Diseases: Stomach and Duodenum: Gastroparesis
In this group of uncommon disorders, patients suffer from symptoms which are suggestive of blockage (obstruction) of the stomach, yet investigations show no evidence of a mechanical blockage. The underlying problem is disturbance of the hormonal and nervous control of stomach emptying.
In most cases the cause is unknown. The most common identifiable cause is long-standing diabetes, which causes damage to the nerves supplying the stomach. Other neurological disorders which affect these nerves can also lead to delayed stomach emptying. Certain medications may also slow stomach emptying, e.g. powerful narcotic pain killers. A minority of cases may result from an acute viral infection of the stomach, often in children.
Nausea, vomiting after meals, lack of appetite (anorexia), bloating and early satiety (feeling full after only a small amount of food) are the key symptoms. Abdominal pain may also be present. Because of inability to eat properly, weight loss also occurs and in diabetic patients these problems may interfere with control of blood sugar levels.
How is gastroparesis diagnosed?
The diagnosis is usually suspected from the characteristic symptoms but investigations are necessary to rule out mechanical blockage in the stomach or duodenum and to exclude other problems such as a peptic ulcer or stomach tumor. At endoscopy there may be a lot of fluid and food residue in the stomach even though the patient has fasted properly for the procedure. Normally, the stomach is seen to undergo regular muscular contractions during endoscopy and these may be weak or absent in patients with this problem. Endoscopy also confirms that the exit from the stomach to duodenum (pylorus) is open and that no blockage exists.
Barium x-rays (an upper GI series) may also be useful as the radiologist can observe stomach contractions and watch the flow of barium as it passes through and out of the stomach.
To confirm the diagnosis it is possible to perform a gastric emptying study. In this test patients are given a standardized test meal (for example scrambled eggs) which contains tiny amounts of a harmless radioisotope and drink containing a different radioisotope. Using a special camera, it is possible to measure the rate at which both solids and liquids are emptied from the stomach and determine whether a significant delay in gastric emptying is present or not. Other tests are also performed to try to establish the underlying cause.
What treatments are available for gastroparesis?
Gastroparesis can be a very difficult problem to treat. In a few cases which may be viral in origin, the symptoms often slowly improve and disappear over six months to two years. In other cases, including those resulting from diabetes, the problem may be irreversible. Careful assessment by a dietitian helps to ensure that patients receive adequate nutrition. Small, frequent meals are generally advised and a low fat diet may be helpful as fat slows down gastric emptying. A low-fiber diet may reduce the feeling of bloating.
Several medications (“prokinetics”) are available which help the stomach empty faster. and these include Metoclopramide, Domperidone and Cisapride. One side-effect of the antibiotic erythromycin is rapid gastric emptying and this drug has been used with some success in treating patients with gastroparesis. Not all patients respond to these medications but they are certainly worth trying. Medications to alleviate nausea may also help symptoms as will strict control of blood sugar levels in diabetic patients.
Surgery is not helpful in management of this disorder but sometimes patients with very severe problems benefit from placement of a feeding tube into the small intestine (jejunostomy). People suffering from this distressing problem require close support from family, friends and physicians alike.