Gastroparesis
What
is it?
Gastroparesis is the failure
of the stomach to empty because of decreased
gastric motility. Normally,
your stomach contracts slowly to squeeze solid
food into small
particles. Your stomach pushes these
compressed solids and liquids into the small
bowel.
With gastroparesis, the stomach is paralyzed, so its function
is greatly reduced or lost. Because
the stomach isn’t moving the food into the small
bowel, it stays in the stomach longer than normal.
Who
gets it?
Gastroparesis is one of the
common gastrointestinal complications of diabetes.
People with scleroderma, those on
anticholinergic medications commonly used for
treatment of conditions such as asthma and
Parkinson’s disease, and those who have had
surgery (vagotomy) for treatment of a duodenal
ulcer may also suffer from gastroparesis.
What
causes it?
The major causes are diabetes, vagotomy,
gastric resection, and use of anticholinergic
medications. For most patients the cause is
unknown.
What
are the symptoms?
Typical symptoms of
gastroparesis
include nausea, frequent and uncontrollable vomiting,
abdominal bloating, feeling of immediate fullness
upon eating, and loss of appetite. In patients
with diabetes, frequent vomiting can cause dehydration,
which can lead to diabetic ketoacidosis, a toxic
build-up of chemical compounds in the blood that
can lead to coma in patients with diabetes. Prolonged
vomiting can also make the lining of the stomach
bleed.
Vomiting usually occurs after meals. People
with gastroparesis usually vomit undigested food
eaten anywhere from 8 to 24 hours earlier. Some
patients experience days of nausea, bloating, and
little appetite, but no vomiting.
How
is it diagnosed?
To accurately diagnose
gastroparesis, your doctor may order tests that
include an upper-gastrointestinal (GI) series of
x-rays or a gastroscopy (gastricemptying study), which allows the doctor to
look into the stomach with a scope to measure the ability of your stomach to empty
food.
What
is the treatment?
Treatments for gastroparesis
include eating small meals throughout the day and
avoiding fatty foods and other foods that are
difficult to digest, such as legumes, lentils, and
citrus fruits. If you have gastroparesis as a
complication of diabetes, you may need to
intensify insulin therapy to get better control of
your blood glucose.
A number of drug therapies are also used to treat
gastroparesis. The most effective is
metoclopramide, which helps the stomach to empty
by stimulating stomach activity.
It may also relieve nausea and vomiting.
Common side effects include
drowsiness and fatigue.
Some people may also experience depression,
movement disorders, anxiety, and breast tenderness
or discharge. Metoclopramide is not recommended
for patients with Parkinson's disease. While
the antibiotic erythromycin improves stomach
emptying, its side effects of nausea, vomiting,
and abdominal cramps limit its usefulness.
One additional drug, domperidone, is not
yet approved for use in the U.S., but is under
review by the FDA. Domperidone
improves stomach emptying by stimulating stomach
motor activity, relieves nausea, and has few side
effects. If
drugs do not work for you, your physician may
recommend a jejunostomy tube, which allows food to
bypass your stomach. Liquid
nutrition, fluids, and medication are delivered
directly to the small bowel through the tube
during severe attacks of gastroparesis.
In extremely severe cases of gastroparesis, patients may need
a semi-permanent intravenous line that delivers
nutrients and fluids directly into the
bloodstream.
Self-care
tips
While you cannot prevent gastroparesis, you can reduce symptoms by
following your doctor’s recommendations for diet
and drug therapy.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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