Understanding Gastroparesis: Causes, Symptoms, and Treatment Options

Definition   |   Types of Gastroparesis  |  Prevalence |  Causes  |   Symptoms  | Complications  | Risk Factors   |   Diagnosis   |   Treatment   |   Prevention  |   Note from Dr. Sannoufi

What is gastroparesis?

Gastroparesis, or as some call it “stomach paralysis,” is a challenging condition affecting the nerves and muscles in your stomach. Imagine, a crew of workers whose job is to move food through a factory line – that’s what your stomach normally does. But with gastroparesis, it’s like that crew suddenly goes on strike, and the movement of food through your stomach gets disrupted.

This interruption means your stomach can’t process food as effectively as it should, which can slow down your digestive process significantly. Now, this isn’t simply a problem of slow meal processing – gastroparesis can lead to some uncomfortable symptoms while you’re digesting.

Beyond the immediate discomfort, this condition can also have long-term effects on your overall health. It may lead to poor appetite, making it difficult to get the essential nutrients you need. It can also interfere with the regulation of your blood sugar levels, which is concerning if you’re dealing with diabetes.

In some cases, food doesn’t pass through your stomach completely, leaving behind some residuals. Over time, these can accumulate and harden into what we call a bezoar, which can create even more complications.

We won’t sugarcoat it – living with gastroparesis requires vigilance. It means watching out for potential complications and being proactive about managing your condition. But the silver lining is that with understanding and the right approach, this condition can be effectively managed.

Remember, your path to managing gastroparesis begins with understanding it. And together, we’ll work out a strategy to ensure you’re getting the right nutrition and care to manage this condition and maintain your health.

What are the different types of gastroparesis?

Understanding the different types of gastroparesis can be quite beneficial when it comes to managing this condition. There are several classifications of gastroparesis, based largely on what is the cause.

First, we have diabetic gastroparesis, which happens as a result of diabetes. The high blood sugar levels can sometimes damage the nerves controlling the stomach muscles, leading to this condition.

Then there’s post-surgical gastroparesis, which occurs as a result of a surgical procedure. It’s like the stomach muscles still haven’t woken up from anesthesia, and they’re having trouble getting back to their normal job of digesting food.

Finally, we have idiopathic gastroparesis, where idiopathic essentially means ” any disease or condition which arises spontaneously or for which the cause is unknown”. Although the word idiopathic might sound rather ominous, it’s surprisingly the most common type of gastroparesis, accounting for about 25 to 50 percent of all cases.

But don’t let that term worry you. When we say “idiopathic,” it doesn’t mean that there are no causes. It means that the exact cause is either unknown or varies from person to person.

Among the known causes, diabetes is known to be the most common culprit, accounting for about one-third of diagnosed cases. As healthcare providers, we use these categories to guide us in figuring out the best way to manage and treat your condition, based on its root cause or contributing factors.

How common is gastroparesis?

As we discuss gastroparesis, it’s crucial to understand the prevalence of this condition across the globe. In Canada, approximately 3 to 6 percent of the population experiences the effects of gastroparesis. We also see a higher prevalence in the United States, with about 1.4 percent of people exhibiting symptoms similar to gastroparesis.

In the East, both Japan and Singapore show significantly lower numbers, with around 0.3 percent of their populations affected. The prevalence in the United Kingdom also seems comparatively lower, with roughly 13.8 individuals per 100,000 diagnosed with gastroparesis in 2016.

These variations in global prevalence may be due to differences in diet, lifestyle, healthcare approaches, and genetic factors. Despite these varying numbers, the need for awareness, understanding, and effective management strategies for gastroparesis remains universal.

What causes gastroparesis?

Gastroparesis is a complex condition and it can occur due to a number of different reasons, all of which interfere with the normal functioning of your stomach muscles and nerves.

Let’s look at diabetes. Roughly a third of people with diabetes can develop gastroparesis. High blood sugar levels can be quite damaging to the nerves and blood vessels that supply your stomach, leading to nerve damage and, consequently, gastroparesis.

Now, surgery in or around the stomach can also result in gastroparesis. This is because it can injure the vagus nerve, which is like the master controller for your stomach movements. This is what we refer to as post-surgical gastroparesis, and it can happen right after surgery or even years later.

Infections, especially viral ones like norovirus and rotavirus, can trigger gastroparesis as well. It’s not fully understood whether it’s the infection itself or the body’s immune response that causes the nerve damage.

Autoimmune diseases can also be the culprit. In these cases, the body’s immune system mistakenly sees your own cells, including those in the stomach, as foreign invaders and attacks them, leading to gastroparesis.

