Gastroparesis

What is Gastroparesis?

Gastroparesis (GP), also known as Delayed Gastric Emptying, is a gastric motility disorder in which the movement of food through the stomach is delayed or halted. Gastric motility refers to the movement of the stomach muscles, which normally pushes food through the digestive tract. When food does not properly move through the stomach, a variety of symptoms can result ranging from mild to severe. 

Symptoms

 

Symptoms of gastroparesis can vary from person to person. Some individuals experience symptoms on a daily basis, while others find that their symptoms come in cycles or flares with fairly normal gastric functioning in between.

Common symptoms include

  • Nausea

  • Vomiting, including vomiting up undigested food eaten a few hours earlier

  • Dehydration from repetitive vomiting

  • Feeling full after eating a few bites

  • Bloating in the abdomen

  • Abdominal pain

  • Acid reflux

  • Fluctuating blood sugar levels

  • Lack of appetite

  • Weight loss and malnutrition

Causes

 

The cause of Gastroparesis is not always able to be identified. For some individuals, there is no known cause and the diagnosis of Idiopathic Gastroparesis (IG) is given. In some cases, damage to the vagus nerve, which controls bodily functions of digestion, heart rate, respiration, and reflexes such as coughing, swallowing, and vomiting, results in gastroparesis. When the nerve is damaged, or not functioning properly, signals to the gut can be interrupted, resulting in food moving more slowly through the digestive tract. Diseases such as diabetes, surgical damage, and even autonomic disorders, can result in dysfunction of the vagus nerve, causing gastroparesis. Risk factors of developing GP include Median Arcuate Ligament Syndrome (MALS), viral infections, medications that slow gastric emptying, amyloidosis, scleroderma, multiple sclerosis, Parkinson’s, and hypothyroidism. 

 

 

Treatment

As there is no cure for gastroparesis, treatment focuses on symptoms management depending on the severity of the gastric delay. Mild GP symptoms can usually be controlled through dietary changes and avoidance of medications that delay gastric emptying, such as narcotics. More information on dietary changes can be found below. 

 

For gastroparesis that is not controlled through dietary changes, medications that increase gastric motility can be used such as Reglan (metoclopramide), Motilium (domperidone), Motegrity (prucalopride), and others. Additional medications are also used to help relieve specific symptoms of nausea, abdominal pain, bloating, and more. Newer, experimental treatments such as botox injections into the pyloric sphincter or gastric stimulators have also been used after traditional treatments have failed. For severe symptoms of GP resulting in gastric failure, individuals may need tube feeding, intravenous fluids, medications, nutrition, and/or surgery. Treatment is individualized and should be discussed with the provider and routinely monitored and managed. 

Dietary Changes

Many patients with mild to moderate gastroparesis find relief by maintaining a low fat, low fiber diet. Fats and fiber take more time for the stomach to digest, so reducing or removing them from one’s diet may alleviate symptoms. Eating soft or blended foods such as soups, smoothies, or mashed potatoes may also bring relief as it preemptively mechanically breaks down the food, making the stomach’s job easier. Maintaining good nutrition is paramount, so patients must eat more nutritious foods first before filling up on unhealthier foods. Some patients find that supplementing with liquid nutrition helps them maintain a balanced diet while reducing symptoms. More thorough gastroparesis diet guides have been published by the Cleveland Clinic, the University of Virginia, the Mayo Clinic, and other institutions. Please discuss any diet plans and changes with your provider. Asking for a consult with a Registered Dietician can also help an individual tailor a diet plan for their particular needs. 

Additional Resources:​

Breit, S., Kupferberg, A., Rogler, G., & Hasler, G. (2018). The Vagus Nerve as Modulator of the Brain-Gut Axis in Psychiatric and Inflammatory Disorders. Frontiers in Psychiatry. 9, 44. doi: 10.3389/fpsyt.2018.00044

 

Cleveland Clinic. (2020). Gastroparesis

https://my.clevelandclinic.org/departments/digestive/depts/gastroparesis

 

Cleveland Clinic. (2017). Median Arcuate Ligament Syndrome (MALS). 

https://my.clevelandclinic.org/health/diseases/16635-median-arcuate-ligament-syndrome-mals#:~:text=Median%20arcuate%20ligament%20syndrome%20(MALS)%20is%20a%20condition%20in%20which,the%20area%20(celiac%20plexus).

 

Healthline. (2016). Type 2 Diabetes and Gastroparesis. https://www.healthline.com/health/type-2-diabetes/gastroparesis

 

Mayo Clinic. (2019). Gastroparesis

https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787

 

National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Gastroparesis. U.S. Department of Health and Human Services. https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis

 

National Organization for Rare Disorders. (2012). Gastroparesis. https://rarediseases.org/rare-diseases/gastroparesis/

Image Source: 

 

Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436.

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