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Understanding Gastroparesis

~ by Jo Jordan

Also known as delayed gastric emptying, gastroparesis is a digestive disorder in which the muscles in the wall of the stomach work poorly – or not at all – preventing the stomach from emptying properly or in a timely manner.

Gastroparesis develops when the vagus nerve – which normally controls the transportation of food from the stomach through the digestive tract – is damaged. As a result, intestinal and stomach muscles fail to initiate the strong contractions necessary to propel food along (peristaltic wave action). This causes food to move too slowly, and can even prevent food from making its way through the digestive tract.

This disruption of the digestive cycle interferes with proper digestion, and can upset blood sugar levels and nutritional intake, and cause nausea and vomiting.

What Causes Gastroparesis?

Although gastroparesis can occur as a result of direct damage to the stomach muscles, vagus nerve damage itself is the leading cause of delayed gastric emptying.

Factors that can damage nerves or stomach muscles:

  • Cancer treatments
  • Diabetes, types 1 or 2
  • Gastroesophageal reflux disease
  • Medical conditions such as anorexia and bulimia; smooth muscle disorders such as amyloidosis and scleroderma; nervous system disease such as Parkinson's and abdominal migraine; metabolic disorders such as hypothyroidism; and flu or other viral illness
  • Medications such as narcotics, anticholinergics (medicines that calm intestinal muscle spasms), tricyclic anti-depressants, calcium channel blockers, antacids that contain aluminum hydroxide, some high blood pressure medications, and the psychiatric drug lithium1
  • Surgery involving the esophagus, stomach, or upper part of the small intestine


Signs and Symptoms of Gastroparesis

Gastroparesis is sometimes difficult to diagnose as sufferers experience a range of symptoms: some mild, others severe, frequent in some people, and less so in others. These include,

  • Abdominal bloating
  • Changes in blood sugar levels
  • Early feeling of fullness after eating just a few bites
  • Heartburn or gastroesophageal reflux
  • Lack of appetite
  • Nausea
  • Pain in the upper abdomen
  • Spasms in the stomach area
  • Vomiting of undigested food, sometimes several hours after a meal
  • Weight loss and malnutrition due to poor absorption of nutrients or low calorie intake

These symptoms are sometimes exacerbated by consumption of fatty foods, high-fat/high-carbonation beverages, and high-fiber foods such as vegetables and fruits.


Gastroparesis Complications

Bacterial overgrowth and bezoars:

Food that stays in the stomach too long can cause bacterial overgrowth from the fermentation of food, and disrupt gut flora balance. Stagnation can lead to small intestinal bacterial overgrowth (SIBO), also referred to as small bowel bacterial overgrowth (SBBO).

Conditions that interfere with muscular activity in the small intestine allow bacteria to stagnate and multiply in the small intestine. The lack of muscular activity may also allow bacteria to spread backwards from the colon and into the small intestine.2

SIBO is a condition in which abnormally large numbers of bacteria are present in the small intestine. Normally, the types of bacteria within the small intestine are different than those within the colon. With SIBO, the types of bacteria present resemble colonic bacteria rather than those normally present in the small intestine.

Undigested food can also harden into a bezoar, a solid mass that can be likened to the hairballs that develop in cats. This may cause nausea, vomiting, and can be life-threatening if they prevent the passage of food into the small intestine.


Diabetes and blood sugar fluctuations:

While delayed gastric emptying doesn't cause diabetes, the disorder can make diabetes worse by making blood sugar levels more difficult to control. Inconsistent food absorption and unpredictable stomach emptying can cause erratic changes in blood glucose levels, in turn worsening both diabetes and gastroparesis.

Malnutrition and weight loss:

Delayed stomach emptying can affect the body's ability to digest and absorb nutrients, leading to malabsorption problems and unwanted weight loss.


Screening and Diagnosis

Health care providers normally begin with a full physical exam, medical history, blood count, and chemical and electrolyte levels tests. Subsequent lab testing to diagnose for gastroparesis may involve the following procedures:

Barium X-ray coats the stomach with a thin layer of barium, making it visible on film. Gastroparesis is likely if food in the stomach shows up in the X-rays after twelve hours of fasting.

