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Gastroparesis

Definition


Disease: Gastroparesis Gastroparesis
Category: Digestive diseases

Disease Definition:

When the muscles in the stomach don't function normally, a condition called gastroparesis occurs.

 

Normally, food is propelled through the digestive tract by strong muscular contractions. However, the muscles in the wall of the stomach work poorly or not at all in case someone has gastroparesis, which prevents the stomach from emptying properly. This could interfere with digestion, play havoc with blood sugar levels and nutrition along with causing nausea and vomiting.

 

Unfortunately, gastroparesis cannot be cured. Although not affective in every case, however, dietary changes and certain medications could help control the symptoms of gastroparesis. Serious side effects could be caused by the drugs that treat gastroparesis. Other types of therapies for gastroparesis are still being researched.

 

Work Group:


Symptoms, Causes

Symptoms:

Some of the most common signs and symptoms of gastroparesis are:

 

  • Early satiety, which is when a person feels full after eating just a few bites.
  • Nausea
  • Vomiting

 

Usually, several hours after someone has eaten, when the stomach is still full of undigested food and normal stomach secretions, vomiting occurs. Sometimes, vomiting occurs even if the person hasn't eaten, due to accumulated stomach enzymes and acids. Someone may have problems with solid foods only, in rare cases with liquids only, or with both solids and liquids because different stomach muscles empty solid food and liquid.

 

Some of the other signs and symptoms of gastroparesis could be:

 

  • Changes in blood sugar levels
  • Abdominal bloating
  • Weight loss
  • Heartburn or gastroesophageal reflux
  • Lack of appetite
     

Causes:

Located in the upper middle of the abdomen just below the ribs is a muscular sac known as the stomach. It is about the size of a small melon in an average adult, however, it could stretch to hold nearly one gallon of food and liquid. When someone eats or drinks, their stomach expands, and when it's empty, the stomach folds in on itself.

 

Three layers of powerful muscles line the walls of the stomach and mix food with enzymes and acids produced by glands in the stomach's inner lining. When the food is reduced to the consistency of porridge (thoroughly pulverized), strong muscular contractions also known as peristaltic waves, will push it toward the pyloric valve that leads to the upper portion of the small intestine called duodenum, where the real digestion will take place. Each time, the valve opens just enough in order to release only an eighth of an ounce of food.

 

Depending on someone's diet, it could take up to three or four hours for the stomach to empty after eating. The emptying time of the stomach prolongs considerably when a person eats foods that are high in fat. This slow process insures that the food is thoroughly mixed with digestive juices for the best possible absorption.

 

WHY DOES THE STOMACH STOP WORKING:

The vagus nerve, which is the most important nerve in the body, stretches from the brainstem to the colon. This nerve helps in orchestrating the complex microcircuits in the digestive tract, such as signaling the smooth muscles in the stomach in order to contract in peristaltic waves, which is usually at the rate of about three contractions every minute. However, food does not move out of the stomach into the duodenum as it should in case these contractions slow or stop completely.

 

The most common cause of gastroparesis is damage to the vagus nerve, despite the fact that this disorder could also result when the stomach muscles themselves are damaged.
Listed below are some of the factors that could damage nerves or muscles in the stomach:

Surgery:

The vagus nerve could be injured leading to gastroparesis due to operations that involve the esophagus, stomach or upper part of the small intestine. Symptoms could either appear years later or they could develop immediately after the surgery.

Diabetes:

One of the most common causes of gastroparesis is diabetes, either type 1 or type 2. The vagus nerve could be damaged and its normal functioning disrupted due to high blood glucose levels and their metabolic effects over time. Because erratic stomach emptying and poor absorption make blood sugar levels harder to control, once gastroparesis develops, diabetes becomes worse.

Cancer treatments:

Most anti-cancer drugs target fast-growing cells throughout the body including healthy cells in the intestinal tract; because of this, nausea and vomiting are some of the common side effects of chemotherapy. However, these side effects are usually only temporary, and improve when treatment ends.
Chemotherapy-induced gastroparesis could cause intractable nausea and vomiting in some people who are receiving high doses of chemotherapy drugs. In this case, motility problems, which are problems with the stomach being able to move food, originate in the nausea center of the brainstem, located just above the spinal cord. Gastroparesis could also result from radiation therapy to the chest and abdomen.

Medications:

Stomach emptying is slowed down by many commonly prescribed drugs; some examples are tricyclic antidepressants, calcium channel blockers and narcotic pain medications. The normal functioning of the stomach could also be disrupted by antacids containing aluminum hydroxide, the psychiatric drug lithium in addition to some high blood pressure medications. However, once the medications are stopped, symptoms usually improve. 

Other disorders:

Scleroderma, which is a connective tissue disease, anorexia and bulimia, Parkinson's disease and other nervous system illnesses and hypothyroidism, a metabolic disorder, are some of the other conditions that could cause gastroparesis. After a bout of the flu or other viral illness, some otherwise healthy people develop gastroparesis, the reason of which is still not clear.
 

Complications

Complications:

Some of the complications that gastroparesis could cause include:

Blood sugar fluctuations:

Inconsistent food absorption could cause erratic changes in blood sugar levels making diabetes worse; and poor control of blood sugar levels makes gastrparesis worse, however, gastroparesis itself does not cause diabetes.

Bezoars:

A bezoar is a solid mass, similar to a hairball in a cat. Undigested food in the stomach could harden into a bezoar, which is likely to cause nausea and vomiting, and if it prevents food from passing into the small intestine, it could be life-threatening.

