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Understanding gastroparesis: causes, symptoms, and treatments

SEPTEMBER 2, 2021•FAMILY MEDICINEGASTROENTEROLOGY

Gastroparesis is an uncommon illness, occurring only in about 10 men and 40 women out of 100,000. Even though the disorder itself is rare, around 1 in 4 adults in the United States experience gastroparesis symptoms even if they do not have the condition. It is important to recognize the signs and symptoms of gastroparesis and know where to find treatment if you are diagnosed.


What is gastroparesis?

Gastroparesis is a stomach disorder that occurs when your stomach takes too long to process an empty food. Also called delayed gastric emptying, gastroparesis can delay digestion, potentially causing complications and health issues.


In a healthy stomach, your stomach muscles grind the food you eat into smaller pieces and filter it into your small intestine. If you have gastroparesis, your stomach muscles work very poorly or not at all, making it difficult for the stomach to empty its contents, delaying digestion.


What are the causes of gastroparesis?

Finding the underlying causes for gastroparesis is challenging even with extensive medical testing. Nearly 36 percent of cases are not linked to any known cause. Circumstances like this are known as idiopathic gastroparesis.


The most common cause of gastroparesis is diabetes. Diabetes can damage the vagus nerve and the pacemaker cells in your stomach wall. Your vagus nerve controls the muscles of your stomach and small intestine. If damaged, your vagus nerve can prevent your stomach muscles and small intestines from working properly, potentially causing a damaged digestive tract. Additionally, if the pacemaker cells are damaged, your stomach will not empty properly.


In addition to diabetes, there are other known causes of gastroparesis, including:


  • Injury to the vagus nerve due to surgery of the esophagus, stomach, or small intestine

  • Hypothyroidism

  • Certain autoimmune diseases such as scleroderma

  • Some nervous system disorders such as multiple sclerosis and Parkinson’s disease

  • Viral stomach infections

  • High blood sugar

What are the symptoms of gastroparesis?

Some other common symptoms of gastroparesis include:


  • Feeling full before starting a meal

  • Feeling full for long periods after eating a meal

  • Nausea

  • Poor appetite

  • Abdominal pain

  • Heartburn

  • Acid reflux

  • Vomiting

  • Bloating

  • Belching

  • Pain in your upper abdomen

Do medications cause gastroparesis?

Some medications can delay the gastric process and may create similar symptoms to gastroparesis. If you have been diagnosed with gastroparesis, consult with your gastroenterologist to make sure your medications are not making your symptoms worse. While the following medications do not cause gastroparesis, they can cause worsening symptoms:


  • Narcotic pain medicines including tapentadol, oxycodone, codeine, morphine, and hydrocodone.

  • Some antidepressants including venlafaxine, amitriptyline, and nortriptyline.

  • Some anticholinergics that block nerve signals

  • Medications used to treat overactive bladder

  • Pramlintide

How do you treat gastroparesis?

Your gastroenterologist may recommend medications, suggest a diet plan to improve your gut health, or, in extreme cases, recommend surgery. If you are experiencing diabetic gastroparesis, the first step in your treatment plan is to improve your underlying condition.


Medications

Your gastroenterologist may recommend one or more of the following medications to alleviate some of your symptoms:


To control nausea or vomiting:


  • Prochiorperazine (Compro)

  • Ondansetron (Zofran)

  • Promethazine (Phenergan)

To stimulate your stomach muscles and aid digestion:


  • Metoclopramide (Reglan)

  • Erythromycin (EES)

  • Domperidone (Motilin)

Many of these medications can cause side effects. Make sure to consult with your doctor about the potential pros and cons of each medication to determine which option is right for you.


Gastroparesis Diet Plan

In addition to prescribing medications, your doctor may recommend you to a licensed dietician who can suggest foods that your body can more easily digest. Some suggestions your dietician may offer include:


  • Eating four to six times per day

  • Drinking high-calorie liquids

  • Limiting alcohol and carbonated drinks

  • Taking a daily multivitamin

  • Limiting certain meats and dairy

  • Eating low-fat foods

  • Avoiding foods rich in fiber like broccoli and oranges

  • Substituting solid foods for pureed or liquid meals

  • Quitting cigarette smoking


If you have a severe case of gastroparesis, you may not be able to eat solid foods. In these cases, you may need to use a feeding tube until your condition improves.


Surgery

If your condition does not improve even with medications and a diet plan, your doctor may decide that stomach surgery is necessary. A stomach stimulator known as a gastric electrical stimulator (GES) may be implanted into your stomach to strengthen your stomach muscles and improve digestion. 97 percent of people with a GES have had less nausea and vomiting in the first year after the surgery.


If you have any questions regarding your digestive health, or if you are experiencing gastroparesis symptoms, consult with your primary GI specialist or visit the Revere Health Gastroenterology st. George's page to find a doctor today.


If you would like to join a support group, visit the Gastroparesis Patient Association for Cures and Treatment main website. Their website provides online support and information for those experiencing gastroparesis.


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