What is Gastroparesis (Delayed Stomach Emptying)?
Gastroparesis is a disorder where the stomach takes too long to empty its contents, even though there’s no physical bloackage. This situation persists for at least three months. Symptoms of this condition include nausea, vomiting, bloating, feeling full quickly, and stomach pain. The cause of this slow emptying is due to issues in the digestive system’s functioning involving various parts of the nervous system, muscle cells, natural pacemakers within the stomach and intestine, and a stomach valve named the pyloric sphincter. There might also be changes in immune cell presence and certain protein expressions in the stomach lining.
The most common cause of gastroparesis is unknown, but it can also be caused by diabetes, surgery, and infections. The number of people getting gastroparesis has been on the rise in the last few decades, which might be linked to increasing rates of diabetes, obesity, and the use of certain medications. It’s essential to know that many patients with gastroparesis share symptoms with another disorder called functional dyspepsia, and these two conditions often exist together. Tests are needed to confirm if a patient has gastroparesis. Treating this condition can be challenging due to side effects of medications and reduced effectiveness over time. It’s crucial to make diet changes for managing the symptoms.
What Causes Gastroparesis (Delayed Stomach Emptying)?
Gastroparesis happens for many different reasons, but most often, the cause isn’t known. Other common causes include diabetes, surgery, and following infections. It can also occur due to certain neurological disorders that affect nerve supply to the gut.
Gastroparesis occurs due to a variety of reasons:
* Unknown causes make up about 50% of cases.
* Diabetes: Gastroparesis is often more common and severe in those with Type 1 diabetes, but it can be found in those with Type 2 as well.
* Surgery and illness: Stomach emptying can be impacted due to nerve damage or changes in your stomach from surgery. Some infections, especially from Norwalk virus, rotavirus, and Epstein-Barr virus, can also lead to gut issues.
* Diseases and conditions: Problems like amyloid neuropathy and systemic sclerosis (scleroderma), certain autoimmune conditions, spinal cord injuries, and certain medications can cause gastroparesis.
People with gastroparesis caused by unknown factors are typically women, white, and describe symptoms like stomach pain and feeling full quickly. This can happen in episodes or cycles.
People with diabetes who are at a higher risk of getting gastroparesis often have had diabetes for a long time, have difficulty controlling their blood sugar, and already have nerve damage complications from their diabetes. Especially those with Type 1 diabetes are more prone to gastroparesis. Even with controlled sugar levels, gut emptying might not improve, particularly in the short term. Gastroparesis itself can also impact sugar control, and high blood sugar can cause slower stomach emptying, even in people without diabetes.
Surgery on the esophagus, stomach, duodenum, or pancreas can also frequently lead to gastroparesis. This can happen right after surgery or months to years later. Some stomach surgeries can lead to slower stomach emptying due to a smaller stomach size.
Gastroparesis following an infection is also common, but usually, people recover fully. Viruses such as the Norwalk virus, rotavirus, Epstein-Barr virus, cytomegalovirus, and Varicella Zoster virus are known to cause gastroparesis due to their ability to make lasting changes to nerve functioning.
Risk Factors and Frequency for Gastroparesis (Delayed Stomach Emptying)
Because symptoms of gastroparesis do not always correlate with the severity of the condition and is often underdiagnosed, it’s hard to get exact numbers on how many people actually have this condition. However, in one of the largest studies that looked at this issue, 3604 possible cases were examined. Out of these, 83 were confirmed as definite gastroparesis, and 127 were classed as probably having gastroparesis.
- A large review of related studies from 1994 to 2019 found that gastroparesis affects 13.8 to 267.7 of every 100,000 adults.
- The yearly occurrence rate was calculated as 1.9 to 6.3 per 100,000 people.
- Gastroparesis is four times more likely in women than in men, and the chances increase with age for both sexes.
- The number of people being hospitalized for gastroparesis went up by 300% from 1997 to 2013.
Signs and Symptoms of Gastroparesis (Delayed Stomach Emptying)
Gastroparesis is a condition that affects the stomach muscles, resulting in slow digestion. It’s important to note that the severity of symptoms doesn’t always tie directly to the level of delay in gastric emptying. Some people with test results that point to gastroparesis don’t experience any symptoms at all. The most common symptoms are nausea and vomiting, and these often directly relate to the severity of the delay in the stomach emptying.
