Is your stomach having trouble digesting food? Let's talk about gastroparesis!

Do you often feel a stomachache, a feeling of fullness after eating, or a feeling of fullness even after eating a small amount? Do you sometimes feel nauseous or vomit? Then it is very important for you to be aware of this condition called gastroparesis . Let's talk about it simply, in a way that you can understand.

What is gastroparesis? Simply put…

The word gastroparesis means “stomach failure.” To be precise, it’s a condition that affects the nerves and muscles in your stomach. The muscles in your stomach contract and relax in a special way to move the food you eat from your stomach to your small intestine. This is called peristalsis. So, in a person with gastroparesis, the muscles and nerves in your stomach don’t work properly, so food gets stuck in your stomach and doesn’t empty properly. This disrupts the entire digestive process.

Think of it like a water motor. If the switch on the motor doesn't work, or if there's something wrong with the motor itself, the water won't go into the tank. That's how the stomach works.

People with this condition have a lot of difficulty digesting food. In addition, there can be long-term side effects. These can include loss of appetite, malnutrition, and difficulty controlling blood sugar levels. Sometimes, even though food passes through the stomach, it may not be completely emptied, leaving behind pieces of food. These remaining pieces of food can accumulate and harden like stones, forming a hard mass called a bezoar.

Are there different types of gastroparesis?

Yes, doctors usually classify this condition by cause.

• Diabetes -related Gastroparesis: This can develop as a side effect in people with diabetes mellitus.
• Post-surgical Gastroparesis: It can also occur as a complication after stomach surgery.
• Idiopathic Gastroparesis: Sometimes no clear cause can be found. This is called idiopathic gastroparesis.

What is the most common type?

Most cases (about a quarter to a half) of gastroparesis are classified as idiopathic . This means that doctors have not been able to find a specific cause. However, in some cases that fall into this category, there may be a cause that has not been identified. Diabetes is the single most important cause of this condition. About a third of patients develop the condition in connection with diabetes.

What are the symptoms of gastroparesis?

In this case, you may experience one or more of the following symptoms:

• Indigestion: A condition in which food is not digested.
• Bloated stomach: Feeling as if the stomach is bloated.
• Feeling full quickly and for a long time: Even eating a small amount of food can make you feel full, and that feeling of fullness can last for hours. Imagine eating a small amount of rice in the morning and feeling full until noon.
• Upper abdominal pain: Pain in the upper part of the stomach .
• Nausea and vomiting : Sometimes undigested food particles may come out.
• Regurgitating whole pieces of undigested food: Like a parrot regurgitating food.
• Loss of appetite .
• Acid reflux and heartburn.
• Abnormal changes in blood sugar levels (Blood sugar fluctuations).
• Constipation .

How does it feel to have gastroparesis?

When your stomach muscles don't work properly, food stays in your stomach for a long time after you eat. You may feel full as soon as you start eating, and that feeling may last for a long time. You may experience stomach cramps, nausea, and vomiting. Your stomach may feel bloated and tight. You may also experience heartburn due to acid reflux.

Is this a painful condition?

Gastroparesis symptoms vary from person to person. A small number of people report persistent stomach pain that is so severe that they are unable to perform daily activities. However, there does not seem to be a strong correlation between the amount of pain people experience, the severity of their gastroparesis, or the speed at which their stomach empties. Some people may experience more pain, possibly because their nerves are more sensitive. This may also be related to the cause of the gastroparesis.

How does gastroparesis affect bowel movements?

Because gastroparesis slows down your entire digestive process, it can also delay your bowel movements. Also, large, undigested food particles can get stuck in your intestines, making it difficult to pass. Although gastroparesis doesn't directly affect the movement of the muscles in your intestines, some of the conditions that cause this condition can also affect your intestines. That's why some people can have gastroparesis and constipation at the same time.

What is the main cause of gastroparesis?

Simply put, gastroparesis is caused by damage to the nerves that control your stomach muscles. Rarely, the muscles themselves can also be damaged. However, the end result is that the muscle contractions that grind food in the stomach and then push it out are weakened. This can lead to digestive problems and delayed gastric emptying – meaning food stays in the stomach for too long.

What are the specific causes of gastroparesis?

Here are some of the reasons that have been identified:

1. Diabetes (Diabetes Mellitus)

About a third of people with diabetes develop gastroparesis. This is called diabetes-related neuropathy. When blood sugar levels are high for a long time, the nerves are damaged. Also, high blood sugar levels damage the blood vessels that carry oxygen to the tissues. So it affects both the nerves and muscles of the stomach.

2. Surgery

Surgery on or near your stomach can damage the vagus nerve, which runs through your stomach and coordinates its movements. This condition can occur at any time after surgery. It can happen right away, or it can happen months or years later. Some surgeries that can cause this include:

• Nissen fundoplication
• Gastrectomy (removal of part or all of the stomach)
• Pancreatectomy (removal of part or all of the pancreas)
• Vagotomy (cutting the vagus nerve)
• Cholecystectomy (removal of the gallbladder)

3. Infections

Gastrointestinal infections, especially viral infections (e.g., norovirus, rotavirus) and some bacterial infections, can also cause gastroparesis. Scientists are still not sure whether these infections directly damage the nerves, or whether immune cells that are fighting the infection mistakenly damage the nerves.

