According to the U.S. National Wealth Observances calendar, August is Gastroparesis Awareness Month. The goal is to help educate patients and their families, so they better understand the diagnosis and condition. Gastroparesis is not a common condition with only about 10 men and 40 women out of each 100,000 persons will receive the diagnosis. However, symptoms similar to those related to gastroparesis occur in approximately 25% of adults in the US.
What is Gastroparesis?
When someone has gastroparesis, their stomach doesn’t empty itself of food like normal. The term actually means partial paralysis of the stomach. The nerves and muscles in the stomach do not respond normally in terms of strength and coordination. This prohibits the normal movement of content through the digestive system. The condition is common for individuals who have dealt with diabetes for a long time. However, it’s not limited just to those with long-term diabetes. In many instances, Gastroparesis is misdiagnosed, and the symptoms are mistaken for those of ulcers or heartburn (GERD). Sometimes it’s incorrectly labeled as an allergic reaction. Individuals who are not diabetic may have Gastroparesis related to acid reflux.
Signs and Symptoms of Gastroparesis
There are several symptoms of Gastroparesis. Many of these are characteristic of other GI-related conditions. Here are some of the typical symptoms:
- Feeling full after only a few bites of food
- Lack of appetite
- Heartburn or GERD (gastroesophageal reflux disease
- Abdominal bloating or pain
- Vomiting
- Nausea
- Excessive unplanned weight loss
Causes of Gastroparesis
Diabetes is the most commonly known cause of gastroparesis, but for many individuals, doctors can’t make a specific determination when it comes to the cause. It does tend to affect women more often than men. For some patients damage to the vagus nerve, or the nerve controlling the stomach muscles leads to gastroparesis. The branches of the vagus nerve often become damaged by diseases like diabetes. Surgery to the small intestine or stomach can also damage this important nerve. Some of the other causes may include:
- Viral infection
- Medications including some antidepressants and some narcotics
- Amyloidosis – deposits of protein fibers in organs and tissue
- Scleroderma – connective tissue disorder affecting the skin, internal organs, skeletal muscles, and blood vessels
There are a few antidepressants, narcotics, and other medications associated with gastroparesis. Some medications that can impair gastric emptying include:
- Narcotics
- Tricyclic antidepressants
- Calcium channel blockers
- Clonidine
- Dopamine agonists
- Lithium
- Nicotine
- Progesterone
- Marijuana (the THC can significantly delay gastric emptying)
How does a GI specialist diagnose gastroparesis?
A doctor will consider your symptoms and their severity. They may perform a physical exam and may order blood tests including checking your blood sugar levels. Some of the other tests used to diagnose gastroparesis may include:
- Gastric Emptying Study – This four-hour test will determine how long it takes for a meal to move through the stomach. You be given a meal tagged with a radioactive isotope. After the meal is consumed, a minute-long image of the stomach is taken. Another image of the stomach is taken after one, two, and four hours.
- Smart Pill – Patients swallow a pill that contains an electronic device. Once the capsule is swallowed, it moves through the digestive tract and sends information to a receiver being worn by the patient. It communicates how quickly or slowly food travels through the digestive tract.
- EGD – An upper endoscopy is performed by a GI specialist to determine the cause of vomiting, nausea, difficulty swallowing, or upper abdominal pain.
Gastroparesis Treatment Options
Gastroparesis is a chronic condition. Treatment won’t cure the condition, but it can help manage symptoms and keep them under control. Your GI may offer numerous treatment options based on the severity of your symptoms and how well you respond to treatment. Two of the first options your physician may try include dietary changes and medications.
Dietary Changes for Gastroparesis
Changing eating habits is often the best way to control gastroparesis symptoms. The first option is eating smaller portions more frequently throughout the day. Six small meals instead of three large ones help you feel less full because there’s not as much food in your stomach.
Another dietary change may include getting nutrition and hydration from more liquids like juices, sports drinks, low-fat broth, soups, and water. Eating applesauce is often recommended rather than eating whole apples. It’s often helpful to avoid high-fiber foods that are more difficult to digest and high-fat foods that tend to slow digestion. A dietician may be consulted to help you find easily digested foods that can help you get adequate nutrition.
Mediations to Treat Gastroparesis
Some of the medications used to treat Gastroparesis include:
- Metoclopramide: This medication is taken prior to eating. It helps the stomach muscles contract and keeps food moving. It can also help reduce stomach upset and vomiting. It does have some side effects including diarrhea, anxiety, drowsiness, and in rare cases, a serious neurological disorder.
- Erythromycin: This common antibiotic also helps the stomach contract and helps keep food moving. If it is taken for a long time it can cause diarrhea and encourage the growth of resistant bacteria.
- Antiemetics: These medications are beneficial for helping control nausea.