Malnutrition and weight loss:

When the delayed stomach emptying affects the body's ability to digest and absorb nutrients, these problems occur. Bacterial overgrowth, which is the explosive growth of harmful microorganisms that normally inhabit the gut, also contributes to poor absorption. Beneficial bacteria usually keep in check these organisms; however, the balance of good and bad bacteria is disrupted due to fermenting food in the stomach.
 

Treatments:

The first step in treating gastroparesis is controlling diabetes or any other underlying condition that could be causing it.
In addition to this, some of the things that are involved in gastroparesis treatment include medications that increase stomach contractions and dietary changes. 

 

However, doctors are trying less conventional approaches because the few drugs that are approved for treating this condition could have some serious side effects and aren't effective in every case.

 

DIETARY CHANGES:

One of the cornerstones in gastroparesis treatment is diet; specific dietary changes are recommended by most doctors, such as:

Low-fiber foods:

Food is helped to whisk through the intestinal tract by fiber, which is mainly found in raw fruits and vegetables, whole grains and legumes. However, in the stomach, fiber has the opposite effect and needs extra time and effort to break down roughage. Also, softer foods are less likely to cause bezoars than fibrous foods are.
This is why people with gastroparesis are advised to substitute low-fiber foods, such as well-cooked fruits and vegetables, yogurt, fish, chicken and refined breads and grains, for fiber-rich foods. Potato and tomato peels, dried figs, coconut, brussels sprouts, berries of all kind and corn are some of the foods that are likely to cause bezoars.

Smaller but more frequent meals:

Someone's likely to do better eating six to eight small meals a day instead of two or three large ones because a big sized meal takes longer to digest than a light snack. The feeling of fullness that plagues many people with gastroparesis could also be avoided by smaller and more frequent meals.

 

Dietitians usually suggest eating solid, nutrient-dense foods in the morning, and then switching to lighter meals or liquids in the afternoon and evening, especially for people whose appetite wanes later in the day. Lying on the right side after eating allows gravity to help empty the stomach, which could be of help to some people. In case someone has diabetes, until their blood sugar is brought under control, or the gastroparesis is better managed, they may be recommended a liquid diet.

Water:

If someone has gastroparesis, it is particularly important to drink plenty of water because the vomiting that is caused by this disorder could lead to dehydration. When someone's nauseous, to keep water down, they could take small sips or try sucking on ice chips.

Low-fat foods:

Despite the fact that fat slows digestion, sometimes doubling the amount of time food remains in the stomach, however, some experts argue that people suffering from gastroparesis need the calories and nutrients in high-fat liquids, such as milkshakes. Although the patient will be recommended avoiding fatty foods as a general rule, however, they could be allowed small amounts of milkshakes or other rich drinks particularly between meals in case they can tolerate them.

Nutritional supplements:

People with gastroparesis could be deficient in important nutrients, such as iron, calcium and vitamin B-12 because this disorder interferes with digestion. A liquid vitamin and mineral supplement should not be used as a substitute for meals, despite the fact that it could help in supplying the missing nutrients.

Pureed and liquid foods:

Almost any food could be pureed, including cooked fruits and vegetables, cereals, which should be blended with milk or rice milk for flavor and texture, pasta dishes, poached or baked chicken and fish; chicken or fish could be added broth in order to achieve a workable consistency. Most people that have gastroparesis feel like they do best with soups or pureed foods.

Feeding tube:

Although most people with gastroparesis do well eating pureed foods and using nutritional supplements, however, some people that are suffering from severe stomach problems cannot tolerated any foods or liquids, in which case a jejunostomy tube (feeding tube) will be placed in their small intestine.
Usually, a nasal or oral tube is tried first in order to make sure that the person can tolerate this type of feeding. The nasal or oral tube is threaded into the small intestine through the nose or mouth. This tube is usually only temporary and is inserted when gastroparesis is severe or any other method cannot control blood sugar levels. After trying that, the tube will be inserted directly into the small intestine through the skin.

 

MEDICATIONS:

Usually, to treat gastroparesis, two types of drugs are prescribed:

Prokinetics:

These medications stimulate contractions of the stomach muscles.

Anti-emetics:

These medications help control nausea and vomiting. One example is prochlorperazine.

 

Medications may be injected or given in a liquid form because pills are usually poorly absorbed.

 

SURGERY:

When all other measures have failed to provide relief from severe nausea and vomiting or malnutrition, a surgical operation could be an available option. In the surgery, in order to help improve stomach emptying, the lower part of the stomach may be stapled or bypassed. This type of surgery is left as a last resort because it could cause some serious complications.

 

EMERGING THERAPIES:

Researchers are looking to find better ways to manage gastroparesis because despite the fact that it's not life-threatening, however, it could greatly affect a person's quality of life and make diabetes more difficult to control. Some of the emerging therapies are:

Botulinum toxin:

Even though at first botulinum toxin was exclusively used to treat wrinkles and migraines, however, it is now being tried for a variety of problems, one of which is gastroparesis. It has been discovered in trials that botulinum toxin allows the stomach to release more food because it relaxes the pyloric muscle in some people. However, more studies are needed in order to determine the overall usefulness of botulinum toxin; but at present, its benefits are only temporary.

Electrical gastric stimulation:

This is a new treatment that involves using an electric current in order to stimulate stomach contractions. A stomach pacemaker that works just like a heart pacemaker consists of a tiny generator and two electrodes and is placed in a pocket created by surgeons on the stomach's outer edge. Stomach pacemakers reduce nausea and vomiting in addition to improving stomach emptying. However, it takes some time for the pacemaker to produce these effects and this procedure is not available everywhere.
 

Prognosis:

Not available

Expert's opinion

Expert's Name:
Certificate:
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Expert's opinion:

For Specialists

Clinical Trials:

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