Breath testing involves ingesting a meal containing a small amount of isotope. Afterwards, the carbon dioxide of exhaled breath is examined to measure the presence of the isotope. The results illustrate the rate at which the stomach is emptying.

Electrogastrogram is similar to an electrocardiogram (ECG), recording the stomach’s electrical signals before and after eating. Rather than the steady rhythm of a healthy stomach, most people with gastroparesis have an irregular electrical rhythm; it does not increase after eating and is sometimes nonexistent, compared to a normal stomach where the electrical rhythm speeds up after a meal.

Gastric emptying scintigraphy involves ingesting a meal containing a radioisotope (a small amount of a radioactive substance) that will show up on scans. At one, two, three, and four hours, a scan is conducted to measure the rate of gastric emptying. When more than ten percent of the meal is still in the stomach after four hours, a gastroparesis diagnosis is confirmed.

Gastroduodenal manometry involves the threading of a pressure-sensitive plastic tube into the throat, stomach, and small intestine. The tube – which is connected to a computer – monitors the strength, frequency, and co-ordination of muscle contractions before and after eating.

Magnetic resonance imaging (MRI) scans use magnetization and radio waves to produce cross sectional images of the internal organs.

The SmartPill is a small device in capsule form. After being swallowed, it moves through the digestive tract collecting data that is sent to a cell phone-sized receiver worn by the patient. Once the capsule is passed in the stool, the information is collected from the receiver by a health care provider, and entered onto a computer for analysis.

Ultrasonography/ultrasound (high-frequency sound waves bounced off internal tissue, the echoes of which are converted into images) is used to rule out gallbladder disease and pancreatitis.

Upper gastrointestinal (GI) endoscopy is a procedure using a long, flexible, lighted tube to obtain diagnostic images of the digestive tract and the surrounding tissue and organs. Through the endoscope, the lining of the stomach can be examined for abnormalities, ruling out conditions that can cause gastroparesis.


Treatment for Gastroparesis

The level of treatment for delayed gastric emptying depends on the severity of the symptoms. Currently, there is no cure for gastroparesis. However, because gastroparesis is common in people with diabetes, it is essential that blood sugar levels be controlled in order to prevent the onset of the disorder.

As well, other possible underlying conditions that may cause gastroparesis ought to be explored. Dietary changes and various medications can help to control gastroparesis symptoms. However, medication is not always effective, and some drugs are associated with negative side effects.

Treatment can help patients manage the condition so they can function as normally as possible.

Dietary changes:

  • Digestive enzymes with meals are recommended to combat malabsorption problems;
  • Smaller, more frequent meals (i.e. six small ones per day instead of three large ones) are suggested;
  • Solid, nutrient-dense foods in the morning; lighter meals or liquids in the afternoon and evening are recommended;
  • High-fat / high-fiber foods (fat slows digestion and fiber is difficult to digest) ought to be avoided;
  • High-fiber foods like oranges and broccoli contain material that cannot be digested and so they ought to be avoided;
  • Fiber from well-cooked fruits and vegetables, fish, chicken, yogurt, and refined breads and grains are recommended;
  • Dried figs, berries of all kinds, apples, coconut, corn, Brussels sprouts, and potato and tomato peels ought to be avoided as these can cause bezoars;
  • Lying on the right side after eating can allow gravity to help with emptying the stomach;
  • A liquid or pureed diet (for severe cases) including soups is often helpful – cooked fruits and vegetables, poached or baked chicken in broth, cereals with milk or rice milk, as well as pasta dishes can be pureed;
  • Nutritional supplements including vitamin B12, iron, and calcium are recommended because of the potential for nutrient deficiency;3 and
  • Plenty of water is necessary to avoid dehydration; take small sips or suck on ice chips when nauseous.

A temporary feeding tube inserted into the small intestine may be recommended by health care providers in cases where gastroparesis is severe, or when blood sugar levels cannot be controlled by any other means.

