Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls the movement of food from the stomach through the digestive tract. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.

Symptoms

The symptoms of gastroparesis may be mild or severe, depending on the person. Symptoms can happen frequently in some people and less often in others. Many people with gastroparesis experience a wide range of symptoms, and sometimes the disorder can be difficult to diagnose. Eating solid foods, high-fiber foods such as raw fruits and vegetables, fatty foods, or drinks high in fat or carbonation may contribute to the symptoms of gastroparesis.

Symptoms include:

• heartburn
• pain in the upper abdomen
• nausea
• vomiting of undigested food, sometimes several hours after a meal
• early feeling of fullness after only a few bites of food
• weight loss due to poor absorption of nutrients or low calorie intake
• abdominal bloating
• high and low blood glucose levels
• lack of appetite
• gastroesophageal reflux
• spasms in the stomach area

Complications

If food lingers too long in the stomach, it can cause bacterial overgrowth from the fermentation of food. Also, food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach.

Gastroparesis can make diabetes worse by making blood glucose control more difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person’s blood glucose levels can be erratic and difficult to control.

What Causes Gastroparesis?

The most common cause of gastroparesis is diabetes. People with diabetes have high blood glucose which in turn causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Over time, high blood glucose can damage the vagus nerve which controls the movement of food through the digestive tract.

Other causes of gastroparesis include surgery on the stomach or vagus nerve, viral infections, anorexia nervosa or bulimia, certain medications, gastroesophageal reflux disease, smooth muscle disorders, nervous system disorders, and metabolic disorders.

Many people have idiopathic gastroparesis, meaning the cause is unknown and cannot be found even after medical tests.

Diagnosis

After performing a full physical and taking a medical history, the doctor may order several blood tests to check blood counts and chemical and electrolyte levels. The doctor may also perform an EGD to look at the lining of the stomach and to check for any abnormalities. A gastric emptying scintigraphy may also be ordered.  This test involves eating a bland meal that contains a small amount of a radioactive substance that shows up on scans. The scan measures the rate of gastric emptying to see the degree to which it is delayed.

Treatment

Treatment of gastroparesis depends on the severity of the symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic condition. Treatment merely helps to manage the condition.

Several medications are used to treat gastroparesis. The doctor may try different medications or a combination of medications to find the most effective treatment. It is important to discuss the risk of side effects of any medications that are prescribed.

The use of botulism toxin has been associated with improvement in symptoms of gastroparesis in some patients. A small amount of botulism toxin is injected into the tissue  where the stomach empties into the small intestine. This injection is performed while under sedation during an EGD.

Making dietary changes can be helpful in controlling the symptoms of gastroparesis. The doctor may recommend eating six small meals a day instead of three large meals. In some cases, a liquid diet may be recommended for a short period of time. Liquid diets provide all the nutrients found in solid foods, but can pass more quickly from the stomach into the intestine. Dietary charges are especially helpful to control fluctuations in blood glucose, which in turn help improve the symptoms of gastroparesis. Sometimes an adjustment in insulin dosage or administration may be necessary to control blood glucose and gastroparesis.

Points to Remember

• Gastroparesis is the result of damage to the vagus nerve, which controls the movement of food through the digestive system. Instead of moving through the digestive tract normally, the food is retained in the stomach.
• Gastroparesis may occur in people with diabetes. The vagus nerve becomes damaged after years of high blood glucose, resulting in gastroparesis. In turn, gastroparesis contributes to poor blood glucose control.
• Symptoms of gastroparesis include early fullness, abdominal pain, stomach spasms, heartburn, nausea, vomiting, bloating, gastroesophageal reflux, lack of appetite, and weight loss.
• Gastroparesis is diagnosed with tests such as EGD and gastric emptying scans.
• Treatment includes dietary changes, oral medications, adjustments in insulin injections for those with diabetes, or injections of botulism toxin.

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