What is Delayed Gastric Emptying gastroparesis?

Also known as Gastroparesis, Delayed Gastric Emptying is a term used for paralysis of the stomach, referring to a condition that affects the nerves and muscles in your stomach and interferes with muscle activity (called peristalsis) that propels food down your stomach and into your small intestine. If the stomach's nerves and muscles fail to activate appropriately, food fails to undergo the process in the stomach. It clogs the entire digestive process.

People with gastroparesis experience uncomfortable symptoms during digestion, but they may also have effects that persist longer. Appetite can decrease, making it difficult for people to meet their nutritional needs, and blood sugar levels can sometimes become difficult to control. Finally, when the food leaves the stomach, it may only be partially digested, eventually forming a hard, solid mass called a bezoar.

What are the different types of gastroparesis?

Healthcare providers usually classify gastroparesis into subtypes based on the cause. For example, gastroparesis that is due to an adverse effect caused by diabetes is usually called diabetes-related gastroparesis. Gastroparesis resulting from surgery is generally called post-surgical gastroparesis. Idiopathic gastroparesis is the name given to those cases where no cause is determined.

Which type of gastroparesis is most common?

Most cases of gastroparesis (from 25% to 50%) have no identifiable reason, which makes them idiopathic, meaning that no cause was clear. Setting aside these cases, reasons might include known causes, readily determinable causes, and unknown causes altogether. The most common single cause of gastroparesis is diabetes, with about a third of cases attributed to diabetes-related factors.

Symptoms & Causes

What are the symptoms of gastroparesis?

Frequent symptoms include:-

• Indigestion.
• A feeling of fullness in the stomach.
• Feeling full very early and/or late into the meal.
• Pain in the upper abdomen.
• Nausea; vomiting.
• Regurgitating entire pieces of undigested food.
• Increased appetite.
• Reflux and heartburn.
• Blood sugar fluctuations.

What does gastroparesis feel like?

It feels like food sitting in the stomach, undigested. Food stays in the stomach too long. Eating can make you feel full immediately or for a long time. Another effect includes stomach aching, maybe nausea, or vomiting. Your stomach may feel distended or bloated; acid reflux may accompany this. It feels just like heartburn when the acid from your stomach refluxes into your esophagus.

Is gastroparesis painful?

Symptoms of gastroparesis can vary between affected persons. A small proportion of individuals may report a constant abdominal pain that interferes with their day-to-day activities. However, there appears to be no relationship between the intensity of pain that a person feels and the severity of their gastroparesis or the rate of emptying of their stomach. Some people may have to endure more pain because their nerves are hypersensitized. It could be the cause of their gastroparesis condition.

How does gastroparesis influence one's bowel movement (feces)?

Gastroparesis slows the entire digestive process, potentially delaying bowel movements. It can also supply or deliver large, undigested pieces of food into your intestines that are more difficult to pass through. Though gastroparesis generally does not affect intestinal muscle movements, some conditions that cause gastroparesis might, leading some people to have both gastroparesis and constipation at the same time.

What is the cause of gastroparesis?

The primary causative agent in gastroparesis is damage to the nerves that activate the muscles of the stomach. Rarely are damaged muscles attributed to the cause. Overall, the result is impaired muscle contractions that churn food in the stomach and squeeze it through the bottom. Therefore, there are cases in which food sits poorly in the stomach, causing indigestion and delayed gastric emptying.

Problems around gastroparesis would include complications around weight loss, malnutrition, and dehydration.

Chronic nausea and vomiting, or loss of appetite, can cause a gradual decrease in body weight and a nutrient-poor condition. Constant vomiting may deplete acids and fluids in the body, which might lead to hospital admission for more nutritional therapy and fluid replacement in case of severe dehydration.

Acid reflux complications

Gastroparesis leads to abdominal distension; the distension allows acidic gastric juice to reclaim the esophagus through the upper part of the stomach. Chronic reflux may then lead to complications in the esophagus, including heartburn and acute inflammation (esophagitis).

Blood sugar complications

Gastroparesis disrupts the controlled, timed release of gastric contents through the digestive system. Hence, the synchronized release of glucose into the bloodstream gets impacted. Thus, glucose levels are affected when food stays in the stomach for too long, resulting in hypoglycemia; when it finally empties, it results in hyperglycemia. Variance in these blood sugar levels can complicate the existing situation of someone with diabetes further.

Bezoars & gastric outlet obstruction

Bezoars are hardened lumps of food stuck somewhere in the stomach, composed of leftover particles, usually hard, resisting dissolution, and subsequently emptied from the stomach. A bezoar may become large enough to impede passage through the outlet at the bottom of the stomach; it may even block it, thereby obstructing the passage of other food particles. Bezoars will be treated medically with dissolving agents or surgically removed if necessary.

Diagnosis & Tests

How is gastroparesis diagnosed?

Your healthcare provider who suspects gastroparesis will take a history of symptoms and medical conditions associated with gastroparesis. The next step is to obtain imaging tests to visualize the inside of your stomach better and rule out any obstruction or other causes of these symptoms. If doctors find no obstruction, they'll proceed with gastric motility tests that assess the muscle activity of your stomach.

What tests are necessary to diagnose gastroparesis?

The first step is to undergo imaging tests to rule out an obstruction as the etiology for your symptoms. These tests could include:-

• Upper endoscopy.
• Upper GI series.
• CT scan.
• MRI.
• Abdominal ultrasound.