Parenteral nutrition is another temporary feeding option for patients with severe gastroparesis. Parenteral nutrition delivers nutrients into the bloodstream, bypassing the digestive system altogether. A catheter (thin tube) with an opening outside the skin is inserted into a chest vein. A bag containing liquid nutrients is attached to the catheter enabling nutrient rich fluids to enter the bloodstream via the vein.

Medications:

Two types of medication are commonly prescribed for treating gastroparesis – anti-emetics to help control nausea and vomiting, and prokinetics to stimulate stomach muscle contractions. These may be injected or given as a liquid to maximize absorption.

Metoclopramide is a common prokinetic prescribed to stimulate stomach muscle contractions to help emptying. It also helps reduce nausea and vomiting. Unfortunately, it is known to have serious side effects, and is not ideal for long-term use. In other parts of the world, domperidone is an alternative to metoclopramide with few side effects. The use of this drug is restricted in the United States, but it is now under review with the Food and Drug Administration (FDA).

Erythromycin is an antibiotic that works to clear up bacterial infection, as well as improve stomach emptying. It helps to increase the contractions that move food through the digestive tract. Nausea, vomiting, abdominal cramps, and diarrhea are common side effects.

New therapies:

Botulinum toxin (Botox) relaxes the pyloric muscle in some patients, allowing the stomach to release more food, and as such has been associated with improvement in gastroparesis symptoms. More research is needed, however.

Gastric electrical stimulation involves the surgical implantation of a battery-operated device (an astric neurostimulator) that releases mild electrical pulses to stimulate stomach contractions, improve stomach emptying, and help control the nausea and vomiting that often accompany gastroparesis.

Surgery:

As a final option, an operation in which the lower part of the stomach is stapled or bypassed may help to improve stomach emptying. This surgery is associated with serious complications, however, and is normally only recommended when all other treatments are unsuccessful in providing relief from gastroparesis.


Prevention, Health, and Overall Wellness

While there are many treatments for gastroparesis, success varies from individual to individual, and some come with unpleasant side effects. One of the simplest things you can do for yourself is to work toward improving and maintaining your general health in order to avoid the onset of disease.

If you already have gastroparesis, strengthening your body nutritionally is of vital importance. Gastroparesis affects the body's ability to digest and absorb nutrients, leading to malabsorption problems and unwanted weight loss. A daily dose of Advanced Supplementation will help to ensure you are getting the vitamins and minerals your body needs.

Bacterial overgrowth from gastroparesis ­ a result of food being in the stomach too long ­ can disrupt gut flora balance, and lead to other health problems such as SIBO / SBBO. Probiotics (lactobacillus acidophilus) help the body maintain and restore gut flora (otherwise known as healthy bacteria) to levels that are essential to good health.

And finally, everyone who eats and has a digestive system can benefit from a regular colon and liver cleansing regime to help improve their overall wellness. Your colon is the center of your health; everything you eat passes through it. So if your digestive processes are not working well, your entire body will feel the negative effects.

Likewise, your liver performs many vital functions...from removing environmental toxins from the blood, to manufacturing the enzymes and bile that aid digestion. A sluggish liver can lead to fatigue, weight gain, water retention, and a host of other problems such as gastroparesis, while a healthy liver will increase your energy, improve metabolism, help you burn excess fat, and put you on the road to optimum health.

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Notes:
1. Mayo Clinic.com, Tools for healthier lives, “Digestive System: Gastroparesis,” http://www.mayoclinic.com/health/gastroparesis/DS00612 (accessed January 1, 2008). 2. Dennis Lee, MD, “Small Intestinal Bacterial Overgrowth,” MedicineNet.com, http://www.medicinenet.com/small_intestinal_bacterial_overgrowth/article.htm (accessed January 8, 2008). 3. Mayo Clinic.com, Tools for healthier lives, “Digestive System: Gastroparesis,” http://www.mayoclinic.com/health/gastroparesis/DS00612 (accessed January 1, 2008).

 
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