What is gastroparesis and how should you treat it? Our Dr. Ismail weighs in.

Gastroparesis is a disorder in which the stomach takes too long to empty after eating. The delay is caused by abnormal function of the stomach nerves or muscles and results in bloating, nausea, and/or belly pain.

Diabetes is one of the most common causes of gastroparesis. Other causes include some disorders of the nervous system — such as Parkinson's disease— and some medicines; including tricyclic antidepressants, calcium channel blockers and opioids.

We recently spoke with UK HealthCare’s Dr. Bahaaeldeen Ismail, MD, MSc, assistant professor of medicine at the University of Kentucky, about gastroparesis 

What is gastroparesis?

Gastroparesis is a condition affecting the stomach leading to food retention. Normally, after we ingest food, the stomach relaxes in order to accommodate the meal; this prevents the sense of fullness and allows the stomach to adequately digest the food. The muscles in the stomach wall then push the food towards the distal part of stomach (antrum) in a synchronized way, resulting in the grinding, mixing, then emptying of solids into the small intestine. With gastroparesis, there is disturbance in one or more of these processes.

At what age can gastroparesis begin to develop and are certain people at greater risk?

Gastroparesis is more common in adults and is believed to be more common in females. Studies estimate approximately 24 in 100, 000 people are affected by the condition. 

Gastroparesis occurs more commonly in association with certain conditions. For example, patients with long standing diabetes are at high risk due to the associated neuropathy. Certain neurologic (eg: Parkinson’s disease) and rheumatologic conditions (eg: scleroderma) are also considered a risk for developing delayed gastric emptying. The same process can occur with medications that reduce the contractions of smooth muscles (present in multiple organs including the stomach wall). Common examples are narcotics, some antidepressants and calcium channel blockers. 

Moreover, slow emptying can occur after surgical procedures involving areas close to the vagus nerve (which supplies the stomach and controls its motility). Patients without any of these conditions can also develop gastroparesis following an acute viral infection (particularly Norwalk virus and rotavirus). Interestingly, up to half of gastroparesis patients have no underlying cause (idiopathic gastroparesis).

What are the most common symptoms of gastroparesis?

As food accumulates in a stomach that is not emptying effectively, patients develop early fullness and are typically unable to finish their meal. Frequently, patients describe decreased quality of life due to the associated nausea, vomiting, bloating and abdominal discomfort. Severity varies widely and more severe cases can lead to weight loss, dehydration or malnutrition —often requiring emergency room visits and hospitalization.

It is important to note that these symptoms are not specific and can occur in other conditions involving the digestive tract or even involving other organs. Hence, a thorough evaluation by the gastroenterologist is essential. This typically begins with esophagogastroduodenoscopy (EGD), wherein a tube with a camera is passed through the throat into the stomach while the patient is sedated. This allows examination for ulcers, masses or stomach blockage. If that does not result in a diagnosis, the provider then orders a test to assess the rate of stomach emptying. Most commonly, a radionucleotide gastric emptying scan is requested, in which the patient is asked to eat a labelled standardized meal, then serial imaging is performed over four hours to assess the amount of food retained in the stomach. Other tests serving similar functions include a swallowed motility capsule as well as a breath test.

Additional tests may also be required to evaluate the patient’s nutritional status and to examine for associated motility disorders involving other organs (for example, the bowel and esophagus). 

What are the best methods of treating gastroparesis?

After diagnosis is confirmed, the gastroenterologists work with medical team members to correct the underlying cause. Common treatment examples are optimizing diabetes control and stopping (or reducing the dosage of) the culprit medicine. Patients then receive detailed instructions on dietary management and are often referred to a dietician. 

We typically prescribe medications that reduce nausea and vomiting (antiemetics) as needed. Prokinetics are medications that enhance the stomach emptying, and are often given before meals. However, their prolonged use is limited by the variable efficacy over time and potential side effects. Common medications in this group are metoclopramide, erythromycin and domperidone. Research to identify additional prokinetic agents is ongoing.

Can it be treated by changing your diet?

Dietary modifications represent one of the treatment cornerstones. Patients typically feel better when consuming smaller, more frequent meals. We also advise patient to remain well-hydrated andl imit fat and insoluble fiber components in their meals. We provide detailed written instructions and often refer patients to a dietician for more comprehensive instruction on diet modification. Some patients may also benefit from shifting to a full-liquid diet and adding supplemental nutritional drinks — particularly when symptoms flare up.

At what point should someone consider surgery for gastroparesis?

Endoscopic and surgical options are reserved for those with no response to the measures mentioned above. Through endoscopy, a feeding tube can be placed to bypass the diseased stomach and deliver the feeding formula directly into the small bowel. The endoscopist can also treat the muscle at the stomach exit (pylorus) using a relaxing agent (such as Botulinum toxin injection), stretching using a balloon dilator or even partially cutting the muscle fiber. These measures might help symptoms by facilitating the passage of food out of the stomach. More invasive surgical options include surgically cutting the muscle sphincter to ease the food passage into the small bowel (pyloroplasty) or connecting the stomach directly to the small bowel (gastrojejunostomy). Gastric stimulator is also considered in certain patients.

These options have variable response rates and are typically evaluated on a case-by-case basis in a tertiary care center. 

How can UK HealthCare help?

UK Healthcare serves as a referral center for gastroparesis and other gastrointestinal motility disorders. We offer a multi-specialty team approach addressing the patient’s symptoms, underlying etiology and offer suitable treatment plans. Our team includes experienced gastroenterologists, dieticians, endoscopists, radiologists and surgeons. 

To schedule an appointment with UK HealthCare digestive health providers, click here to visit our website or call 859-323-0079.