The following are other possible symptoms:
- Feeling full or bloated after eating a small amount
- Unintentional weight loss due to not eating enough – more common in severe and persistent cases
- Vomiting food eaten several hours prior
The symptoms experienced might vary depending on the cause. For instance, people with gastroparesis due to unknown causes (idiopathic) frequently report feeling full quickly, fullness after meals, and abdominal pain. On the other hand, those with diabetes-related gastroparesis often have more severe nausea and vomiting.
Although abdominal pain is frequently seen in people with gastroparesis, it is usually not the most significant symptom. When abdominal pain is the most significant symptom, other causes should be considered. Certain conditions like functional dyspepsia have similar symptoms and may coexist in the same patient group. A test called “gastric emptying study” is often needed to differentiate between gastroparesis and functional dyspepsia.
A physical examination may reveal a bloated or tender upper belly area. However, there would be no signs of peritonitis, a serious condition where the inner lining of the abdomen becomes inflamed. Some patients might show signs of the underlying condition causing the gastroparesis such as shaking related to Parkinson’s disease, reduced sensation due to diabetic neuropathy, or surgical scars if the gastroparesis occurred after surgery.
Testing for Gastroparesis (Delayed Stomach Emptying)
If a patient is experiencing long-term symptoms such as nausea, vomiting, feeling full quickly after starting to eat, feeling uncomfortably full after meals, stomach pain, or bloating, gastroparesis might be the cause. In order to confirm this, doctors usually start with a detailed interview about the patient’s medical history and a physical examination. They will often order common lab tests like a metabolic panel, liver function test, complete blood count, and lipase. Doctors also use imaging techniques such as CT scans or MRIs to rule out other causes of the symptoms. These imaging tests can help them see if there is a physical blockage, like a tumor, causing the problems.
The most reliable test for detecting gastroparesis is called a scintigraphic gastric emptying study (GES). In this test, patients eat a meal that contains a very low dose of a radioactive substance. The test measures how long it takes for the meal to leave the stomach. Depending on the amount of food that remains in the stomach 4 hours after eating, doctors can classify gastroparesis as mild (less than 15% of the meal remains), moderate (15% to 35% remains), or severe (more than 35% remains).
Another method used to evaluate gastroparesis is called a gastric emptying breath test (GEBT). This test measures the amount of a certain carbon isotope in the patient’s breath after they have eaten a meal containing the isotope. It is a non-invasive option and doesn’t expose the patient to radiation, making it an attractive choice in some cases. However, its use is limited in patients with liver or lung disease.
The wireless motility capsule (WMC) is a tool that provides further information about gastroparesis. The patient swallows the capsule, and it sends information back to the doctors as it moves through the digestive system. However, this method is often limited by the cost, availability, and it doesn’t always give an accurate representation of how food is moving through the stomach.
Gastric ultrasonography is another method used to examine the stomach and its functions. It uses sound waves to create images and can provide information about the motions of the stomach wall, the flow of contents through the stomach, and an estimate of how fast the stomach is emptying. Despite its non-invasive nature and lack of radiation exposure, it is limited by its lower level of detail compared to other imaging methods, and requires a skilled technician to perform and interpret. Because of these limitations, it is generally only used in certain patient populations, for example, children and pregnant patients, where avoiding radiation is necessary.
Treatment Options for Gastroparesis (Delayed Stomach Emptying)
Treating patients with gastroparesis should be comprehensive, taking into account the patient’s nutritional condition. This involves correcting any deficiencies in fluids, electrolytes, and nutrition. The aim is to alleviate symptoms, improve the emptying time of the stomach, and treat the underlying cause of the disease.
Dietary changes are crucial for managing this condition. Experts suggest small, frequent meals to aid digestion. These should consist of low-fat, low-fiber, and easy-to-digest foods. Liquid foods are recommended as they’re more easily absorbed. As carbonated drinks can cause stomach discomfort and both tobacco and alcohol can worsen digestion, they should be avoided. Despite the patient’s weight, malnutrition is common, so vitamin supplements may be needed. If the patient cannot consume enough food, a feeding tube or, in rare cases, nutrition given directly into a vein can be considered.
Medications like antiemetics can help with acquiring relief from gastroparesis symptoms. Metoclopramide is the only drug specifically approved for treating this condition and should be taken shortly before meals. It is initially administered in low doses and may be increased, but with careful monitoring due to potential serious side effects, including restlessness, anxiety, and heart rhythm irregularities.