4. Autoimmune diseases

In autoimmune diseases, our body's immune system attacks our own cells by producing antibodies (autoantibodies). New research shows that these autoantibodies can damage the nerves in the stomach. You can develop gastroparesis even if you don't have other autoimmune symptoms, or if those symptoms aren't related to the stomach.

5. Drugs

Some medications and drugs can block the nerve signals that control the stomach muscles. This can cause temporary gastroparesis. Some of these medications may also be prescribed for other conditions that are associated with gastroparesis (such as diabetes). If you already have gastroparesis, or have had it in the past, you should avoid these medications. Examples:

• Opioids (narcotics)
• Nicotine (contained in tobacco)
• Marijuana (Hemp)
• Tricyclic antidepressants
• Progesterone (a hormone)
• Allergy medications such as antihistamines (Anticholinergics)
• Calcium channel blockers for high blood pressure
• Amylin analogs / GLP-1 antagonists for type 2 diabetes
• Cyclosporine (a drug given to prevent rejection during organ transplants)
• Clonidine (a medicine for high blood pressure)
• Lithium (a medication for bipolar disorder)
• Some medications for mental illness (Antipsychotic medications)

6. Other reasons

Other causes that rarely affect:

• Neurological diseases: Diseases that affect the nervous system, such as Parkinson's disease, multiple sclerosis, and autonomic dysfunction, can cause the nerves in the stomach to become dysfunctional.
• Collagen-vascular diseases: Chronic inflammatory connective tissue diseases such as amyloidosis, scleroderma, lupus, and Ehlers-Danlos syndrome can cause weakness of the stomach muscles.
• Endocrine disorders: Conditions such as thyroid disease, adrenal disorders, electrolyte imbalances, and kidney failure can cause chemical damage to the nerves.
• Cystic fibrosis: This disease causes mucus (a mucus-like substance) to build up in the digestive tract, slowing down the entire system. It is estimated that about one-third of people with this disease have gastroparesis.

What are the possible complications of gastroparesis?

This condition can cause various complications, including:

• Weight loss, malnutrition, and dehydration: Persistent nausea, vomiting, and loss of appetite can lead to weight loss and nutritional deficiencies. Frequent vomiting can lead to dehydration and electrolyte (body salt) deficiencies. You may need to be hospitalized and given nutritional therapy and saline.
• Complications related to acid reflux: Because the stomach is swollen due to gastroparesis, it is easy for stomach acid to come up into the esophagus . This continued reflux can damage the esophagus . For example, heartburn and esophagitis .
• Blood sugar complications: Gastroparesis disrupts the regular, controlled process by which food moves through the digestive tract. This disrupts the regular release of glucose (sugar) into the bloodstream. When food remains in the stomach for too long, blood sugar levels can drop. When food is released suddenly, blood sugar levels can spike. This type of blood sugar fluctuation is especially problematic for people with diabetes, and it can make gastroparesis worse.
• Bezoar and Gastric Outlet Obstruction: A bezoar is a hard, solid lump of food that has become stuck in the stomach. It is formed from the pieces of food left over when the stomach empties. Sometimes, the bezoar can become too large to pass through the outlet at the bottom of the stomach. It can also block the passage of other food. Doctors can give you medicine to dissolve the bezoar, or they can remove it surgically.

How is Gastroparesis diagnosed?

A doctor will first ask you about your symptoms and your medical history (conditions that may cause gastroparesis, surgeries). Then, they will do some special imaging tests to look inside your stomach. These tests look for any physical blockages, as these can cause the same symptoms. If no blockages are found, they will then do gastric motility tests . These tests look at how your stomach muscles are working.

What tests are done to diagnose gastroparesis?

The first thing you will do is run tests to see if there is any blockage causing your symptoms. These include:

• Upper endoscopy: A procedure in which a small camera is inserted through the mouth to look at the stomach.
• Upper GI series: An X-ray taken after drinking a substance such as barium.
• CT scan
• MRI `(MRI)`
• Abdominal ultrasound

If these tests do not find a physical blockage, the next step is gastric emptying studies, which measure the movement of the stomach. These may include:

• Gastric emptying scintigraphy (GES): This is a nuclear medicine test. You are given a small amount of food or drink mixed with a radioactive substance, and the time it takes for it to pass through your digestive system is recorded.
• Gastric motility breath test (GEBT): This measures the speed at which food moves through your digestive system by measuring the amount of air you breathe out. This involves you eating a food that contains a special carbon molecule called ``carbon-13''. When it enters your intestines, it produces a special type of carbon dioxide ``CO2-13'', which can be measured in your breath.
• Colon transit study: This tests how quickly food moves through the large intestine . This involves swallowing small pellets that can be seen on an X-ray as they pass through the body.

If your GES test results are abnormal, your doctor may order an electrogastrogram (EGG) , which measures the electrical activity of the stomach muscles.

Other tests may be done to find the cause of gastroparesis. For example, a blood test can look for antibodies left over from a previous infection, or autoantibodies, which may indicate an autoimmune disease.