Medications and drugs, such as opioids, nicotine, marijuana, and even certain prescribed medications can disrupt nerve signals and temporarily cause gastroparesis.

There are also less common causes such as neurological diseases like Parkinson’s disease, collagen-vascular diseases like scleroderma and lupus, endocrine disorders like thyroid disease and adrenal disorders, and even conditions like cystic fibrosis.

What are the symptoms of gastroparesis?

Gastroparesis is a condition that can disrupt how your stomach processes and moves food. This can lead to a variety of symptoms, particularly affecting your digestive system. Let’s discuss some of the common symptoms you might encounter:

Indigestion, or feeling discomfort while digesting food, is one common sign. You might also experience a bloated stomach, or a sense of fullness and swelling in your abdomen. Another symptom is feeling full very quickly when eating, and this full feeling can persist for quite some time.

Sometimes, there might be discomfort or pain in the upper part of your abdomen, a symptom we generally refer to as upper abdominal pain. Nausea and vomiting can be distressing symptoms, making you feel unwell and leading to episodes of throwing up.

Regurgitation of undigested food might occur, where whole pieces of undigested food are brought back up. Loss of appetite, or not feeling hungry, might also manifest, leading to reduced desire to eat.

Symptoms like acid reflux and heartburn, that burning sensation in your chest or throat, can be part of the gastroparesis symptom profile. In some cases, there may be fluctuations in blood sugar levels, leading to feelings of weakness or dizziness.

Lastly, you might experience constipation, marked by difficulty with bowel movements and feeling ‘backed up’.

But please remember, not everyone with gastroparesis will have all these symptoms. In fact, some people might not experience any noticeable signs at all. If you have ongoing digestive issues, even if your symptoms don’t clearly point towards gastroparesis, it’s good to have a conversation with your doctor.

When to call a doctor

• You experience severe pain or cramping in your abdomen.
• Your blood glucose levels are too high or too low.
• Your vomit contains red blood or materials that resemble coffee grounds.
• You feel light-headedness or fainting.
• You experience signs of severe dehydration like extreme thirst and dry mouth, reduced urination, and dark-colored urine.
• You always feel tired.
• You experience decreased skin turgor, meaning your skin takes longer to return to its normal position after being pinched.

What are complications of gastroparesis?

Patients with gastroparesis face unique challenges to their digestion. It’s important to understand these challenges early on to help manage the condition effectively and ensure overall health.

• Weight Loss, Malnutrition, and Dehydration: Continuous nausea, frequent vomiting, or lack of appetite can lead to significant weight loss and malnutrition. Frequent vomiting can also cause dehydration and deprive your body of essential nutrients. In severe cases, hospitalization might be necessary to ensure proper nutrition and hydration.
• Acid Reflux Problems: Gastroparesis can cause your stomach to bloat, leading to a reflux of stomach acid into your esophagus. This can cause heartburn and potentially inflammation in your esophagus.
• Blood Sugar Fluctuations: Gastroparesis can disrupt the way your body processes food and releases sugar into your bloodstream. This can make the control of blood sugar levels hard. This can be especially challenging if you are diabetic, as it can worsen the symptoms of gastroparesis.
• Bezoars and Blockages: Occasionally, undigested food might form a hard lump in your stomach, known as a bezoar. This mass can grow large enough to obstruct the passage of new food through your stomach. Bezoars can usually be treated with medication to break them down or may require surgical removal in severe cases.

What are the risk factors?

Gastroparesis can be triggered by various factors, and certain individuals are more prone to developing the condition due to specific reasons. Here’s what you need to know:

• Diabetes: If you have diabetes, you are at a higher risk of developing gastroparesis. This is because elevated blood sugar levels can impair the nerves in your stomach.
• Abdominal or Esophageal Surgery: Procedures involving your abdomen or esophagus may increase the likelihood of gastroparesis, as they can potentially injure the nerves that regulate your stomach.
• Infections: Certain infections, particularly viral ones, can contribute to the development of gastroparesis. While the exact mechanism isn’t fully understood, it’s thought that it might be related to the body’s immune response to these infections.
• Medications: Certain medications, such as potent painkillers, that slow the emptying of your stomach can increase your risk of developing gastroparesis.
• Scleroderma: This disease, which impacts the connective tissues in your body, can make you more susceptible to gastroparesis.
• Nervous System Diseases: Conditions that affect your nervous system, like Parkinson’s disease or multiple sclerosis, can increase the risk of gastroparesis.
• Hypothyroidism: An underactive thyroid can slow down many bodily processes, including digestion, increasing the risk of gastroparesis.
• Gender: Women have been found to be more likely to develop gastroparesis compared to men.

