Gastroparesis

Gastroparesis

Gastroparesis, also called delayed emptying, is a disorder in which the stomach takes too long to empty its contents ,in the absence of mechanical obstruction. Normally, the stomach contracts to move food down into the small intestine for digestion.  This process is controlled by the vagus nerve and digestive hormones.  Gastroparesis occurs when the vagus nerve is damaged  or the muscles of the stomach and intestine do not work normally. The most common cause of gastroparesis is diabetes, since the resulting high levels of blood glucose (sugar) can cause chemical changes of the nerves themselves, and damages the blood vessels that carry oxygen and nutrients to the nerves. Other causes of gastroparesis include surgery on the stomach or vagus nerve, viral infection, medications (like narcotics), nervous system diseases ( such as Parkinson”s disease), and metabolic) disorders( like hypothyroid). In at least half the cases, no cause of the gastroparesis can be found despite medical testing, and the condition is referred to as idiopathic ( unknown).

The symptoms of gastroparesis are directly related to the slow emptying of food from the stomach. Commonly, there is a sensation of fullness or bloating after eating, and a sense of feeling full with smaller amounts of ingestesd food (early satiety). Nausea is frequently experienced, and occasionally vomiting of undigested food. Abdominal pain though less likely, can also occur, as can acid reflux/heartburn.  The symptoms of gastroparesis may be mild or severe, frequent or less so, depending on the person.

When a patient’s history is suggestive of gastroparesis, a diagnosis can be made by endoscopy, ( when retained food is found), barium x-ray studies, or more commonly a nuclear gastric emptying study which measures how long it takes for a known quantity of food to exit one’s stomach.

The approach to the therapy of gastroparesis includes eating more frequent but smaller meals so as not to overload the stomach; medications (called prokinetics, like Reglan) , which help the stomach empty by stimulating muscle contractions; and, in severe and intractable cases, gastric electrical stimulation (like a pacemaker of the stomach).