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Gastroparesis

Aria Health Center for Gynecology & Women's Health

Gastroparesis is a stomach disorder in which the stomach takes too long in emptying its contents. Stomach muscles become partly or largely paralyzed.

The condition causes problems such as bacterial overgrowth from the fermentation of the food. The food can also harden into solid masses, called bezoars, that may cause nausea, vomiting, and, sometimes, obstruction in the stomach. Such blockages can be dangerous if they block the passage of food into the small intestine.


Causes/risk factors

Most often, this condition is a complication of type-1 diabetes. It can also occur in persons with type 2 diabetes, although not as frequently. Gastroparesis is caused when the vagus nerve, which controls the movement of food through the digestive tract, is damaged or stops working. When this happens, the stomach's ability to move of food is slowed down or stopped. The vagus nerve becomes damaged in persons with diabetes when blood glucose (sugar) levels remain high over a long period of time.

Other causes of gastroparesis include the following:

  • anorexia nervosa;
  • surgery on the stomach or vagus nerve;
  • postviral syndromes;
  • certain medications, particularly those that slow contractions in the intestine;
  • smooth muscle or connective-tissue disorders, such as amyloidosis and scleroderma;
  • diseases of the nervous system, such as abdominal migraine and Parkinson's disease;
  • metabolic disorders, including hypothyroidism.

Not uncommonly, however, no specific cause can be identified.


Signs & symptoms

Common symptoms include:

  • nausea;
  • vomiting;
  • weight loss;
  • feeling full early when eating;
  • and abdominal bloating and/or discomfort.


Diagnosis

In addition to taking a medical history and performing a physical examination, physicians may request the following diagnostic procedures in order to diagnose gastorparesis:

  • blood tests (to check blood counts and measure chemical and electrolyte levels);
  • barium, upper-GI x-ray;
  • barium meal study;
  • gastric-emptying study;
  • gastric manometry;
  • upper endoscopy;
  • or x-ay, ultrasound, or CT.


Treatment

Gastroparesis slows and disrupts the timing of food absorption. Therefore, persons with diabetes should take insulin more often, take insulin after eating instead of before, and check blood glucose levels frequently after eating, administering insulin when necessary.

Gastroparesis is usually a chronic condition, so treatment does not cure it, but rather helps the patient manage the condition. In gastroparesis related to diabetes, the primary goal is to regain control of the blood glucose levels.

Treatments may include:

  • medications. Drugs that serve to increase muscle contractions and motility in the stomach, or those that relieve nausea and vomiting, can be helpful;
  • dietary modifications. Sometimes, eating six smaller meals more frequently during the day is helpful in controlling gastroparesis. Some physicians recommend several liquid meals a day until blood glucose levels are stable and gastroparesis is stable. Your physician may also recommend avoiding fatty and high-fiber foods, as these can slow digestion and be difficult to digest.
  • surgery. Occasionally, when other approaches fail, patients may need to undergo surgery as treatment for gastroparesis. This approach may involve surgeons implanting tubes into the stomach or the small intestine, or modifying the shape of the stomach. See Aria's Division of General Surgery for more on stomach surgery as a treatment for gastroparesis.
  • parenteral nutrition. An alternative to the jejunostomy tube is parenteral nutrition, in which nutrients are delivered directly into the bloodstream, bypassing the digestive system. The physician places a catheter in a chest vein, leaving an opening on the outside of the skin. A bag with liquid nutrients or medication can be attached to the catheter, allowing the fluid to enter the bloodstream through the vein.