What is gastroparesis?
Gastroparesis is a disease of the stomach. The stomach is, in reality, much like the heart, in that it pulses at regular intervals to push its contents outward. Like the heart, the stomach has a part called a pacemaker which sends an electrcal wave across the stomach, causing the muscles to contract, grinding food and pushing it into the duodenum (the first portion of the small intestine).
Gastroparesis occurs when the vagus nerve in the stomach becomes damaged. This impairs the ability of the stomach to expel food into the intestines. This causes bloating and nausea. People with gastroparesis will feel full after small meals, and often vomit after them as well.
What causes gastroparesis?
This disease can happen because of multiple causes. Gastroparesis is often caused by Type I or Type II Diabetes. High blood sugar levels over long durations of time can cause changes in how the nervous system functions, damaging the vagus nerve. Brain disorders, such as Parkinson's or a stroke can also be the cause. Previous stomach surguries, anorexia, bulemia, problems of the adrenal and thyroid glands, and trycyclic antidepressants have also been known to result in gastroparesis. In 40 to 60 percent of the cases, the cause of this disease is not known.
How do you diagnose gastroparesis?
There are several ways to diagnose gastroparesis. An upper GI x-ray series involves the patient drinking liquid barium and taking a series of x-rays to measure how much has left the stomach. This test often comes out negative because barium, being a liquid, pours down to the bottom of the stomach and into the intestines without the aid of the stomach's rhymthmic contrations. Endoscopies are often preformed to differentiate between gastroparesis and a stomach blockage. In extreme cases, gastroparesis can be diagnosed this way, because after a long fast, food is still found in the stomach. A newer test is called the electrogastrogram (EGG). This test is similar to the EKG on the heart, by measuring the electrical waves coming off the pacemaker of the stomach.
The most common test for gastroparesis is the gastric emptying scan. In this test, a patient eats a food, such as scrambled eggs, mixed with a radioactive marker. The stomach is then scanned every half hour for around four hours to check the placement of the food. The stomach in a healthy person should expel half its contents in 90 minutes.
How is gastroparesis treated?
Gastroparesis can usually be controlled with a combination of diet and medications. If there is an underlying problem causing the gastroparesis, it should be treated first.
In general the diet for people with gastroparesis quite different than a normal person's. Many fruits and vegetables, which are high in fiber and stay in the stomach long, are to be avoided. Foods high in fats and oils should be avoided as well. Frequent small meals are better for the gastroparesis sufferer than three large meals a day.
There are many medications that can treat the disease. Reglan (Metoclopramide) is common but can cause nervous side effects. Motilin (Domperidone) does the same thing as Reglan, but without the side effects. Unfortunately, although it is available in Canada and Europe, it is not available in the United States. Propulsid (Cisapride) can improve the function of the stomach but it can cause heart problems. Surgury is not considered helpful for this condition.
What are the complications of gastroparesis?
Gastroparesis can cause problems for sufferers of diabetes, because the delay in digesting food makes it more difficult to effect blood sugar levels. If food stays too long in the stomach it can harden into masses called bezoars. Although rare, bezoars can cause nausea, abdominal pain, and stomach obstructions.