Gastrointestinal health is an often overlooked part of a person’s overall health and wellbeing, but it is an important facet of maintaining a high quality of life. Some conditions and symptoms, like diarrhea and constipation, are common and relatively easy to treat. Others, like gastroparesis, are more rare but can require a much more involved treatment regimen. Though only about 1 in 100,000 people get gastroparesis, it can cause a series of complications and symptoms. And because August is Gastroparesis Awareness Month, it’s a great time to learn more about the condition.

What is Gastroparesis?

Gastroparesis is the medical term for a condition characterized by delayed gastric emptying; in other words, it means that the movement of food from the stomach to the intestines is slowed or stopped. When the digestive system is functioning normally, food in the stomach is broken down via exposure to stomach acid and peristalsis, a series of muscle contractions that then pushes food into the intestines.

In patients with gastroparesis, however, the stomach muscles responsible for peristalsis are too weak to work properly. As a result, the stomach takes too long to empty into the bowels, thereby delaying the entire digestive process. While this delay in and of itself isn’t necessarily harmful, the disruption to the gastrointestinal system causes the abnormal absorption of dietary nutrients; this, in turn, can lead to a variety of unpleasant symptoms, complications, and related conditions.

Symptoms of Gastroparesis

The delayed stomach emptying and reduced digestive motility associated with gastroparesis can have a significant impact on bowel function. Just as changes in bowel motility can lead to things like diarrhea and constipation, so also changes in stomach motility can cause a number of symptoms:

nausea
vomiting
reduced appetite
unexpected weight loss
malnutrition
bloating
abdominal pain
acid reflux or heartburn
rapid onset of the feeling of satiety when eating
regurgitating undigested food not long after eating
reduced glycemic control that causes blood sugar changes
excessive belching

The symptoms of gastroparesis can sometimes be mistaken for other conditions that also have an impact on stomach motility. Additionally, there are a number of medications that include delayed gastric emptying as a side effect. Pain medicines like codeine or morphine, some antidepressants, and medications that are used to treat an overactive bladder can all cause similar symptoms as gastroparesis. Yet though the symptoms are similar, the medications themselves don’t actually cause gastroparesis.

Causes of Gastroparesis

Gastroparesis is the kind of condition that doesn’t have a discreet “cause” since it can develop for numerous reasons. In fact, doctors are often unable to even determine an underlying cause, and they must instead direct treatment toward easing symptoms. Regardless of the underlying cause, however, one of the basic mechanisms that leads to delayed gastric emptying is damage to the vagus nerve, a bundle of nerve fibers that are involved with control of the lungs, heart, and the digestive system.

The stomach, like most other parts of the gastrointestinal tract, is surrounded by muscles that are responsible for moving food through the digestive process. These muscles are controlled by a network of nerves (the enteric nervous system) that communicate with the vagus nerve. When the vagus nerve (or any of the other nerves) is damaged, it can affect any body system that is connected. There are many possible reasons why damage like this can happen:

Diabetes: One of the most common complications associated with type 2 diabetes is called diabetic neuropathy. This is essentially a kind of nerve damage that results from high blood sugar levels; the damage is thought to be due to the weakening of the walls of blood vessels that supply the nerves with oxygen.
Surgery: Since the vagus nerve extends from the brain to the colon, any surgical operation in the area (though usually involving the esophagus, stomach, or intestines) can cause damage to it. Depending on the severity of the damage, gastroparesis or other conditions related to nerve damage may result.
Scleroderma: Scleroderma is an autoimmune disease that causes problems with the growth of connective tissue in many parts of the body. This abnormal growth most often presents as a hardening of skin, but it can also negatively affect stomach tissue and the nerves that control peristalsis.
Hypothyroidism: This endocrine system disorder involves the thyroid gland not producing sufficient thyroid hormone for normal bodily functions. Since the thyroid is important in regulating metabolism and how the body uses energy, low levels of thyroid hormone can actually slow down overall digestive tract motility.
Parkinson’s Disease: Disorders of the nervous system like Parkinson’s disease and multiple sclerosis can both potentially cause gastroparesis. In Parkinson’s disease specifically, signals from the brain to the stomach are abnormally disrupted in a way that can slow down or stop gastric emptying.

Treatment of Gastroparesis

Treatment options for gastroparesis are dependent on the underlying cause of nerve damage. If the cause is diabetes, for example, the treatment will work in concert with the patient’s overall diabetic treatment; this usually means employing methods to further control blood glucose levels. There isn’t a cure for gastroparesis, so most of the treatment paths involve trying to help improve the muscles that control peristalsis or mitigating the effects of associated nutrient loss. Below are some possible methods of treatment:

Diet Changes: Given the potential for undernourishment inherent in gastroparesis, one of the main elements of treatment is augmenting one’s diet in order to ensure proper nutrition. Diet-related efforts may involve eating less fat, chewing food more thoroughly, taking nutritional supplements, or making sure that food is soft and fully cooked.
Medication: A doctor may prescribe a medication like domperidone, metoclopramide (Reglan), or erythromycin to strengthen the muscles in the wall of the stomach and increase the rate of gastric emptying. To address nausea or vomiting, a doctor may prescribe drugs called antiemetics.
Feeding Tube: In cases of more extreme undernourishment, a feeding tube may be employed; this involves advancing a thin tube through the nose or mouth down the esophagus so that liquified food can be delivered directly into the duodenum of the small intestine. When a longer term solution is necessary, the doctor may perform a jejunostomy so that a feeding tube can be attached directly to the small intestine through a stoma in the abdomen.
Gastric Electrical Stimulation: Gastric electrical stimulation (GES) is a treatment method that sends electrical pulses to the nerves in the stomach. This approach is used primarily for idiopathic gastroparesis or diabetic patients, and it is meant to reduce nausea and vomiting.

Potential Gastroparesis Complications

The delayed gastric emptying associated with gastroparesis can cause a number of complications. In addition to the malnutrition that can happen because of reduced nutrient intake, the undigested food that remains in the stomach can actually harden into a mass known as a bezoar; these hardened masses can cause a blockage that further prevents food and nutrients to pass into the small bowel. In some cases, vomiting can be severe and frequent enough to cause dehydration. These complications, along with the various symptoms, can drastically reduce a person’s quality of life.

When Should You See a Doctor?

Since the symptoms of gastroparesis are often similar to other gastrointestinal problems, it may not be the apparent cause. If you have been experiencing severe versions of any of the symptoms, or signs of dehydration due to vomiting, you should seek advice from a qualified gastroenterologist like our dedicated physicians at Cary Gastro. Our entire team is dedicated to providing excellent digestive care. Please contact us today to request an appointment.

What is Gastroparesis and How is it Treated?