Gastroparesis – What it is, Causes and Treatments

Gastroparesis – What it is, Causes and Drug Treatment. Additionally, Gastroparesis  is a condition that affects the normal spontaneous movement of muscles (motility) in the stomach . Normally, strong muscle contractions propel food through your digestive tract. But if you have Gastroparesis , the stomach ‘s mobility  is slowed down or doesn’t work, preventing the stomach from emptying properly. Certain medications, such as opioid pain relievers, some antidepressants and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. For people who already have Gastroparesis, these medications can make your condition worse.

Gastroparesis can interfere with normal  digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition. The cause of Gastroparesis  is usually unknown. It is sometimes a complication of diabetes, and some people develop gastroparesis  after surgery. While there is no cure for Gastroparesis , changes to your diet, along with medication, may offer some relief.

Causes of Gastroparesis:  It is not always clear what leads to Gastroparesis . But in many cases, gastroparesis  is thought to be caused by damage to a nerve that controls the stomach muscles  (vagus nerve). The vagus nerve helps manage complex processes in your digestive tract, including signaling muscles in your stomach  to contract and push food into your small intestine.

A damaged vagus nerve cannot normally send signals to the stomach muscles. This can cause the food to stay in your stomach longer, instead of moving normally to your small intestine to be digested. The vagus nerve can be damaged by disease, such as diabetes, or by surgery on the stomach  or small intestine.

Symptoms of Gastroparesis:  Signs and symptoms of Gastroparesis  include:

  • vomit
  • Nausea
  • A feeling of fullness after eating just a few bites
  • Vomiting undigested food eaten a few hours before
  • acid reflux
  • abdominal swelling
  • abdominal pain
  • Changes in blood sugar levels
  • Lack of appetite
  • Weight loss and malnutrition

Many people with gastroparesis  have no visible signs and symptoms.

When to See a Doctor:  Make an appointment with your doctor if you have any signs or symptoms that worry you.

Gastroparesis Risk Factors:  Factors that may increase your risk of Gastroparesis :

  • Diabetes
  • Abdominal or esophageal surgery
  • Infection, usually a virus
  • Certain medications that slow the rate of stomach emptying, such as narcotic pain medication
  • Scleroderma (a connective tissue disease)
  • Nervous system disorders, such as Parkinson’s disease or multiple sclerosis
  • Hypothyroidism (low thyroid)

Women are more likely to develop Gastroparesis  than men.

Complications of Gastroparesis:  Gastroparesis can  cause several complications such as:

  • Severe dehydration. Continuous vomiting can cause dehydration.
  • malnutrition. Poor appetite could mean you don’t absorb enough calories, or you may not be able to absorb enough nutrients due to vomiting.
  • Undigested food that hardens and stays in your stomach . Undigested food in your stomach  can harden into a solid mass called a bezoar. Bezoars can cause nausea and vomiting and can be fatal if they prevent food from passing into the small intestine.
  • Unpredictable changes in blood sugar. Although gastroparesis  does not cause diabetes, frequent changes in the rate and amount of food that passes through the small intestine can cause erratic changes in blood sugar levels. These variations in blood sugar make diabetes worse. In turn, poor control of blood sugar levels makes Gastroparesis  worse.
  • Decreased quality of life. An acute flare-up of symptoms can make it difficult to work and maintain other responsibilities.