If there is no obstruction, the next step would involve gastric emptying studies to assess gastric motility. It could include:-

• Gastric emptying scintigraphy (GES). Gastric emptying scintigraphy is a nuclear medicine imaging test that tracks the path of a meal or liquid through your gastrointestinal tract and records how long it takes by incorporating a small amount of radioactive material into a meal or liquid you take, then scanning it periodically.
• Gastric motility breath test (GEBT). With this test, the progression of a meal through your digestive system is easy to track by measuring the gases produced in your breath. In this test, you eat a specialized meal that contains a specified carbon atom (carbon-13) that makes a measured form of CO2 (carbon dioxide-13). After the meal reaches your intestines, this gas will show up in your breath.
• The colon transit study. It measures how quickly food moves through your colon (large intestine) by swallowing small capsules that are easy to scan via X-ray as they pass through your body.

If your GES test shows abnormalities, your physician may recommend an electrogastrogram (EGG), a diagnostic test that counts the electrical activity of your stomach muscles.

You might have other tests to identify the cause of your gastroparesis. For instance, a blood test might detect antibodies from a previous infection or autoantibodies that could indicate certain autoimmune diseases.

Management & Treatment

What treatment is available for gastroparesis?

Doctors and healthcare providers cannot directly treat the underlying cause of gastroparesis; they can, however, treat the symptoms by stimulating stomach muscle contractions and encouraging emptying. Medical management is the first-line treatment; surgery applies to those who do not respond to medications or are unable to take them. Side effects from these treatments are a possibility, and none of them is a catchall for any patient.

Treatment aims at these goals:-

• Stimulating your stomach muscles and/or facilitating stomach emptying.
• Ensuring your body receives the nutrition and hydration it needs.
• Controlling symptoms and side effects of the condition.
• If possible, treat the cause to prevent the problem from progressing.

Your treatment plan might involve:

Medications

First-line treatment for gastroparesis with Prokinetics: Drugs that stimulate gastrointestinal motility include:-

• Metoclopramide - It is the only FDA-approved medication for the treatment of gastroparesis, which causes the stomach to contract and can also help relieve nausea. But it has a black box warning due to possible adverse effects, including tremors and twitching.
• The motilin agonists are a second type of prokinetic drug that your health care provider might suggest. They include erythromycin and azithromycin. They work as antibiotics, but health care providers may prescribe them off-label for the treatment of gastroparesis.
• Serotonin agonists - Tegaserod and prucalopride are serotonin agonists typically prescribed to stimulate your bowels to improve constipation. Doctors have not evaluated them for treating gastroparesis; however, a few healthcare providers may prescribe them for that use.

Besides, other medications may include:-

• Antiemetics to control nausea and vomiting.
• Proton pump inhibitors to treat acid reflux.
• Strong analgesics for stomach pains.  
• Medicines for diabetes to regulate blood sugar.

Nutrition

With a condition like gastroparesis, you may have to change your diet, say, eat less fiber and fat to make digestion easier. You might also need specific nutritional therapy to supplement any nutrient deficiencies. Your provider might recommend dietary supplements or even short-term tube feeding or IV feeding. Some may even temporarily require IV fluids to restore hydration and balance electrolytes.

Surgery

Surgery is one of the last resort treatments for gastroparesis. Surgery may be a last-ditch option for you if everything else has failed and you need a modification to help the food pass through your stomach. The various procedures performed to modify your stomach include:-

• Pyloroplasty - It is a procedure performed by doctors to modify the pylorus to allow food to pass out. An incision into the pylorus muscle is standard in most pyloroplasties to relax and expand its opening. The latest version, G-POEM, is an endoscopic surgical procedure, meaning that instead of cutting into the abdomen to access the stomach, a surgeon operates an endoscope, a long tube passed through the mouth into the stomach.
• Gastric bypass - In some cases, the lower part of your stomach is no longer functioning, and in such cases, the procedure's success rate is higher; some individuals need the entire lower part of their stomach bypassed. It involves a partial gastrectomy- removing part of your stomach or closing it off completely through a new outlet created in the stomach to your small intestine. It happens as weight loss surgery, especially among individuals with obesity-related Type 2 diabetes. It will dramatically affect both conditions. Your provider might recommend this for profound diabetes-related gastroparesis.

Outlook / Prognosis

What does gastroparesis hold for the prognostic angle?

For some, gastroparesis resolves with short-term drug usage or infection. For most people, it is not curable but manageable through treatment, except it may take various attempts to find just the proper treatment, and there may be persistent symptoms or side effects of the treatment to manage. You must be confident that your provider will help you manage when any of these symptoms flare up.

Does gastroparesis really affect your life expectancy?

Generally, gastroparesis does not threaten life. Some possible, although rare, complications of gastroparesis are life-threatening when they become sufficiently severe. These complications relate to malnutrition, dehydration, electrolyte imbalances, and blood sugar fluctuations with diabetes.

Living With

How else should I take care of myself as I live with gastroparesis?

Learn what symptoms make you feel better or worse, as well as how certain foods and habits help. Those little things can make a huge difference in how you think. Some people find that it helps to:-

• Find that eating smaller meals more often is a good way to go about it. Instead of three per day, try four to six.
• A gastroparesis diet, lower in fat and fiber, can be an option.
• Abstain from alcohol, tobacco, and illicit drugs, which cause delays in gastric emptying.
• Take a light walk after a meal to encourage motility.

Why choose Tender Palm Super-Speciality Hospital for Delayed Gastric Emptying treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Delayed Gastric Emptying treatment in Lucknow, India, at an affordable cost. We have a team of experienced gastrointestinal specialists who provide accurate diagnosis with advanced scans, personalized medical care, and surgical management. Our General and Laparoscopic Surgery team has decades of experience in successfully treating Delayed Gastric Emptying in Lucknow, India.

To seek an Expert Consultation for Delayed Gastric Emptying treatment in Lucknow, India:

Call us at +91-9076972161
Email at care@tenderpalm.com

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