Gastroparesis

What is gastroparesis?

Gastroparesis is a disorder involving your stomach muscles. It happens when your stomach muscles take too long to move and empty out food into your small intestine.

If food stays in your stomach for too long, it can cause problems. The food can harden into solid masses. These are called bezoars. These masses may upset your stomach and make you vomit. They can also create a blockage, ulcer, or bleeding in your stomach. This can be dangerous if it stops food from passing into your small intestine.

In most cases, gastroparesis is a long-term (chronic) condition.

What causes gastroparesis?

Gastroparesis is caused when your vagus nerve is damaged or stops working. The vagus nerve controls how food moves through your digestive tract. When this nerve doesn’t work well, food moves too slowly or stops moving.

The vagus nerve can get damaged if you have diabetes and your blood sugar or blood glucose levels stay high over a long period of time.

Other causes of gastroparesis include:

• Eating disorders, such as anorexia or bulimia

• Surgery on your stomach or vagus nerve

• Extreme tiredness that does not seem to be caused by a health problem (chronic fatigue syndrome)

• Some medicines that slow movement in your intestine, such as narcotics for chronic pain

• Disorders involving smooth muscle that may affect the stomach, such as amyloidosis and scleroderma

• Nervous system disorders such as abdominal migraine and Parkinson's disease

• Metabolic disorders that make the body have either too much or too little of essential things it needs to stay healthy, such as having too little of the thyroid hormone (hypothyroidism)

• A viral illness, such as a viral gastroenteritis

Who is at risk for gastroparesis?

You are more likely to have gastroparesis if you have type 1 or type 2 diabetes.

What are the symptoms of gastroparesis?

Each person’s symptoms may vary. Symptoms may include:

• Upset stomach or nausea

• Vomiting

• Weight loss

• Feeling full too soon after you start eating

• Belly (abdominal) bloating or pain

• Heartburn or GERD (gastroesophageal reflux disease)

The symptoms of gastroparesis may look like other health problems. Always see your healthcare provider to be sure.

How is gastroparesis diagnosed?

Your healthcare provider will give you a physical exam and ask about your past health. You may also have other tests, including:

• Blood tests. These tests check your blood counts and measure your chemical and electrolyte (mineral) levels.

• Upper GI (gastrointestinal) series. This is also called a barium swallow. This test checks the organs of the top part of your digestive system. These are your food pipe (esophagus), your stomach, and the first part of your small intestine (duodenum). You will swallow a chalky liquid called barium. Barium coats the organs so that they can be seen on an X-ray. X-rays are then taken to check your digestive organs.

• Radioisotope gastric-emptying scan. During this test, you will eat food containing a mildly radioactive substance, or radioisotope, that will show up on a scan. The amount of radiation is very small. It's not harmful. But it lets the radiologist see the food in your stomach during the scan. They can also see how quickly food leaves your stomach. This test can take as long as 4 hours.

• Gastric manometry (antroduodenal manometry). This test checks the muscle movement in your stomach and small intestine. A thin tube is passed down your throat into your stomach. This tube has a wire that measures the muscle movement of your stomach as it digests foods and liquids. This helps show how your stomach is working. It also shows if your digestion is slower than normal.

• Upper endoscopy. This diagnostic procedure allows your healthcare provider to examine the lining or inside of your esophagus, stomach, and duodenum. This is done using a thin, lighted tube, called an endoscope. The tube has a camera at one end. Once you have been given sedation, the tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. They can also take a small tissue sample (biopsy) if needed.

• Wireless capsule study. This test involves swallowing a wireless capsule (or pill) that collects information as it moves through your digestive system. The capsule sends information to a small computer you wear around your waist or neck. A healthcare provider uses the information to determine how fast or slow food and fluids pass from your stomach to your small and large intestine. You will pass the capsule out of your body with a bowel movement.

• Gastric emptying breath test (GEBT). This test checks stomach emptying by measuring how much carbon dioxide you breathe out over several hours after eating food.

