients who have been living with diabetes for a long time. Common signs of gastroparesis include:

• Chronic pain in the abdomen
• Inconsistent blood sugar levels
• Frequent nausea
• Feeling full even with eating very little
• Vomiting of undigested food
• Abdominal bloating
• Poor appetite and unintended loss of weight
• Heartburn or gastroesophageal reflux (the backup of stomach contents into the esophagus)

Numerous individuals living with gastroparesis may not experience any recognizable symptoms. At times, it occurs briefly and subsides naturally or improves with medical attention. Certain cases may be unresponsive to care.

What factors cause gastroparesis?

Unfortunately, the main source of this GI concern is not always obvious. However, physicians have pinpointed a number of causes that can contribute to gastroparesis, including the following:

• Damage to the vagus nerve. Diabetic conditions, viral infection, and surgery to the small intestine or stomach can harm the vagus nerve. Essential for managing the intestinal system, the vagus nerve causes the muscles in the gut to contract to move food into the small intestine. An impaired vagus nerve is unable to send proper signals to the muscles in the stomach. In these cases, food can remain in the stomach for a longer period of time as opposed to migrating into the small intestine for proper digestion.
• Amyloidosis: Amyloidosis is a condition that develops when deposits of protein fibers accumulate in organs or tissues throughout the body.
• Scleroderma: This condition affecting the muscles, skin, organs, and blood vessels.
• Medications: Narcotics, high blood pressure medications, certain antidepressants, and allergy medications can result in sluggish gastric emptying and induce gastroparesis-like symptoms. These forms of medications tend to worsen the effects of gastroparesis.

Other complications that may occur from gastroparesis are:

1. Extreme dehydration. Frequent vomiting could result in a state of dehydration.
2. Poor nutrition. Appetite loss and repeated vomiting can induce insufficient caloric intake and thwart the ability to digest adequate nutrients.
3. Undigested food. Food that remains in the stomach can form a hard mass referred to as a bezoar. A bezoar may cause nausea and vomiting and can be fatal if it blocks food from passing into the small intestine.
4. Unpredictable blood sugar changes. While gastroparesis isn't a cause of diabetes, frequent variations in the rate and the volume of food migrating into the small bowel could lead to inconsistent blood sugar levels. Such variations in blood sugar have a negative effect on diabetic conditions which, in turn, might cause further issues with gastroparesis.
5. Reduced quality of life. The health effects of gastroparesis can make it complicated to perform daily tasks and activities.

Diagnosing gastroparesis

Gastrointestinal physicians specialize in treating gastric disorders, such as gastroparesis. In addition to learning about a patient's symptoms and medical history, a gastroenterologist will complete a physical evaluation and most likely order certain blood screenings, including those performed to assess blood sugar levels. Additional processes utilized to identify gastroparesis could include:

• Four-hour solid gastric emptying study: This test determines the time it takes food to makes its way through the stomach. Individuals receive a meal that includes a special radioactive isotope. An image of the stomach is performed one minute after the meal is consumed. Additional scans are then captured at the one, two, and four-hour marks post-consumption to examine how the food passes through the stomach and bowels.
• SmartPill™ motility testing system: With this test, patients swallow a miniature, digestible capsule that houses an electronic device. Once the capsule is ingested and migrates down the digestive system, it delivers gastric information to a receiver kept on the patient. SmartPill mobility testing records and monitors how fast food passes through the GI system.

Treating gastroparesis

Gastroparesis is a long-standing health illness. Treatment usually doesn't resolve gastroparesis, but it can help to control and manage its symptoms. People living with diabetes need to continually assess and control their blood glucose values to minimize issues with gastroparesis. In some cases, patients with gastroparesis might benefit from medications, like:

• Erythromycin: This is an antibiotic that causes gastric contractions and assists in propelling food through the gastric tract. Side effects include loose bowels and the risk of developing antibiotic-resistant bacteria if taking the medication for a long time.
• Reglan: This type of medication also stimulates stomach muscle contractions to help propel food into the small intestine. It can help relieve stomach upset and vomiting. Secondary effects might include loose bowels and, on rare occasions, a serious nerve disorder.
• Antiemetics: These medications help minimize queasiness.

Some people may be candidates for surgical procedures to treat gastroparesis, including:

• Gastric bypass: With a gastric bypass, a little pouch is developed from the upper area of the stomach. Half of the small intestine is connected directly to the newly created small pouch. This surgery substantially limits the quantity of food the patient can consume. A gastric bypass might be more effective than either gastric electrical stimulation or medication therapy for patients who are both obese and diabetic.
• Gastric electrical stimulation: A small device referred to as a gastric stimulator is placed into the abdominal region. This stimulator contains two leads connected to the stomach muscles that administer tiny electric shocks in an effort to help manage the need to regurgitate.

Alternative approaches to treat gastroparesis include:

• IV Nutrition: During this parenteral, or intravenous, feeding process, nutrients directly enter the bloodstream through a catheter routed into a vein in the chest area. Like a jejunostomy tube, parenteral nutrition is a temporary option for treating advanced cases of gastroparesis.
• POP: Peroral pyloromyotomy (POP) is a newer treatment during which a doctor inserts a flexible, thin scope in the throat and advances it to the stomach. The doctor then severs the pylorus, or the structure that empties the stomach, allowing stomach contents to migrate into the small intestine more normally.
• Feeding/jejunostomy tube: In a severe case of gastroparesis, a jejunostomy tube or feeding tube might be appropriate. A special tube is surgically inserted through the abdomen into the small bowel. Liquid nutrients are administered through the tube, which then go straight into the small bowel and enter the bloodstream more quickly. The jejunostomy tube is typically a temporary treatment.

Can a special diet help with gastroparesis?

As per the American College of Gastroenterology, a healthy diet is a pillar of gastroparesis treatment and also serves as a natural approach to managing the condition. In addition, physicians can recommend medication and perform other medical services to improve symptoms of the GI condition. However, these medical therapies work most effectively when following a certain diet. This type of diet includes limiting the consumption of foods that are hard to digest, like high fiber and fatty foods. Doing so can help enhance digestion and reduce the risk of complications associated with gastroparesis.

Should you or a loved one experience gastroparesis signs or symptoms, or complications related to a diagnosis of gastroparesis, we encourage you to visit a Phoenix, AZ gastrointestinal physician near you as soon as possible. Please reach out to Arizona Digestive Health today to schedule a consultation with one of our board-certified gastroenterologists.