Gastroparesis is a chronic disorder of the gastrointestinal tract which slows or impedes the movement of food from the stomach to the small intestine. Affecting about 1.5% to 2% of the U.S. population, the disease is more commonly diagnosed in women than men. While no standard cure exists for the condition, relief can be achieved in many cases through a healthy diet and lifestyle modification, medication, and surgery techniques.
UT Physicians gastroenterologist Brooks D. Cash, MD, provided insights into the symptoms, how it is diagnosed, and ways to reduce pain and discomfort.
“The condition is defined by delayed emptying of the stomach. People with gastroparesis commonly exhibit symptoms of nausea and vomiting,” said Cash, who is chief of the Division of Gastroenterology, Hepatology, and Nutrition and Dan and Lillie Sterling Professor in Clinical Gastroenterology with McGovern Medical School at UTHealth Houston. “About two-thirds of people with gastroparesis complain of abdominal pain. Another common symptoms is bloating, or early fullness, where a person is unable to finish meals.”
Cash added that while there are several causes of gastroparesis, one of the most common causes of the disorder is gastrointestinal nerve damage caused by long-standing diabetes and elevated blood sugar.
“Gastroparesis can affect patients with persistently, poorly controlled diabetes. Studies point to a connection with neurologic diabetic complications of prolonged hyperglycemia negatively impacting gastrointestinal motility,” Cash said. “It is often more difficult to treat and control in Type 1 diabetics, which is considered more of an autoimmune condition due to impaired insulin levels. For Type 2, or adult-onset diabetics, it is tied to insulin resistance and often accompanied by medical conditions such as obesity, hypertension, or high cholesterol.”
Other common classifications of gastroparesis include idiopathic gastroparesis, where a cause cannot be determined, and iatrogenic gastroparesis, typically occurring after surgery involving the gastrointestinal tract or abdomen. Popular diabetes and weight loss medications are another increasingly recognized cause of iatrogenic gastroparesis symptoms. These medications work in part because they slow down digestion and stomach emptying.
Because the symptoms of gastroparesis – nausea and abdominal pain – are common in otherwise healthy individuals, acute or temporary symptoms are not necessarily a sign of the disorder. Cash noted that gastroparesis symptoms should be experienced persistently over an extended period and generally with increasing severity for someone with the condition.
“You shouldn’t run to your doctor if you’ve felt bad for just a couple of days. Gastroparesis is a slow, progressive, and complex condition,” Cash explained. “Additionally, once diagnosed, gastroparesis treatment can vary from patient to patient. Like all diseases, symptoms are experienced on a spectrum. Some patients can manage their symptoms with lifestyle modifications, while other patients are affected more severely and require chronic medications and still others can experience repeated hospitalizations.”
The first line of therapy for patients experiencing gastroparesis symptoms is to decrease the size of meals and increase the number of small meals per day to maintain caloric intake. By this method, the digestive work of the stomach is eased before moving food to the small intestine. In addition, for patients with diabetic gastroparesis, optimizing blood glucose levels is another important component of treatment.
Diagnosis, tips for management, surgical treatments
Cash noted that gastroparetic symptoms are often vague, nonspecific, and common to other conditions that affect the upper gastrointestinal tract, and the disease should ideally be assessed by a physician.
“Because of the common nature of gastroparesis symptoms, the initial evaluation typically involves an upper endoscopy examination, which involves passage of a flexible fiber-optic camera though the mouth to examine the upper gastrointestinal tract,” Cash said. “A normal stomach should empty within four hours of a solid food meal. So, if we encounter undigested food in the stomach after a monitored fast, we suspect gastroparesis. The gold standard diagnostic test used to confirm gastroparesis is a four-hour gastric emptying study.”
Cash noted that while other tests can be used, the upper endoscopy and four-hour gastric emptying study are the most widely used diagnostic tests. If the disorder is confirmed, Cash recommends the following tips for management:
- Eat smaller and more frequent meals.
- Diminish fatty food intake, because dietary fat slows digestive motility.
- Lower intake of sugars and work with health care providers to improve blood glucose levels if consistently elevated.
- Avoid highly acidic, spicy, or roughage-heavy foods that are harder for the stomach to digest that may lead to heartburn or regurgitation symptoms.
- Supplement dietary intake with high-calorie, liquid-based meals.
- Remain upright after eating for at least three hours and avoid immediately lying down after a meal.
He added that the gastrointestinal medication can be prescribed. Anti-nausea medications can also be used to relieve symptoms.
“If lifestyle changes or medicinal therapies are unsuccessful in reducing the symptoms of gastroparesis, there are other interventions that can be considered,” Cash said. “One option beyond medications is gastric bypass, a surgery in which a portion of the stomach is removed. Another treatment option that is gaining popularity is a pyloromyotomy, a procedure that involves the interruption of the circular muscle leading from the stomach to the small intestine. A pyloromyotomy can be done via an upper endoscopy or through minimally invasive surgical techniques. There is recent data that suggests combining this procedure with the implantation of a gastric electrical stimulator to increase coordinated stomach contractions may provide additional benefit beyond pyloromyotomy alone.”
If you suspect you have gastroparesis, call 713-572-8122 or 713-704-3450 to schedule an appointment.