Other medications not officially approved but that may be effective include domperidone, certain antidepressants, and a drug called tegaserod. Domperidone is similar to metoclopramide and can reduce nausea and stimulate digestion. However, it can cause heart rhythm irregularities and hormonally related side effects. Taking erythromycin, a type of antibiotic, can also be beneficial, but it should be used for only a short duration due to the body’s tendency to become used to it quickly. Additionally, this medication can cause nausea, hearing damage, heart rhythm irregularities, and resistant bacteria development.
Alternatively, gastric electrical stimulation may also be used for individuals whose symptoms do not respond to medication. Although this procedure involves surgery and is not without risks, it can significantly reduce vomiting and the need for nutritional supplements. Less common interventions include various surgical procedures such as a venting gastrostomy, feeding jejunostomy, partial gastrectomy, and pyloroplasty. However, these have not been well-studied and their effectiveness remains undetermined.
In terms of future developments, potential treatments like granisetron, aprepitant, cannabinoids, and acupuncture are under investigation and have shown promising results in initial trials.
What else can Gastroparesis (Delayed Stomach Emptying) be?
If you’re feeling constantly nauseous and vomiting, it might not necessarily mean you have gastroparesis. There are quite a few other conditions that can cause similar symptoms. Here are some examples:
- Functional dyspepsia: This condition has symptoms really similar to gastroparesis. Often, doctors need to carry out a functional test to tell these two conditions apart.
- Gastric outlet obstruction: This condition also presents similarly to gastroparesis. However, here, an actual physical blockage causes the problems.
- Cyclical vomiting syndrome: Here, people suffer from repeated episodes of intractable nausea and vomiting. These episodes can last from several hours to a few days.
- Rumination syndrome: This is a behavioral disorder. Patients regurgitate undigested food daily just after they have eaten their meal. Compared to gastroparesis, it’s not preceded by feelings of nausea or vomiting.
- Cannabinoid hyperemesis syndrome: It’s a condition caused by long-term cannabis use. It leads to episodes of vomiting, and patients often find relief in hot showers. The symptoms improve once they stop using cannabis.
- Psychiatric disorders: Some mental health conditions, including anxiety neurosis, anorexia nervosa, or bulimia, could also cause persistent upper digestive tract symptoms, which could be confused with gastroparesis.
Remember, it’s really important that a healthcare professional evaluates you fully to figure out the correct diagnosis.
What to expect with Gastroparesis (Delayed Stomach Emptying)
People with gastroparesis – a condition that affects the normal movement of muscles in your stomach – often experience persistent symptoms and poor nutrition, which can lead to a reduced quality of life. In one long-term study of 20 patients with diabetes, the symptoms related to delayed stomach emptying remained fairly constant over the 12 years.
In a different study with 86 diabetic patients, even after accounting for other health conditions, gastroparesis symptoms did not seem to be linked to the risk of death. However, contrasting results came from a study conducted at a specialized medical center, where it was found that 7% of patients with gastroparesis died and 22% required long-term special nutritional support after a follow-up period of 6 years.
It needs to be noted that more controlled studies are required for understanding the long-term outlook of gastroparesis in a community setting, as the data from specialized medical centers might not accurately reflect the outcomes of the disease in the general population. On a positive note, gastroparesis that is caused by a virus often shows improvement within a year.
Possible Complications When Diagnosed with Gastroparesis (Delayed Stomach Emptying)
The risk of developing complications from gastroparesis, a condition that affects how the stomach moves food, can vary depending on the root cause of the condition. People suffering from gastroparesis for an extended period may experience several complications such as:
- Severe protein-calorie malnourishment
- Formation of bezoars that may need surgery to remove
- Mallory-Weiss tears, which are tears in the lining of your stomach or esophagus
- Complications related to clinical procedures
- Repeated hospitalizations
- A significant impact on healthcare resources
Preventing Gastroparesis (Delayed Stomach Emptying)
Training healthcare professionals properly can help ensure high-quality care for people with gastroparesis, a condition that slows or stops food movement from the stomach to the small intestine. Anyone with diabetes or other health conditions linked to gastroparesis should be taught how to spot its symptoms. It’s also important for patients to learn in-depth about how they can adjust their diet and lifestyle to manage their symptoms. This includes eating several small meals throughout the day and avoiding alcohol, smoking, and fizzy drinks. Gastroparesis symptoms are often long-term and the condition has no definitive treatment, which can affect a patient’s quality of life.