Latest update March 29th, 2024 12:59 AM
Jun 24, 2018 Dr Zulfikar Bux, Features / Columnists
By Dr Zulfikar Bux
Assistant Professor of Emergency Medicine
Gastroparesis is a disorder that happens when your stomach muscles don’t work properly. It is sometimes called “delayed gastric emptying.” Normally, after you swallow food, your stomach muscles begin squeezing and tightening – these movements are called contractions. This crushes the food and moves it into the small intestine to continue the digestive process.
If you have gastroparesis, your stomach muscles don’t contract properly. This can delay or prevent the process of crushing the food and sending it to the small intestine. It is a condition that is showing a slow increase, worldwide, especially in diabetics and older persons.
Today we will discuss this condition, because patients are not often sure what is going on and can be easily be misdiagnosed.
WHAT ARE THE SYMPTOMS OF GASTROPARESIS?
Symptoms of gastroparesis can be mild or severe, and may include:
• Heartburn or stomach pain
• Nausea
• Vomiting, especially vomiting pieces of undigested food
• Feeling full after only a few bites of food
• Bloating
• Lack of appetite
• Unintended weight loss
• Unstable blood sugar levels in people who have diabetes
As you can see, these symptoms can suggest many conditions. That’s why gastroparesis can be difficult to diagnose.
WHO IS AT RISK OF GASTROPARESIS?
People who have diabetes are most at risk for gastroparesis because high blood sugar levels can damage the vagus nerve. The vagus nerve tells your stomach muscles when to contract. Damage to this nerve is one of the most common causes of gastroparesis. Diabetes can also damage the blood vessels that carry oxygen and nutrients to the vagus nerve. Other things that can lead to gastroparesis include:
• Some medicines, such as certain pain medicines, antidepressants and others
• Surgery on the esophagus (the tube the runs from the mouth to the stomach), the stomach or the upper small intestine
• Radiation of the chest or stomach area for cancer treatment
• Eating disorders, such as anorexia nervosa and bulimia
• Gastroesophageal reflux disease (GERD)
• Other disorders, including hypothyroidism, scleroderma, Parkinson’s disease and some autoimmune disorders
• Rarely, viral infections such as the flu
HOW DO DOCTORS DIAGNOSE GASTROPARESIS?
Your doctor will start by examining you and asking you about your medical history. Be sure to tell your doctor about any prescription or over-the-counter medicines you are taking. You may have blood tests to check the quality of your blood and measure some chemical levels. Your doctor might want to do some other imaging testing to make sure you don’t have a blockage or another medical problem.
HOW IS GASTROPARESIS TREATED?
There is no cure for gastroparesis. Treatment will focus on treating any underlying problem that is causing the gastroparesis and controlling your symptoms. For example, your doctor may ask you to stop taking any drugs that can affect the digestive system. Don’t stop any medicine without first talking to your doctor. Your doctor also may want to treat any eating disorders, infections or other issues that could be causing gastroparesis. He/ She may also recommend one or more of the following:
• Eat several smaller meals each day instead of 2 or 3 large ones.
• Eat softer foods, such as vegetables or pasta that are cooked thoroughly.
• Limit fat (which can slow digestion) and fiber (which can be hard to digest).
• Supplement your diet with nutrition drinks (such as Ensure or Boost) or solid food that you’ve pureed in a blender.
Medicine – Anti-nausea medicines called antiemetics can help with nausea and vomiting. Some other medicines, such as metoclopramide and erythromycin, can stimulate stomach muscle contractions. Each of these drugs has some drawbacks, including potentially serious side effects. You and your doctor need to discuss whether the benefits of taking these medicines outweigh the risks.
Feeding tube – If your gastroparesis is severe, you may need a feeding tube. This tube will be inserted through your skin into your small intestine. Or, it may be passed into your intestines through your nose or mouth. The tube allows nutrients to be delivered directly to your bloodstream. A feeding tube can also help when gastroparesis causes unstable blood sugar levels in people who have diabetes.
WHAT ARE THE COMPLICATIONS OF GASTROPARESIS?
• Weight loss, malnutrition and dehydration. If you’re not able to eat enough food, or if you vomit up a lot of what you eat, you may not get enough nutrition. Following the suggestions listed above may help with this problem.
• Bezoars. A bezoar is a solid mass of food that your stomach is not able to digest. Bezoars can cause nausea and vomiting. In severe cases, they may block other food from entering the small intestine. This situation can be life-threatening, and the bezoar may have to be removed by surgery.
• Bacterial infections. When food stays too long in your stomach, bacteria can grow out of control, which can lead to infection.
• Problems controlling blood sugar. When you have gastroparesis, your timing for digesting food doesn’t follow normal patterns. For this reason, people who have diabetes and gastroparesis often have a lot of trouble controlling their blood sugar levels.
If you are at risk for gastroparesis and suspect that you have symptoms suggestive of it, let your doctor know. It may save you time, complications and unnecessary testing.
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