Gastroparesis (Delayed Stomach Emptying)
Alternative names: Delayed Gastric Emptying, Gastroparesis Diabeticorum
Gastroparesis is a disorder in which the stomach muscle has weakened, and takes too long to empty the stomach's contents into the small intestine. People with gastroparesis often have diabetes, but many other things can cause this disorder.
Because the stomach's muscles don't squeeze properly, it empties very slowly. This can lead to:
- Heartburn and nausea
- Feeling full before the meal is finished
- Abdominal bloating
- Vomiting undigested food
- Lack of appetite and unintentional weight loss
- For diabetics, blood sugar levels that are erratic and difficult to control
Doctors are not exactly sure what causes gastroparesis, but it has something to do with how the nerves communicate with the muscles of the stomach. In many cases, gastroparesis is idiopathic, meaning that there is no clear cause.
Other possible causes of gastroparesis include:
- Certain bacterial or viral infections
- Stomach surgery
- Muscle disorders
- Nervous system diseases, such as Parkinson's disease
- Thyroid disorders
- Anorexia nervosa
- Certain medications, such as antispasmodic drugs and narcotics
To diagnose gastroparesis, your doctor may do one or more of the following tests:
- An upper gastrointestinal X-ray (upper GI series) shows the condition of your esophagus and stomach. Before the test, you will drink a chalky material that helps the esophagus and stomach show up on the X-ray.
- A manometry motility study tests the muscles of the stomach. The doctor inserts a thin, flexible tube that has pressure sensors on its sides into one nostril of your nose, and eases it down into your stomach. Your doctor will then take readings of the muscle contractions as you digest liquid and food.
- In a radioisotope gastric-emptying scan, you eat food that contains a slightly radioactive substance. This substance allows a machine to show images of your stomach digesting the food, and to see if the food remains in your stomach an overly long time. The test takes two to four hours.
- In an upper gastrointestinal endoscopy, the doctor uses an endoscope - a tiny video camera mounted on a thin, flexible tube with a light at the end - to look inside your esophagus and stomach. The doctor inserts the endoscope through your mouth. You will be given medication to make you relaxed and drowsy during the procedure, which only takes 15-20 minutes.
If you are a diabetic with gastroparesis, you may need to adjust your insulin habits and check your blood sugar levels more frequently. This will be done with help from your doctor.
In some cases, gastroparesis resolves on its own, but most often a patient will need to control the symptoms over time. Several things can help a patient with gastroparesis:
- Dietary changes. Your doctor or dietitian may recommend a temporary liquid diet, or ask you to eat many small meals a day, instead of three large ones. You will need to avoid foods that are difficult for the stomach to digest, such as high-fat and high-fiber foods.
- Medications can help the stomach muscles contract, control nausea, and combat infections.
- Botulinum toxin (BOTOX®) can help the stomach empty by shortening the contractions of the pyloric sphincter, the muscle between the stomach and the small intestine. The toxin is injected into this muscle.
- A gastric neurostimulator, or pacemaker, is a battery-operated device that is surgically implanted in the stomach to help control nausea and vomiting through electrical impulses.
- In a severe case, a surgeon may place a feeding tube into the small intestine of a person with gastroparesis, bypassing the stomach entirely.
- In rare situations, a surgeon may remove most of a patient's stomach.