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Gastroparesis

 Gastroparesis



Overview



Gastroparesis, which means stomach paralysis, is a condition affecting the nerves and muscles in your stomach. It interferes with the muscle activity (peristalsis) that moves food through your stomach and into your small intestine. When your stomach muscles and nerves can’t activate correctly, your stomach can’t process food or empty itself as it should. This holds up your whole digestive process.


People with gastroparesis have uncomfortable symptoms during digestion, and they can also have longer-lasting side effects. They might have low appetite and trouble meeting their nutritional needs, or trouble controlling their blood sugar. When food finally passes from their stomach, it may not pass completely and may leave some behind. This can develop into a hardened, solid mass called a bezoar.


Symptoms

Signs and symptoms of gastroparesis include:

Vomiting

Nausea

Abdominal bloating

Abdominal pain

A feeling of fullness after eating just a few bites

Vomiting undigested food eaten a few hours earlier

Acid reflux

Changes in blood sugar levels

Lack of appetite

Weight loss and malnutrition

Many people with gastroparesis don't have any noticeable signs and symptoms.


Causes

It's not always clear what leads to gastroparesis, but in some cases it can be caused by damage to a nerve that controls the stomach muscles (vagus nerve).

The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals normally to your stomach muscles. This may cause food to remain in your stomach longer, rather than move into your small intestine to be digested.

The vagus nerve and its branches can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine.


Risk factors

Factors that can increase your risk of gastroparesis:

Diabetes

Abdominal or esophageal surgery

Infection, usually from a virus

Certain medications that slow the rate of stomach emptying, such as narcotic pain medications

Scleroderma — a connective tissue disease

Nervous system diseases, such as Parkinson's disease or multiple sclerosis

Underactive thyroid (hypothyroidism)

Women are more likely to develop gastroparesis than are men.


Complications

Gastroparesis can cause several complications, such as:

Severe dehydration. Ongoing vomiting can cause dehydration.

Malnutrition. Poor appetite can mean you don't take in enough calories, or you may be unable to absorb enough nutrients due to vomiting.

Undigested food that hardens and remains in your stomach. Undigested food in your stomach can harden into a solid mass called a bezoar. Bezoars can cause nausea and vomiting and may be life-threatening if they prevent food from passing into your small intestine.

Unpredictable blood sugar changes. Although gastroparesis doesn't cause diabetes, frequent changes in the rate and amount of food passing into the small bowel can cause erratic changes in blood sugar levels. These variations in blood sugar make diabetes worse. In turn, poor control of blood sugar levels makes gastroparesis worse.

Decreased quality of life. Symptoms can make it difficult to work and keep up with other responsibilities.


Diagnosis

Your doctor will ask about your symptoms and medical history. They'll also do a physical exam. They may order tests including:

Radioisotope gastric-emptying scan (gastric scintigraphy). Your doctor will give you food that contains a very small amount of something radioactive. Then, you lie under a scanning machine. If more than 10% of food is still in your stomach 4 hours after eating, you have gastroparesis.

Blood tests. These can spot dehydration, malnutrition, infection, or blood sugar problems.

Barium X-ray. You'll drink a liquid (barium), which coats your esophagus, stomach, and small intestine and shows up on an X-ray. This is also known as an upper gastrointestinal series or a barium swallow.

Gastric emptying breath tests (13C-GEBTs). This is a nonradioactive test that measures how fast your stomach empties after you eat a meal that has a chemical element called the 13C isotope added to it.

Gastric manometry. Your doctor passes a thin tube through your mouth and into your stomach to check electrical and muscular activity and to figure out how fast you're digesting.

Electrogastrography. This measures electrical activity in your stomach using electrodes on your skin.

The smart pill. You swallow a tiny electronic device that sends information about how fast it's traveling as it moves through your digestive system.

Ultrasound. This imaging test uses sound waves to create pictures of your organs. Your doctor may use it to rule out other diseases.

Upper endoscopy. Your doctor passes a thin tube called an endoscope down your esophagus to look at the lining of your stomach.

Gastroparesis Treatment

Depending on the cause, gastroparesis can be chronic, which means it lasts a long time. You can take steps to manage and control it.

Changes in diet for gastroparesis

Changing your eating habits is one of the best ways to control gastroparesis symptoms. You might try eating six small meals each day rather than three larger ones. This way, you have less food in your stomach and don't feel as full.


Have more liquids and low-residue foods, such as applesauce instead of whole apples. Drink plenty of water and fluids like low-fat broths, soups, juices, and sports drinks. Avoid high-fat foods, which can slow digestion, and high-fiber foods, which are harder to digest.


Make sure you're getting enough of the right nutrition. Your doctor might send you to a dietitian who can help you find foods you like that are easy to digest.


Don't lie down for 2 hours after you eat. Gravity can help your digestion and keep food or acid from traveling into your throat. Gentle exercise like walking can help you feel better.


Get some other ideas for eating with gastroparesis.

Gastroparesis medication


Your doctor might give you medicines including:

Drugs to stimulate your stomach muscles. You take metoclopramide (Reglan) before eating. It causes your stomach muscles to contract and move food along. It also helps with upset stomach and vomiting. Side effects include diarrhea, drowsiness, anxiety, and, rarely, a serious neurological disorder. Erythromycin is an antibiotic that also causes stomach contractions and helps move food out. Side effects include diarrhea and the growth of resistant bacteria if you take it for a long time.

Antiemetics. These drugs—including diphenhydramine (Benadryl and others) and ondansetron (Zofran)—help control nausea. If the nausea and vomiting won't go away, prochlorperazine (Compro) may work.

Other treatments for gastroparesis

If you have diabetes, controlling your blood sugar levels will keep you from having serious problems.

Your doctor might need to give you a feeding tube or jejunostomy tube. They put it in through your belly and into your small intestine. To feed yourself, you'll put nutrients into the tube, and they'll go directly into your small intestine. This way, they skip your stomach and get into your bloodstream faster.

Your doctor can also inject botulinum toxin (such as Botox) into your pylorus, the valve from your stomach to your small intestine. This relaxes the valve, keeping it open for longer so your stomach can empty.

Electrical stimulation uses electrodes attached to your stomach wall to trigger stomach contractions.

In a procedure called per-oral pyloromyotomy, your doctor uses an endoscope to cut your pylorus valve so it's easier for your stomach to empty.

Although surgery can sometimes cause gastroparesis, patients who have obesity and diabetes might have gastric bypass surgery. Your doctor creates a small pouch from the top part of your stomach and attaches it to the lower end of your small intestine. This limits how much food you can eat.


If your case is severe, you might also need intravenous nutrition or parenteral nutrition, in which nutrients go straight into your bloodstream through a catheter in a vein in your chest. Doctors tend to use this for only a short time.


Takeaways

Doctors don't always know what causes gastroparesis, but diabetes is one common cause.

If you have symptoms including nausea, throwing up undigested food, heartburn, and belly pain, let your doctor know so they can do tests to see whether you have gastroparesis.

This condition is treated with drugs that stimulate your stomach muscles so food can more easily go through to your intestines. Your doctor may also suggest you take a medicine to calm your nausea and stop you from vomiting.

Making some changes to the way you eat might help your gastroparesis. Drink plenty of fluids and have several smaller meals instead of two or three bigger ones. Make sure your food is nutritious.


Type of Doctor Department : Gastroenterologist

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