Diagnosing Gastroparesis:  Doctors use several tests to help diagnose gastroparesis  and rule out conditions that can cause similar symptoms. Tests can include:

  • Study of gastric emptying. This is the most important test used to make a diagnosis of Gastroparesis . It involves eating a light meal, such as eggs and toast, that contain a small amount of radioactive material. A scanner that detects the movement of radioactive material is placed over your abdomen to monitor the rate at which the food leaves your stomach . You will need to stop taking any medication that could slow down gastric emptying. Ask your doctor if any of your medications can slow down your digestion.
  • Upper gastrointestinal (GI) endoscopy. This procedure is used to visually examine your upper digestive system — your esophagus, stomach , and beginning of your small intestine (duodenum) — with a small camera at the end of a long, flexible tube. This test can also diagnose other conditions such as peptic ulcer or pyloric stenosis, which may have symptoms similar to Gastroparesis .
  • Ultrasound. This test uses high-frequency sound waves to produce images of structures within your body. Ultrasound can help diagnose whether problems with your gallbladder or kidneys could be causing your symptoms.
  • Upper gastrointestinal series. This is a series of X-rays in which you drink a white, chalky liquid (barium) that lowers the digestive system to help abnormalities appear.

Gastroparesis Treatments:  Treatment of Gastroparesis  begins with identifying and treating the underlying condition. If diabetes is causing your gastroparesis , your doctor can work with you to help you manage it.

Diet Changes:  Maintaining adequate nutrition is the most important goal in treating Gastroparesis . Many people can manage gastroparesis  with dietary changes and dietary changes are the first step in managing this condition.

Your doctor may refer you to a nutritionist who can work with you to find foods that are easier to digest so that you are more likely to get enough calories and nutrients from the foods you eat. A nutritionist may suggest that you try:

  • Eat smaller meals more often
  • Mix food thoroughly
  • Eat well-cooked fruits and vegetables instead of raw fruits and vegetables
  • Avoid fibrous fruits and vegetables like oranges and broccoli, which can cause bezoars
  • Choose mostly low-fat foods, but if you can tolerate them, add small portions of fatty foods to your diet.
  • Try soups and pureed foods if liquids are easier to swallow
  • Drink about 34 to 51 ounces (1 to 1.5 liters) of water a day
  • Exercise gently after eating, such as walking
  • Avoid carbonated drinks, alcohol and smoking
  • Try to avoid lying down for 2 hours after a meal
  • Take a multivitamin daily

Here is a brief list of recommended foods for people with Gastroparesis  (your nutritionist can give you a more comprehensive list):

Starches:

  • White bread and buns and “light” whole wheat bread without nuts or seeds
  • Plain or egg bagels
  • English dumplings
  • Flour or corn tortillas
  • pancakes
  • Puffed wheat and rice cereals
  • Cream of Wheat or Rice
  • white cookies
  • Potatoes, white or sweet (skinless)
  • baked potato chips
  • Rice
  • Pasta

Protein:

  • veal and pork (not fried)
  • Chicken or turkey (skinless or fried)
  • Crab, lobster, shrimp, clams, scallops, oysters
  • Tuna (packed in water)
  • Cottage cheese
  • Eggs
  • tofu
  • Forced meat baby food

Fruits and vegetables:

  • Baby food and fruit
  • Tomato sauce, paste, puree, juice
  • Carrots (cooked)
  • Beetroot (cooked)
  • Mushrooms (cooked)
  • vegetable juice
  • vegetable broth
  • Fruit juices and drinks
  • Apple’s Jam
  • bananas
  • Peaches and Pears (Canned)

Dairy:

  • Milk, if tolerated
  • Yogurt (no fruit pieces)
  • cream and pudding
  • frozen yogurt

Medications:  Medications to treat Gastroparesis  may include:

  • Medicines to Stimulate the Stomach Muscles. These medications include metoclopramide (Reglan) and erythromycin (Eryc, EES). Metoclopramide runs the risk of serious side effects. Erythromycin can lose its effectiveness over time and can cause side effects such as diarrhea. A newer drug, domperidone, with fewer side effects, is also available with restricted access.
  • Medications to Control Nausea and Vomiting. Drugs that help relieve nausea and vomiting include prochlorperazine (Compro) and diphenhydramine (Benadryl, Unisom). A class of drugs that includes ondansetron (Zofran) is sometimes used to help nausea and vomiting. The most commonly used drugs for the treatment of Gastroparesis  are:
  • Disodium Ceftriaxone
  • Ceftriaxone Sodium

NOTE:  Only a doctor can tell you which drug is most suitable for you, as well as the correct dosage and duration of treatment. Always follow your doctor’s instructions to the letter and NEVER self-medicate. Do not stop using the drug without consulting a doctor first, and if you take it more than once or in much larger amounts than prescribed, follow the instructions on the package insert.

