Gastroparesis

Understanding Gastroparesis

With gastroparesis, the muscles of the stomach do not work properly. They don't break up food and move it to the small intestine where nutrient absorption normally takes place.

It is more common among women and is one of several disorders relating to muscle movements that carry food through the digestive system. There is no cure, but there are treatment options that can help improve quality of life.

Untreated, it can lead to dehydration, malnutrition and bezoars (hardened masses of food that can block the digestive tract).

Symptoms

Symptoms of gastroparesis can include:

• Nausea
• Vomiting
• Weight loss
• Bloating
• Heartburn
• Pain in the upper abdomen
  

Some patients often get dehydrated, have weight loss from malnourishment, and have electrolyte or mineral imbalances.

Cause

Gastroparesis can develop when the vagus nerve, which controls the stomach muscles, becomes damaged.

Diabetes most commonly causes this condition. It also makes diabetes management more challenging. That's because it causes food to leave the stomach at unpredictable times. When food finally does enter the small intestine, it increases blood sugar.

Other causes include:

• Certain types of surgery, including gastrectomy (removal of part of the stomach)
• Systemic sclerosis (autoimmune disorder affecting the skin and internal organs)
• Nervous system disorders, including Parkinson’s disease and multiple sclerosis

In many cases, physicians cannot find a cause.

Diagnosis

Your doctor will do a series of tests that can include the following:

• The four-hour stomach emptying study will test the time it takes for a meal to get through to your stomach. The meal will have radioactive marker in it and multiple images will be taken over the four-hour period.
• An upper endoscopy or EGD is an exam that is done with a small, flexible tube that goes down your throat into your stomach to examine it while you are asleep. Another test called an Endoflip can be done during this time to see how tight the muscle is at the end of your stomach.
• The SmartPill is a pill you can swallow and through a wireless device, it will send information back to report how fast food is traveling through the digestive tract.
• An upper GI series is when you will drink a barium solution and then have a series of X-rays to see how it passes through the digestive system.
• The small bowel manometry or antroduodenal manometry test is when a catheter is placed down your nose into the stomach and then the small intestine. X-ray is used to position the catheter correctly. You will wake up with the catheter in your nose, and it will read contractions of the GI tract for six hours. You will be given meals to increase stomach motility. This tube can be uncomfortable but a numbing spray will be used in the nose and throat.

Treatment

Gastroparesis affects each person differently. IU Health physicians develop treatment plans based on your specific symptoms, needs and goals. Although no cure exists, your physicians provide effective treatment to relieve your symptoms and help you get proper nutrition.

Your healthcare team includes experienced specialists in the following areas:

• GI motility
• Minimally invasive surgery
• Intestinal transplant surgery
• Neurology
• Medical genetics
• GI radiology
• GI neuromuscular pathology and nutrition.

Your team’s close relationship with Indiana University School of Medicine allows them to conduct research to improve care. They offer clinical trials of new treatments.

Treatment options for gastroparesis include:

• Dietary changes. Adjusting your eating habits can help you control your symptoms. We work with you to design a diet that gives you the nutrients you need while helping you stay as comfortable and active as possible.
• Medicine. Several medicines can improve emptying of the stomach and reduce symptoms. Erythromycin and metoclopramide (in tablet, liquid and IV forms) promote muscle activity in the stomach. Promethazine and prochlorperazine, can help control nausea and vomiting.
• Gastric electrical stimulation. This treatment uses a device to deliver mild electrical pulses to the stomach muscles. This may help if your nausea and vomiting have not improved with dietary changes and medicine. A surgeon places the stimulator (gastric neurostimulator) under the skin of the abdomen and two lead wires connect it to the stomach muscles.
• Surgery. If other treatments do not work your physician may perform a surgical procedure:
  • G-POEM procedure: The G-POEM procedure is a minimally invasive procedure that is done in an operating room. During the procedure, the physician creates a tunnel between the layers of the stomach in order to reach the tight pyloric muscle. Once the tunnel is created, the physician makes a permanent cut on the muscle. This cut creates an opening for food to pass freely into the small intestine.
  • Jejunostomy: Your physicians places a tube in the abdominal wall through which you receive a liquid food mixture. The tube connects to the small intestine, allowing nutrition to bypass the stomach.
  • Several other less common surgical procedures include pyloroplasty (a procedure to make a larger opening at the bottom of the stomach) and gastrectomy (removal of the stomach).
• Parenteral nutrition. This treatment delivers nutrition directly into the bloodstream, bypassing your digestive tract, in cases of severe gastroparesis. Parenteral nutrition often provides a temporary treatment to help you recover after a period of dehydration and malnutrition, but can also provide long-term therapy.
• Diabetes management. If you have gastroparesis related to diabetes, your physician may recommend adjusting your blood sugar management. Possible changes include taking insulin more often, using a different type of insulin and taking insulin after meals, rather than before.