Gastroparesis

Gastroparesis is a medical condition where the stomach's ability to empty its contents is delayed or impaired. This occurs due to dysfunction of the vagus nerve, which controls the muscles of the stomach and regulates gastric motility. In individuals with gastroparesis, the stomach doesn't contract properly, leading to delayed emptying of food into the small intestine. This can cause a range of digestive symptoms and interfere with nutrition, making it difficult for patients to maintain a healthy diet.

What Are the Causes of Gastroparesis?

Gastroparesis can be caused by a variety of factors, including:

Diabetes: One of the most common causes, particularly in individuals with long-standing or poorly controlled diabetes. High blood sugar can damage the vagus nerve, impairing stomach motility.
Neurological Conditions: Disorders such as Parkinson's disease, multiple sclerosis, and stroke can affect the nerves that control the stomach.
Post-Surgical Complications: Gastroparesis may occur after surgeries involving the stomach or abdominal region, such as gastric surgery or bariatric surgery.
Medications: Certain drugs, including opioids, anticholinergics, and some antidepressants, can slow gastric emptying.
Idiopathic Gastroparesis: In some cases, no clear cause can be identified. This is known as idiopathic gastroparesis.
Other Conditions: Conditions such as hypothyroidism, scleroderma, and viral infections can also contribute to the development of gastroparesis.

What Are the Symptoms of Gastroparesis?

The symptoms of gastroparesis can vary in severity but often include:

Nausea and vomiting, especially after eating
Feeling full quickly, even after eating small amounts of food
Abdominal bloating and discomfort
Early satiety, or the sensation of being full soon after starting a meal
Heartburn or acid reflux
Weight loss and malnutrition due to difficulty in absorbing nutrients
Poor appetite and avoidance of food
These symptoms can significantly impact a person's quality of life, and often worsen after meals or when consuming foods that are difficult to digest.

How is Gastroparesis Diagnosed?

The diagnosis of gastroparesis involves a combination of clinical evaluation and diagnostic testing. Some common tests include:

Gastroparesis Scintigraphy (Gastric Emptying Study): This is the most common test for diagnosing gastroparesis. It involves eating a meal containing a small amount of radioactive material, which allows the doctor to monitor how quickly the stomach empties.
Endoscopy: An endoscopic examination of the stomach can help rule out other conditions that may mimic gastroparesis symptoms, such as ulcers or tumors.
Upper GI Series (X-ray with contrast): This can evaluate the stomach’s structure and function.

Treatment options

There are many treatment options for gastroparesis from medical to endoscopic or surgical. This is a very nuanced disease. Your consultation with Dr. Siegal will help decide what is the right treatment for you!

Medical Treatments for Gastroparesis

The treatment of gastroparesis typically focuses on relieving symptoms and improving gastric motility. Some common medical treatments include:

Dietary Modifications: Small, frequent meals consisting of low-fat, low-fiber foods are often recommended. This helps reduce the burden on the stomach and aids in digestion. A dietitian may work with you to develop an individualized eating plan.
Enteral Nutrition: In severe cases where nutritional intake is insufficient, patients may require tube feeding or intravenous nutrition to ensure they receive adequate calories and nutrients.

Medications:

Prokinetic Drugs (e.g., metoclopramide or domperidone) help stimulate stomach motility.
Antiemetics (e.g., ondansetron) are used to help control nausea and vomiting.
Gastric Acid Reducers such as proton pump inhibitors (PPIs) or H2 blockers may be prescribed if acid reflux is a concern.

For some patients, medical treatments alone are not enough to manage the condition, and surgery or other advanced therapies may be needed.

Endoscopic Pyloromyotomy

This non-invasive procedure involves the use of an endoscope (a flexible tube with a camera) to make an incision in the pylorus, the muscle at the end of the stomach that controls the release of food into the small intestine.

The procedure helps to relax the pyloric sphincter, allowing food to pass more easily into the small intestine and improving gastric emptying. It can provide significant symptom relief for patients who do not respond to medical treatment.

Surgical Pyloromyotomy

In cases where endoscopic treatment is not feasible or effective, a traditional surgical pyloromyotomy may be performed. This involves making a small incisions in the abdomen (laparoscopic or robotic) to cut the pyloric muscle, which can help improve stomach emptying. While this procedure is more invasive than the endoscopic approach, it can provide long-lasting benefits for patients with severe gastroparesis and it can be combined with other procedures that a patient may need (hiatal hernia repair, weight loss surgery, etc).

Gastric
Electrical
Stimulator

Gastric electrical stimulation involves implanting a small device (similar to a pacemaker) in the stomach that delivers electrical pulses to stimulate the stomach muscles. This therapy can help improve gastric motility and reduce symptoms such as nausea and vomiting.

The device is typically implanted surgically, and patients can adjust its settings as needed. It has been shown to be effective in some patients, particularly those with idiopathic or diabetic gastroparesis where the predominant symptom is nausea and vomiting.

Gastric Resections

In severe cases of gastroparesis where the stomach is severely damaged or dysfunctional, a gastric resection may be considered. This involves surgically removing a portion of the stomach to improve its function and alleviate symptoms. The goal is to remove the part of the stomach that is not working properly, thus allowing the remaining stomach to function more effectively.

Recent research has shown gastric resection procedures that are also used in bariatric surgery may offer benefit. This is typically reserved for patients who do not respond to less invasive treatments.