Surgical Treatment:  Some people with Gastroparesis  may be unable to tolerate food or liquids. In these situations, doctors may recommend that a feeding tube (jejunostomy tube) be placed in the small intestine. Or doctors may recommend a gastric vent tube to help relieve pressure from gastric contents.

Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. The tube is usually temporary and is only used when Gastroparesis  is severe or when blood sugar levels cannot be controlled by any other method. Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest.

Treatments Under Investigation:  Researchers continue to investigate new drugs to treat gastroparesis . One example is a new drug in development called Relamorelin. Results from a phase 2 clinical trial revealed that the drug could speed up gastric emptying and reduce vomiting. The drug has not yet been approved by the Food and Drug Administration (FDA), but a larger clinical trial is underway.

A number of new therapies are being tested with the help of endoscopy – a slender tube that is threaded into the esophagus. One procedure used endoscopy to place a small tube (stent) where the stomach  connects to the small intestine (duodenum) to keep this connection open.

Several research trials have investigated the use of botulinum toxin administered via endoscopy without much success. This treatment is not recommended. Doctors are also looking into using a minimally invasive surgical technique when someone needs a feeding tube placed directly into the small intestine (jejunostomy tube).

Gastric Electrical Stimulation and Rhythm:  Gastric electrical stimulation is a surgically implanted device that provides electrical stimulation to stimulate the stomach muscles  to move food more efficiently. Study results were mixed. However, the device appears to be most useful for people with diabetic gastroparesis  .

The FDA allows the device to be used under a compassionate use waiver for those who cannot control their gastroparesis  symptoms with dietary or medication changes. However, larger studies are needed. Gastric stimulation also involves a surgically implanted device that stimulates the stomach muscles , but this device attempts to more closely mimic normal stomach contractions. Currently, the device is too large and causes discomfort. Gastric pacing devices are only available in clinical trials at this time.

Alternative Medicine:  There is some evidence that certain alternative treatments may be helpful for people with Gastroparesis , although more studies are needed. Some treatments that look promising include:

  • Acupuncture and Electro Acupuncture. Acupuncture involves inserting extremely fine needles through your skin at strategic points on your body. During electro acupuncture, a small electrical current is passed through the needles. Studies have shown these treatments to relieve symptoms of Gastroparesis  more than a sham treatment.
  • STW 5 (Iberogast). This herbal formula from Germany contains nine different herbal extracts. It hasn’t been shown to speed up gastric emptying, but it was slightly better at relieving digestive symptoms than a placebo.
  • Rikkunshito. This Japanese herbal formula also contains nine herbs. This can help reduce abdominal pain and post-meal fullness.
  • cannabis. There are no published clinical studies on cannabis and Gastroparesis . However, cannabis – commonly known as marijuana – is thought to relieve nausea and other digestive complaints. Cannabis derivatives have been used by people who have cancer in the past, but there are better FDA-approved drugs available to control nausea now. As cannabis is often smoked, there is concern about possible addictions and harm, similar to what happens with tobacco smoke. In addition, daily users of marijuana (cannabis) can develop a condition that mimics the symptoms of Gastroparesis  called Cannabis Hyperemesis Syndrome. Symptoms can include nausea, vomiting and abdominal pain. Stopping cannabis can help.

Prevention of Gastroparesis:  Prevention is done by avoiding the changes that can cause Gastroparesis . Maintain glycemic control in patients with diabetes mellitus. Adequately treat other endocrine disorders such as hypothyroidism or metabolic disorders.

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