Gastroparesis

Gastroparesis is a gastric motility disorder that involves paralysis of the stomach muscle, causing food to remain in the stomach for too long. Gastroparesis is relatively uncommon and is typically caused by damage to or dysfunction of the vagus nerve, the main component of the parasympathetic nervous system. It can cause debilitating symptoms and life-threatening malnutrition. As such, early intervention is critical.

The Causes of Gastroparesis

As mentioned above, the leading cause of gastroparesis is damage to the vagus nerve. Diabetes (high blood sugar) is often to blame. If blood sugar levels stay high for long, the risk of nerve damage increases. This is not, however, the only reason for gastroparesis, as people with eating disorders such as anorexia and bulimia are at a higher risk of developing this motility disorder as well. Surgery on or around the stomach can also damage the vagus nerve.

Other diseases and conditions that cause can cause gastroparesis include:

• A viral infection like gastroenteritis
• Metabolic disorders
• Narcotic medication for chronic pain
• Parkinson’s disease and other nervous system problems
• Hypothyroidism
• Other possible issues that are not well-known

The Symptoms of Gastroparesis

Because of the varied causes of gastroparesis, symptoms may vary between patients, and as such, proper diagnosis and treatment from a qualified specialist are critically important. The average time between the onset of symptoms and diagnosis is often prolonged because patients try to manage the condition at home. Typically, however, gastroparesis worsens over time. Some of the most common symptoms include:

• Vomiting
• Nausea
• Unwanted weight loss
• Inability to eat enough
• Abdominal pain
• Bloating
• Chronic acid reflux or GERD / gastroesophageal reflux disease.

Bear in mind that the symptoms of gastroparesis can mimic those of other gastrointestinal disorders. A specialist in gastroparesis like Dr. Mansour can typically diagnose the concern earlier to allow for more effective treatment. If your gastrointestinal issues have not been solved through conservative or medical treatment, you should speak to the qualified specialists at Surgical Association of Mobile.

The Diagnostic Process

Creating an efficient diagnostic process is one of the most crucial aspects of addressing gastroparesis. As mentioned above, many patients have a delayed diagnosis because GI issues may be shared between many conditions. A physician attuned to the possibility of gastroparesis can often identify the problem sooner. To make the diagnosis, we have several tools available this can include:

• Upper GI or barium swallow. During this diagnostic test, you swallow a fluid that coats the organs as it goes down from the esophagus into the stomach. By taking an X-ray, we can see how food and liquid pass through your system.
• Radioisotope gastric emptying scan. You will be given food containing mild radioactive components to follow food through your digestive tract. As the food passes through your digestive tract, a radiologist can see its movement and understand if there are any concerns.
• Upper endoscopy. Using an endoscope or a thin tube with a light, we can check your esophagus, stomach, and the upper portion of your small intestine, known as the duodenum. By looking at these structures, we can understand what may be causing your gastrointestinal issues and, if needed, take a biopsy.
• Gastric emptying breath tests. This surprisingly simple diagnostic test measures the amount of carbon dioxide you exhale after eating, which tells us how efficiently your stomach functions.
• Gastric manometry. By placing a thin tube down your esophagus and into the stomach, we can accurately see how the stomach is contracting and whether the muscle is firing. This can tell us if there is a motility concern anywhere in the upper digestive system.

Common Treatments

Unfortunately, we do not yet have a cure for gastroparesis, and we consider it a lifelong chronic health concern. However, there are treatments to alleviate symptoms and potentially increase motility in the stomach. Once a diagnosis of gastroparesis has been made, Dr. Mansour will immediately evaluate any medications or lifestyle factors that may promote or worsen gastroparesis. Blood sugar will need to be brought under control through diet and exercise or appropriate medication. Other medicines that may be exacerbating gastroparesis must also be stopped. Of course, depending on the severity of the gastroparesis, the subsequent treatment plan may vary between patients. Some of the common treatments we use include:

• Medicines. Several medications are approved for treating gastroparesis; we may try a few to see if they are effective.
• Lifestyle change is a critical part of any gastroparesis treatment plan. Patients will be asked to modify their diet and exercise program to reduce their blood sugar levels, lose weight, and reduce the likelihood of their condition worsening.
• A gastric neurostimulator called Enterra may be connected to your stomach to improve the symptoms of vomiting and nausea. Much like a pacemaker, a pulse generator is implanted in the abdomen, and leads are run to the stomach. Symptoms can be managed by sending mild pulses of electricity into the stomach, and we have also seen motility improvement in some patients. Enterra is FDA-approved for gastroparesis.
• A surgical procedure known as a jejunostomy involves inserting a feeding tube through the skin and into the small intestine to bypass the stomach. Nutrients are introduced directly into the small intestine, which can be absorbed into the body. This is reserved for severe cases of gastroparesis.
• Also, for severe cases, it is feeding via IV. Nutrients are injected directly into the blood through the veins, bypassing the digestive system entirely.

The Bottom Line

We encourage any patient experiencing gastric motility issues to schedule an appointment to understand the problem. Earlier intervention allows for better outcomes in treatment as we work to slow the progress of gastroparesis.