Gastroparesis | The motility issue

Gastroparesis is an impairment in the body’s motility ability to empty the stomach of its contents in a normal fashion, resulting in delayed gastric emptying or incomplete emptying. 

What causes Gastroparesis

Most commonly gastroparesis is caused by nerve damage. The vagus nerve which controls the muscle contractions in your stomach to empty the stomach contents may become damaged causing gastroparesis. This damaged vagus nerve is no longer able to communicate with the stomach muscles keeping the contents of the stomach there for longer. 

Risk factors

Certain individuals or groups are more at risk of developing gastroparesis. Diabetic patients are the most common sufferers, but also scleroderma, amyloidosis, hypothyroidism and multiple sclerosis or parkinson's disease sufferers are considered higher risk of gastroparesis. Other groups at risk of developing gastroparesis include those who have a viral infection as well as post surgery and certain medications such as narcotics and antidepressants.

Complications arising from Gastroparesis

• Dehydration
• Bacterial growth and infections
• Formation of bezoar
• Malnutrition
• Uncontrolled blood sugar levels, particularly for diabetic patients

Signs and Symptoms of Gastroparesis

• Nausea
• Vomiting
• Bloating
• GERD (Gastroesophageal Reflux Disease)
• Heartburn
• Decrease in weight
• Loss of apetite
• Uncontrolled blood sugar levels

Diagnosis of Gastroparesis

A range of assays and tests are performed to diagnose gastroparesis and rule out other possible causes. These include an ultrasound, endoscopy, X-rays and most commonly a gastric emptying study where a radioactive substance is consumed with food so that the progression of digestion can be viewed using a scanner. Some medical clinics may use what is known as a ‘smart pill’. This pill is a small electronic device which when swallowed allows the medical team to track it’s movement through the digestive tract. 

Treatment of Gastroparesis

If possible it is always best to uncover the underlying reasons causing the gastroparesis and address the problem at the source. With that being said there are other approaches including supplements and medication. Medications such as reglan and domperidone are used as prokinetic, to help stimulate the movement of food out of the stomach. Other medications such as erythromycin also have prokinetic properties and can be of great benefit in gastroparesis. Antiemetics can help control the feeling of nausea and vomiting that unfortunately often accompanies gastroparesis.
 

• Reglan (Metoclopramide)
• Domperidone
• Erythromycin
• Resolor (prucalopride)
• Motegrity (prucalopride)

When surgery is considered for gastroparesis

After trying the available medications the patient is still suffering from nausea and vomiting and is unable to attain adequate nutritional intake, surgery may be of great benefit. There are different types of surgery ranging from gastric electric shocks to induce muscle contractions by the introduction of a small electrical device. Another commonly performed surgery for gastroparesis is a gastric by-pass.

Lifestyle advice for gastroparesis

• Eat small amounts of food frequently throughout the day and chew thoroughly.
• Try blending your food to make smoothies or consume soups if they are easier to consume.
• Supplement with multivitamins
• Do regular blood work to monitor for any vitamin, mineral or other supplement you are not absorbing enough of.
• Cook your fruit and vegetables.
• Avoid trigger foods that you find harder to digest.
• Avoid alcohol.
• Avoid smoking.
• Drink water frequently and aim for 1.5 liters per day.
• Try to remain upright for 2 hours after eating any meals to allow gravity to assist in the natural movement along the alimentary canal.