Controlling Blood Glucose Levels
For those who have diabetes and gastroparesis, it’s important to control blood glucose levels. Hyperglycemia may cause your stomach to delay emptying out. Work closely with your primary doctor or GI specialist to make sure blood glucose levels stay in a normal range without fluctuating. Your doctor may suggest:
- Taking insulin more often
- Changing the type of insulin taken
- Taking insulin after meals instead of before
- Monitoring glucose levels after eating and taking insulin when needed
Other Treatment Options
If you have diabetes, it’s important to control your sugar levels. That can help prevent serious problems from developing. In some cases, if you cannot get enough nutrients from eating, a feeding tube or jejunostomy tube may be needed. A tube is surgically placed in your small intestine. This allows nutrients to be delivered directly to the small intestine and bypasses the stomach. They will reach your bloodstream much faster. In severe cases, your GI specialist may recommend intravenous nutrition or parenteral nutrition. These options are short-term solutions to help you get the nutrition you need.
Does gastroparesis affect your lifestyle?
Gastroparesis can have a devastating effect on a person’s physical well-being. Sometimes, it causes chronic vomiting or nausea which can lead to malnutrition and dangerously low blood glucose levels. Gastroparesis can also affect a person’s emotional well-being. Constant bouts of discomfort stemming from chronic vomiting and nausea can have a negative effect on school and work performance, personal relationships, social activities, and family life.
Gastroparesis Complications
Due to the nature of gastroparesis symptoms, it can cause several complications. This includes:
- Severe dehydration is often the result of chronic vomiting.
- Malnutrition can occur because of a poor appetite which prohibits taking in adequate nutrients. Sometimes, vomiting prevents your body from absorbing enough nutrients.
- Undigested food may harden and stay in the stomach. When undigested food remains in your stomach and becomes harden it is called a bezoar. This can be life-threatening if it prevents food from passing from the stomach and into the small intestine.
- When food remains too long in your stomach, it can ferment. This can cause bacteria to grow.
- Unpredictable changes to blood sugar levels. Gastroparesis does not cause diabetes, but because the amount of food passing into the small bowel changes frequently, it can cause extreme changes in blood sugar levels. Variations in blood sugar levels can make diabetes worse. Also, not being able to properly control blood sugar levels can make your gastroparesis symptoms worse.
- Decreased quality of life is often the result of gastroparesis as symptoms can make it hard to keep a regular schedule and take care of responsibilities regularly.
Foods to Eat or Avoid
It can be difficult to get adequate nutrition when you have gastroparesis. Remember to eat smaller meals throughout the day. Focus on eating foods that are easily chewed and swallowed. These foods will also be easier to digest. Here are a few foods that may be suitable for helping you manage gastroparesis:
- Eggs
- Peanut butter
- Bananas
- Crackers
- Hot cereals
- Bread
- Fruit juice
- Vegetable juice
- Fruit purees
If you currently experience the symptoms of gastroparesis, you should know what foods to avoid so you can minimize symptoms as much as possible. Generally, foods high in fiber and saturated fats should be eaten in very small amounts and avoided when possible. Here are some foods that you may want to avoid as they tend to make symptoms worse:
- Carbonated drinks
- Alcohol
- Beans and legumes
- Corn
- Seeds and nuts
- Broccoli
- Cauliflower
- Cheese
- Heavy cream
- Excess butter or oil
Tips for Prevention and Management of Symptoms
It’s important to work with your medical team and essential members like your primary care physician, and GI specialist. Work closely with a registered dietician or nutrition specialist who can help you design a dietary plan to help you meet nutritional needs and reach specific goals. In general, these tips can help you manage and sometimes prevent symptoms:
- Eat smaller meals low in fiber and fat because large meals tend to delay stomach emptying and make symptoms worse.
- Stay hydrated. Dehydration can make nausea worse. You can hydrate on sports drinks and juices as long as your blood sugar levels remain under control.
- Work on being nutritionally fit. Focus on eating small amounts of highly nutritious foods.
- Try eating solid foods earlier in the day, like in the morning. Then eat liquid and softer meals later in the day. If necessary, you may try juicing or a liquid diet to help manage symptoms.
- Remember to chew all your foods well. This helps your stomach be able to digest foods easier. Solid food is more difficult to digest.
- If you also suffer from diabetes, maintain good control of your blood sugar levels.
- If you need medical surgery, talk to your health care team about the risks and benefits. Ask about non-surgical alternatives.
- Always inform your doctor or GI specialist of all medications you are taking. Be sure to include over-the-counter medications and supplements, herbal remedies, and prescription medications.
- Discuss possible drug interactions with your medical provider and talk about possible alternatives if needed.
- Avoid consuming alcohol and smoking tobacco. Both can slow gastric emptying.
- Engage in physical activity as much as you are able. Discuss an exercise regimen with your GI specialist or primary care physician. Be sure to know your limits.
Take an active role in your own health journey. Working with your health care team will help you control, prevent, or reduce symptoms and complications. When you experience a flare-up, avoid going to an Urgent Care or Emergency Room for pain meds. They usually prescribe narcotics for the pain which may or may not work to relieve gastroparesis-related pain. Many narcotics don’t relieve this type of pain and can delay the recovery process.
What to do if you Suspect you have Gastroparesis
If you or one of your loved ones are displaying symptoms characteristic of gastroparesis, it’s important to visit with your primary care physician or consult with a GI specialist. Let Pinnacle GI Partners provide you with the care you need. Our specialists have the medical knowledge, experience, and expertise to make a proper diagnosis and recommend treatment. Contact us today to learn how we can help you manage or reduce symptoms of gastroparesis for yourself or your loved one.