Understanding these risk factors can help in the early identification and management of gastroparesis. If you have any of these risk factors and are experiencing digestive issues, it’s crucial to discuss them with your healthcare provider or myself. Together, we can work out the best course of action to manage your symptoms.

How is gastroparesis diagnosed?

Diagnosing gastroparesis can be a complex process due to its complicated nature. Healthcare providers often follow a series of steps to accurately identify it. Here’s an overview:

1. Patient Interview: The first step is a thorough conversation with you, the patient. This involves discussing your symptoms and going over your medical history in detail, noting any conditions or previous surgeries that may predispose you to gastroparesis.

2. Imaging Tests: If the cause isn’t readily apparent from your medical history, we use imaging tests to examine the stomach and surrounding areas. These tests may detect any obstruction in the stomach, and can include an upper endoscopy, capsule endoscopy, upper GI series, CT scan, MRI, or abdominal ultrasound.

3. Gastric Motility Tests: If no physical blockage is found, we proceed to test the functionality of your stomach muscles. Some of these tests may include:

• Gastric Emptying Scintigraphy (GES): This test involves consuming food or drink that contains a minuscule amount of radioactive material. We then monitor how long it takes for the material to exit your stomach.
• Gastric Motility Breath Test (GEBT): This involves eating a special meal that contains a specific form of carbon. We then measure the gases you exhale to understand how food is moving through your digestive system.
• SmartPill™ Wireless Motility Capsule: This entails swallowing a capsule that records and transmits data as it travels through your digestive tract. We then analyze the collected data.

4. Additional Tests: Depending on the outcomes of the initial tests, we may recommend additional tests to pinpoint the root cause of your gastroparesis. For instance, a blood test can reveal antibodies associated with infections or autoimmune conditions.

Using these steps, we can diagnose gastroparesis accurately and formulate a treatment plan that is specific to your situation.

How to treat gastroparesis

In managing gastroparesis, it’s important to note that we can’t directly repair the damage causing the condition. However, we do have treatments that can help your stomach muscles perform better and facilitate proper emptying. Here’s an overview of these options:

1. Medications: Our first line of defense usually involves a group of medications known as prokinetics, which stimulate your digestive system’s movement. Various types of prokinetics include:

• Metoclopramide: This medication, approved by the FDA for gastroparesis treatment, aids in muscle contractions and relieves nausea. However, be aware that it can cause side effects such as tremors and muscle twitching.
• Motilin agonists: Certain antibiotics, such as erythromycin and azithromycin, may also be beneficial in managing gastroparesis.
• Serotonin agonists: Drugs like tegaserod and prucalopride can alleviate constipation and are occasionally prescribed for gastroparesis.
• Dopamine antagonists: Domperidone, a medication that improves stomach movement and reduces nausea by blocking dopamine, a chemical in your body.

Alongside medications, we might consider other treatments. This can include antiemetics to manage nausea and vomiting, proton pump inhibitors for acid reflux, pain relievers for stomach discomfort, and diabetes medications for blood sugar regulation.

2. Nutrition and Hydration Therapy: Making changes to your diet might be necessary – consuming less fat and fiber can ease digestion. In certain cases, implementing special nutrition plans, using dietary supplements, opting for temporary tube feeding, or intravenous (IV) feeding may be warranted. IV fluids can also be utilized to rehydrate your body and balance electrolyte levels.

3. Surgery: If the aforementioned treatments aren’t effective, we may have to consider surgery. There are a variety of surgical options:

• Pyloroplasty: This procedure modifies the lower part of the stomach, the pylorus, to help food empty out more easily. It involves making an incision in the pylorus muscle to relax and widen it. A modern method called G-POEM is performed through the mouth using an endoscope.
• Gastric bypass: In some instances, gastric bypass surgery might be necessary. This entails creating a new pathway for food to bypass a part of the stomach and reach the small intestine directly.

4. Treatment of the Underlying Condition: Lastly, we’ll also focus on managing any conditions causing gastroparesis, if possible, to prevent further complications.

It’s important to remember that everyone’s body reacts uniquely to these treatments, and there may be side effects. Collaborating closely with your healthcare providers will ensure you receive the most appropriate and safest treatment plan for your condition.

People Also Ask

What is the common cause of gastroparesis?

Diabetes holds the unfortunate distinction of being the most common identifiable cause of gastroparesis. It wields this negative influence by damaging key nerves in your stomach, specifically, the vagus nerve.