• Scintigraphic gastric accommodation. This test measures your stomach contents before and after a meal. It also checks how well your stomach relaxes after you eat food.

How is gastroparesis treated?

In most cases, gastroparesis is a long-term or chronic health problem. It can’t be cured. But you can manage the disease with a care plan.

If you have diabetes and gastroparesis, the main goal is to control your blood sugar levels. Any medicines that can cause gastroparesis will likely be stopped.

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

Your care plan may include:

• Taking medicines. Your healthcare provider may prescribe a few medicines to see what works best.

• Changing your diet. Changing your eating habits can also help control the disease. In some cases, eating 6 smaller meals a day is more helpful than eating 3 larger ones. Some experts suggest having a few liquid meals a day. They suggest you do this until your blood glucose levels are stable and your gastroparesis is under control. You may also be told not to eat fatty and high-fiber foods. These can slow your digestion and may be hard to digest. See your healthcare provider or a dietitian for the eating plan that is best for you.

• Surgery. In some cases, you may need a type of surgery called a jejunostomy. A feeding tube is inserted through the skin on your abdomen into your small intestine. This tube lets nutrients go right into your small intestine instead of your stomach. This surgery is used only if your gastroparesis is very severe.

• Gastric electrical stimulation (GES). A surgical procedure that implants a device under the skin to deliver mild electrical pulses to the nerves and muscles in the lower stomach. This device may help control nausea and vomiting in those who aren't helped by medicines.

• Feeding by IV (intravenously). This is also called parenteral nutrition. This is when nutrients are put right into your veins. A tube or catheter is put into 1 of your chest veins. The tube has an opening on the outside of your skin. A bag with liquid nutrients or medicine is joined to the tube. The fluids go into your bloodstream through your vein. Parenteral nutrition can be used if other treatments are not helping. It may be used short-term, until you can eat again or until a feeding tube can be placed. In some cases, parenteral nutrition may be long-term.

What are possible complications of gastroparesis?

Gastroparesis can cause other health problems because food moves too slowly through your stomach. These health problems include:

• Having a hard time managing your blood sugar if you have diabetes

• Letting food sit too long in your stomach

• Having hard masses of food (bezoars) build up in your stomach, which can cause upset stomach, vomiting, and block food from passing into your small intestine

• Losing too much weight and not getting enough nutrients (malnutrition)

Living with gastroparesis

Gastroparesis can lead to weight loss and not getting enough nutrients (malnutrition). It's very important to follow your healthcare provider’s diet instructions.

In most cases, you will be given a special diet. This will have foods that are easier to digest and pass through your stomach. You may also be given medicines to take. Follow all instructions carefully.

When should I call my healthcare provider?

Call your healthcare provider or seek medical care right away if your symptoms get worse or if you have new symptoms. Problems such as a stomach blockage or high blood sugar need to be taken care of right away.

Key points about gastroparesis

• Gastroparesis is a stomach disorder. It happens when your stomach takes too long to empty out food.

• The food can also harden into solid masses (bezoars). They may upset your stomach or create a blockage, ulcer, or bleeding in your stomach.

• In most cases, gastroparesis is a long-term (chronic) condition.

• You are more likely to have it if you have type 1 or type 2 diabetes.

• Symptoms may include upset stomach or nausea, vomiting, losing weight, feeling full too soon when eating, belly or abdominal pain or bloating, and heartburn.

• Your care plan may include taking medicines, changing your diet, having surgery to insert a feeding tube in the abdomen, and feeding by IV (intravenously).

• Treatment will not cure gastroparesis, but it can help you manage the disease.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.

• Before your visit, write down questions you want answered.

• Bring someone with you to help you ask questions and remember what your provider tells you.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are and when they should be reported.

• Ask if your condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if you do not take the medicine or have the test or procedure.

• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your provider if you have questions, including after hours and on weekends and holidays.