What are the treatments for gastroparesis?

Doctors cannot directly repair the damage caused by gastroparesis. However, they can provide treatments that stimulate the muscles in the stomach to contract and help it empty. Medications are the first line of treatment. If medications don't work or if they're not available, surgery is considered. All treatments can have side effects, and no one treatment works for everyone.

The goals of treatment are:

• Stimulating the stomach muscles and/or allowing the stomach to empty.
• Make sure your body gets the nutrition and water it needs.
• Managing symptoms and side effects.
• If possible, manage the cause of the disease and prevent the condition from getting worse.

Your treatment plan may include:

• Medicines.
• Nutritional/hydrotherapy.
• Surgery.
• Specific treatment for the condition causing your gastroparesis.

Medications

Prokinetics, a class of drugs that stimulate the movement of the digestive tract, are the first-line treatment for gastroparesis. They include:

• Metoclopramide: This is the only drug approved by the FDA (Food and Drug Administration) to treat gastroparesis. It stimulates muscle contractions in the stomach and helps reduce nausea. However, it can cause side effects (e.g., tremors, muscle twitching), so special care should be taken with it.
• Motilin agonists: These are another type of prokinetic medication. Examples include Erythromycin and Azithromycin . Although these are commonly used as antibiotics, doctors also recommend them to treat gastroparesis.
• Serotonin agonists: Tegaserod and Prucalopride are two medications that stimulate the intestines to improve constipation. Although they have not been fully evaluated for the treatment of gastroparesis, some doctors recommend them for this purpose.

Additional medications:

• Antiemetics control nausea and vomiting.
• Proton pump inhibitors for acid reflux problems.
• Painkillers for significant stomach pain.
• Diabetes medications to control blood sugar levels.

Important: Do not self-medicate with any of these medications without medical advice. Always consult a doctor and take medications only on their recommendation.

Nutrition

You may need to change your diet. For example, eat a low-fiber, low-fat diet to make it easier to digest. You may also need special nutritional therapy to help replace lost nutrients. Your doctor may recommend nutritional supplements, or temporarily give you tube feeding or IV feeding. Some people may also need to have saline solution given intravenously to correct dehydration and electrolyte imbalances.

Surgery

Surgery is the last resort for treating gastroparesis. If all other treatments fail, you may need to have surgery to change the shape of your stomach to help food pass through it. These surgeries include:

• Pyloroplasty: This involves changing your pylorus (the muscular valve at the bottom of your stomach that allows food to pass through). Most often, the pylorus muscle is cut, the opening is enlarged, and the opening is relaxed. A newer procedure is a procedure called G-POEM (gastric peroral endoscopic myotomy) . This means that the surgery is performed through the mouth, without cutting into the stomach.
• Gastric bypass: Some people need to bypass the lower part of the stomach completely. This involves removing or closing off part of the stomach, creating a new passage from the stomach to the small intestine (gastrojejunostomy). Gastric bypass surgery is a weight loss surgery, especially for people with type 2 diabetes caused by obesity. It can have a significant impact on both diabetes and gastroparesis. Your doctor may recommend it for severe diabetes-related gastroparesis.

What is the outlook for gastroparesis?

Sometimes, gastroparesis caused by short-term medication or a short-term infection will get better over time. But for most people, gastroparesis is a condition that cannot be cured, but can be managed with treatment. It may take some time to find the right treatment for you, and you may have side effects from treatment or ongoing symptoms. Your doctor can help you manage these as they develop.

Does Gastroparesis affect lifespan?

Gastroparesis is usually not life-threatening. However, some of the complications that can occur with gastroparesis (malnutrition, dehydration, electrolyte imbalances, and blood sugar fluctuations in diabetes) can be life-threatening if they become severe. Your doctor will work with you to minimize the risk of these complications. With proper treatment, the risk is very low.

How do I take care of myself while living with gastroparesis?

Pay attention to your symptoms, and what foods and habits make them better or worse. Small changes can make a big difference in how you feel. Some people find these things helpful:

• Instead of eating three main meals a day, eat four to six small meals.
• Follow a low-fat, low-fiber diet (gastroparesis diet). Ask your doctor or nutritionist about this.
• Avoid alcohol, tobacco, and drugs. These delay stomach emptying.
• After eating, do some light exercise, such as a short walk. This will help with bowel movements.

Gastroparesis can range from mild to severe, and the way it affects your quality of life can vary. While there is no quick cure, there are many treatments that can help you manage it. Your doctor will work closely with you to find the best treatment plan for you. You may also find that making dietary and lifestyle changes can help. In the meantime, scientists are continuing to research new treatments.

Take-Home Message

Gastroparesis is a condition in which the stomach does not empty properly, but instead fills up. This can be caused by a number of factors, including diabetes and surgery. It is important to seek medical advice if you experience symptoms such as bloating, nausea, vomiting, or stomach pain .

Don't worry, this condition can be managed. With the right diagnosis and treatment, you have the opportunity to live a normal life. Follow your doctor's instructions carefully, and be mindful of your diet and lifestyle.