The vagus nerve plays a vital role in managing the complex dance of muscles in your stomach, orchestrating the rhythmic contractions that propel food through your digestive tract. When diabetes takes a toll on this essential nerve, it can disrupt this crucial process, leading to the slow emptying that characterizes gastroparesis.

In addition, diabetes can also affect special cells found within your stomach’s wall. These are known as pacemaker cells, named after their role in setting the tempo for your stomach’s muscle activity, much like a metronome keeps time in music. If these cells are damaged, the result can be a poorly coordinated and sluggish digestive system.

How do you know if you have gastroparesis?

To diagnose gastroparesis, several tests can be utilized:

• Lab Tests: These basic tests involve analyzing your blood, urine, or stool to exclude other potential health issues.
• Upper Gastrointestinal (GI) Endoscopy: This involves using a long, flexible tube with a camera to examine your upper digestive system.
• Imaging Tests: These tests, like ultrasounds or CT scans, provide detailed images of your digestive tract.
• Stomach Emptying Tests: These measure how quickly your stomach empties its contents, which can aid in diagnosing gastroparesis.

These tests give a comprehensive picture of your condition, assisting in planning the most effective treatment.

How does gastroparesis go away?

While it’s true that there isn’t a complete cure for gastroparesis at the moment, rest assured that there are effective ways to manage its symptoms and significantly improve your quality of life.

• Nutrition and Diet: Making adjustments to your diet plays a vital role in managing gastroparesis. Consuming smaller, more frequent meals, drinking plenty of fluids, and ensuring your food is cooked well can all help. You may also need to limit your intake of fatty and fibrous foods, as these tend to slow down digestion.
• Medication: Medications can be used to stimulate your stomach muscles, helping them to move food along more efficiently. Others can help control symptoms like nausea and vomiting. It’s essential to note that everyone reacts differently to medications, so your healthcare provider will work closely with you to find the right balance.

Living with gastroparesis certainly poses challenges, but by working closely with your healthcare provider, adjusting your diet, and taking prescribed medication, you can significantly ease your symptoms and improve your daily living.

Can you still eat with gastroparesis?

Living with gastroparesis means you may need to adjust your eating habits, and I assure you that these changes can significantly ease your symptoms and improve your overall health. Here are some guidelines to help you along the way:

• Small, Frequent Meals: Instead of the traditional three large meals, aim for five to eight small meals throughout the day. This approach helps your stomach process food more easily, reducing the likelihood of discomfort and other symptoms.
• Chew Thoroughly: Take time to savor and chew your food thoroughly before swallowing. Not only does this aid digestion, but it also ensures you’re taking in all the flavors and textures of your meal, making eating a more enjoyable experience.
• Prioritize Nutrient-Rich Foods: Begin your meals with nutrient-dense foods to ensure your body receives the vital nutrients it needs for proper functioning. This can mean lean proteins, fruits and vegetables, or whole grains, depending on your specific dietary needs and tolerances.
• Avoid Empty Calories: Try to steer clear of foods that are high in calories but low in nutritional value. These foods can fill you up without providing the nourishment your body requires.

It’s crucial to remember that every individual’s experience with gastroparesis is different, and what works well for one person may not work for another. It’s always a good idea to keep an open dialogue with your healthcare provider to determine the best dietary plan for your unique situation.

A note from Dr. Sannoufi

We understand that living with gastroparesis can be challenging. It can affect your daily routine and even disrupt your plans. We want you to know that while there’s no magic bullet for instant relief, there’s a variety of treatment options we can explore together to help manage your condition effectively.

We want to assure you that the medical community is always seeking new and better ways to manage gastroparesis. Science is continually evolving, and new approaches to treating gastroparesis are being explored and tested all the time. We know living with gastroparesis can be tough, but please remember, you’re not alone in this journey.

Together, we can tackle this and help improve your quality of life.

Here’s to a safe, cool, and vibrant summer!

Where can I learn more about gastroparesis?

• International Foundation for Gastrointestinal Disorders. (https://aboutgastroparesis.org)
• Canadian Digestive Health Foundation. (https://cdhf.ca/en/digestive-conditions/gastroparesis/)
• Canadian Society of Intestinal Research (https://badgut.org/information-centre/a-z-digestive-topics/gastroparesis/)
• Canadian Medical Association Journal (https://www.cmaj.ca/content/195/10/E372)
• National Organization for Rare Disorders (https://rarediseases.org/rare-diseases/gastroparesis/)