Our body is nothing less than a complicated wiring system that carries signals from the brain to different parts of the body and brings signals from different parts of the body to the brain. The wiring structure refers to the nervous system, which connects to every part of your body. Proper functioning and coordination of all the organ systems and nervous systems are very important for a healthy and disease-free life. Any abnormality or malfunctioning of a particular nerve that sends a signal to a particular part of your body results in interrupted signal delivery that seizes or reduces the functioning capability of that particular organ or part of your body. One such disease that arises due to nerve damage is called gastroparesis.
Understanding Gastroparesis
As you know, food is one of the basic necessities for every living being; it provides you with the energy to do even the smallest work. The food that you eat gets partially digested in your stomach, which is then sent to the small intestine for further digestion. This movement from the stomach to the small intestine is achieved by incessant contraction of the stomach muscles; the movement of the stomach muscles is controlled by the vagus nerve. Any damage or abnormality to the vagus nerve results in a condition called gastroparesis, which literally means “stomach paralysis”. Gastroparesis arises when a damaged vagus nerve is unable to send signals from the brain to the stomach muscles. As a result, the undigested food from the stomach moves slowly down your small intestine. The food either moves slowly or sometimes even stops moving further, thereby preventing absorption of nutrients and preventing defecation or excretion of the undigested food. Gastroparesis is also called “delayed gastric emptying”.
Causes
There are many causes that can result in damage to the vagus nerves. Diabetes is the most common cause of gastroparesis. High blood glucose levels cause some chemical changes in the nerve and damage the blood vessels that supply oxygen and nutrients to the nerve. As time goes by, a high blood glucose level also damages your vagus nerve.
Other possible causes of gastroparesis are
- Viral infection
- Any surgery in the stomach or vagus nerve
- Anorexia (eating disorder)
- Anticholinergics and narcotic medicines that slow the contraction of the intestine
- Radiation treatment of the stomach or chest region
- Muscle disorders like amyloidosis and scleroderma
- Gastroesophageal reflux disease
- Other nervous disorders like migraine and Parkinson’s disease
- Hypothyroidism and other metabolic disorders
In many people, the cause of gastroparesis is idiopathic, which means the cause is unknown.
Symptoms
The symptoms of gastroparesis vary in every person; many exhibit a wide range of symptoms that make it difficult to diagnose. A few symptoms that will help your doctor in the initial diagnosis of gastroparesis include upper abdominal pain and heartburn. You may feel nauseated or vomit the undigested food after several hours of eating. The food lying in the stomach may cause a feeling of fullness, even if you eat little food. The stomach may seem bloated, and you may have a low appetite. Malabsorption of nutrients may lead to the following:
- Mal-absorption results in weight loss
- Bloating of the stomach
- Fluctuating blood glucose level
- Low appetite
- Spasms in stomach region
Complications
Gastroparesis results in many complications. If the undigested food stays for a long time in the stomach, then it can result in the overgrowth of bacteria from the fermentation of food. Sometimes, the undigested food turns into a hard ball called bezoars that triggers symptoms like nausea, vomiting, and stomach obstructions. Bezoars prove to be dangerous when they block the stomach-small intestine junction. Gastroparesis can worsen your diabetes as the movement of food into the small intestine is unpredictable, and your blood glucose level may show erratic values. Due to improper absorption of nutrients, you may suffer from serious malnutrition and sudden weight loss.
Diagnosis
After examining you physically and evaluating your previous medical history, your physician might proceed further by doing a few diagnostic tests. Blood tests may be done to check the blood count, chemicals, and electrolyte levels.
An upper endoscopy may be advised to check the inner lining of your stomach. During this test, your physician will give you a sedative, which will make you a little drowsy. At this time, he will insert a long, thin tube called an endoscopy into your mouth. The camera attached to the endoscopy will help him study the inner lining of your stomach.
In a procedure called barium X-ray, your physician will give you a thick solution of barium to drink after 12 hours of fasting. After 12 hours of fasting, the stomach is usually empty. Barium coats the inner wall of your stomach, which is shown in the x-ray. If you are diabetic, inform your doctor before fasting.
An ultrasound may be done to rule out the possibility of gallbladder disease or pancreatitis as a source of the disease.
If, after performing these tests, your doctor suspects gastroparesis, he might do a few confirmatory tests, such as
- Gastric emptying study: For this study, you will have to eat or drink something that has a safe amount of radioactive substances. The signals from the radioactive substance will be picked up by a scanner that helps study the time taken by your stomach to empty the food.
- Breath test: After eating food with radioactive substances, your breath will be measured for the presence of radioactive substances in the exhaled carbon dioxide. This test shows how fast your stomach is emptying.
- Gastrointestinal monitoring capsule: It is also called a smart pill and is a small capsule-sized device that has to be swallowed. The device moves through your gastrointestinal tract, collecting information and sending it to a small receiver that is tied around your waist. After 2 days, when the smart pill is excreted, take the receiver to your doctor. He can conclude after studying the results.
Treatment
Treatment for gastroparesis depends on the severity of your disease. As gastroparesis is a chronic condition, treatment doesn’t cure the disease, but it sure helps to manage the symptoms. There are several medicines available for gastroparesis. Your physician might try a different combination of these medicines.
- Metoclopramide (Reglan) stimulates stomach muscle contraction
- Erythromycin increases stomach muscle contraction
- Domperidone increases stomach emptying and improves symptoms like nausea and vomiting
- Antiemetic for reducing vomiting and nausea
- Antibiotics for clearing bacterial infections
- In the case of bezoars, your doctor will inject a medicine to dissolve it
If you have severe gastroparesis and diabetes, then a small tube called a jejunostomy is inserted. This feeding tube bypasses all the food and medicine directly into the small intestine, allowing easy and quick digestion.
Parenteral nutrition may be given in extreme conditions where the nutrients are delivered directly into the bloodstream.
Gastric electric stimulation is a treatment modality where a small electric device delivering a mild electric pulse is placed inside the stomach to control vomiting and nausea.
A main complication of gastroparesis is malnutrition. You should eat properly so that you get the required nutrients. Eat less and more frequently than eating 2 or 3 large meals; prefer a liquid or puree diet; avoid high-fat and high-fiber foods; and eat well-cooked soft foods.
Outlook
Gastroparesis is a neurological disease that is caused by reasons that cannot be avoided or prevented. Being diagnosed with gastroparesis requires you to take care of the food that you eat. Follow your doctor’s instructions carefully and have a personal diet plan that fulfills the required amount of nutrients and is easily digestible.
