Gastroparesis -- This condition occurs when the rate of the electrical wave slows and the stomach contracts less frequently. Now the food just lays in the stomach relying on acid and digestive enzymes to break down the food and on gravity to empty the stomach. There are a number of causes for this condition:
Diabetes is the most common known cause. Adrenal and thyroid
gland problems can also be a cause although these are infrequent
Scars and fibrous tissue from ulcers and tumors can block the
outlet of the stomach and mimic gastroparesis
Certain drugs weaken the stomach (tricyclic antidepressants such
as Elavil, calcium blockers such as Cardizem and Procardia, L-dopa, hyoscyamine, Bentyl, Levsin, narcotics)
Neurologic or brain disorders such as Parkinson's disease, strokes
Certain diseases such as lupus erythematosus and scleroderma
In up to 40% of cases the cause of gastroparesis is not known
It should be noted that not all of these disorders affect the pacemaker of the stomach. Some disorders weaken the stomach muscle itself so it can't respond to the pacemaker. In either case, the result is the same, gastroparesis.
Symptoms -- The usual symptoms of gastroparesis are a feeling of fullness after only a few bites of food, bloating, excessive belching, and nausea. At times there will be a vague, nagging ache in the upper abdomen but usually the pain is not sharp or crampy as might occur with ulcers or a gallbladder attack. There may be vomiting, heartburn, or regurgitation of stomach fluid into the mouth. Medications that reduce or eliminate stomach acid usually don't help much. Diagnosis -- The diagnosis of gastroparesis starts with the medical history where the physician may suspect the diagnosis based on the symptoms. In severe cases, the physical exam and blood tests may show evidence of malnutrition, but usually the exam is normal. An upper GI barium x-ray measures how liquid barium leaves the stomach.
Upper endoscopy is a visual exam of the stomach using a lighted flexible tube. Mild sedation is usually given for this procedure. This exam should always be done to be certain there is not a blockage in
A gastric or stomach emptying test is presently the best method of making the diagnosis. In this test, a food, such as scrambled eggs, is labeled with a marker which can be seen by a scanner. Following ingestion, the scanner tracks the time it takes for the food to leave the stomach. In general, half the stomach contents should leave within about 90 minutes. A final test, which is not available everywhere, is the electrogastrogram (EGG). This test, like the EKG on the heart, measures the electrical waves that normally sweep over the stomach and precede each contraction.
Treatment -- First, if there is an underlying disorder, it needs to be treated effectively. Examples are good blood sugar control in the diabetic patient or thyroid medicine for someone with an underactive thyroid. Second, there may be a need to address diet and nutrition. When gastroparesis is mild, there are usually few food problems. However, if there is marked delay in stomach emptying, then attention to the diet is necessary. Fats, including vegetable oils, normally cause delay in emptying of the stomach, so foods that are high in fat need to be avoided. High fiber foods such as broccoli and cabbage tend to stay in the stomach, so these foods should be restricted when symptoms are severe. Liquids always leave the stomach faster than solid food so liquid type foods such as low-fat milkshakes should be used. Finally, frequent small feedings, 4-6 times a day, are usually more effective than larger meals, 2 or 3 times a day. A registered dietitian can be very helpful Medications -- Several medications are now available to stimulate the stomach to contract more normally. These drugs should be taken 20- 40 minutes before eating to allow enough time for the drug to get into the blood stream where they can then act on the stomach. They all cause the stomach to contract more often and, hopefully, more vigorously thereby emptying the stomach and reducing symptoms.
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