Gastroparesis: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

The condition known as gastroparesis affects the spontaneous, normal movement of the muscles in your stomach. Food is typically moved through your digestive system by strong muscular contractions. However, because it slows down or stops functioning entirely, gastroparesis prevents your stomach from emptying properly.

The cause of gastroparesis is usually unknown. Gastroparesis can occur in persons who have had surgery as well as occasionally be a result of diabetes. By delaying the stomach's emptying, medications for high blood pressure, allergies, narcotic painkillers, and some antidepressants can all produce comparable sensations. For those who already have gastroparesis, these medications may make it worse.

Apart from disrupting normal digestion, gastroparesis may cause nausea, vomiting, and abdominal pain. It may lead to problems with blood sugar and nutrition as well. While there is currently no recognised cure for gastroparesis, some people may find relief with medicine and dietary changes.

Causes Of Gastroparesis

While the exact cause of gastroparesis is rarely identified, damage to the vagus nerve, which controls the stomach muscles, may occasionally be the cause.

In addition to other complex functions in your digestive system, the vagus nerve sends a signal to your stomach muscles telling them to contract and push food into the small intestine. Damage to the vagus nerve prevents your stomach muscles from receiving regular impulses. As a result, food might remain in your stomach for extended periods rather than breaking down in your small intestine.

The vagus nerve and its branches can be harmed by conditions such as diabetes or surgery on the stomach or small intestine.

Symptoms Of Gastroparesis

Symptoms and indicators of gastroparesis include:

• Nausea, bloating in the stomach
• Stomach discomfort
• A feeling of fullness after a small meal
• Throwing up unprocessed food that was eaten a few hours prior
• Acid reflux
• Differences in blood sugar levels
• Not being hungry
• Weight loss and starvation

Many people with gastroparesis don't show any overt signs or symptoms.

Risk factors Of Gastroparesis

The following elements could make you more susceptible to gastroparesis:

• Diabetes
• Oesophagal or abdominal surgery
• Infection is frequently caused by a virus
• Some medications, like opioid medicines, slow down the stomach's emptying process
• Scleroderma is one type of connective tissue condition.
• Parkinson's disease 
• Multiple sclerosis
• Hypothyroidism
• Women are more prone than men to suffer gastroparesis.

Diagnosis Of Gastroparesis

A variety of tests are used by doctors to help diagnose gastroparesis and rule out other conditions that may be causing similar symptoms. Testing might include:

Tests for Gastric emptying

To find out how rapidly your stomach empty itself, one or more of the following tests may be recommended:

• Scintigraphy: This is the test that is most important to diagnose gastroparesis. It involves eating a small amount of radioactive material together with a light meal, like bread and eggs. A radioactive material movement tracker is placed across your abdomen to measure the speed at which food leaves your stomach.
• Drugs that could cause difficulty emptying the stomach should be discontinued. Ask your doctor whether any of the medications you take have the potential to affect how well you digest food.
• Testing of breath: You ingest a liquid or solid meal that contains an ingredient your body absorbs to undergo a breath test. You eventually smell the chemical in your breath. Over a few hours, samples of your breath are taken, and the amount of the drug in those samples is measured. The test measures the amount of the chemical in your breath to determine how quickly your stomach empties after eating.

Gastroenterology (GI) Endoscopy

The duodenum, the first segment of the small intestine, the stomach, and the oesophagus are visually examined during this procedure. The apparatus uses a tiny camera that is attached to a lengthy, flexible tube. Further conditions that can be detected with this test include pyloric stenosis and peptic ulcer disease, which can also exhibit symptoms similar to gastroparesis.

Sonographic Examination

Using high-frequency sound waves, this test produces images of the inside structures of your body. A gallbladder or kidney ultrasound might help determine the cause of your symptoms if you're unsure.

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Treatment Of Gastroparesis

The first step in treating gastroparesis is to identify and address the underlying condition. If diabetes is the cause of your gastroparesis, your doctor can help you control it.

Changes in your Diet

Maintaining adequate nutrition is the most important goal in the management of gastroparesis. For many people, gastroparesis is controllable with dietary changes. Your doctor may suggest a dietitian to help you find foods that are easier for your body to digest. This might help you make sure your diet contains enough calories and nutrients.

A dietitian might suggest that you try:

• Eat more often and in smaller portions.
• Eat the food properly.
• Eat only fully cooked fruits and vegetables instead of raw ones.
• Broccoli and oranges are examples of fibrous fruits and vegetables that should be avoided since they can cause bezoars.
• If you can tolerate fat, incorporate small amounts of fatty foods in your diet, but try to make the majority of your meal choices low in fat.
• If you have problems with liquid swallowing, consider pureed foods and soups.
• Drink 1.5 to 2 litres (34 to 51 ounces) of water every day.
• Walk or do some other mild exercise after eating.
• Steer clear of cigarettes, alcohol, and carbonated drinks.
• After eating, try not to lie down for two hours.
• Take a multivitamin each day.

Medication

The following are some of the drugs used to treat gastroparesis:

Medications that stimulate the stomach's muscles. Erythromycin and metoclopramide (Reglan) are two of these medications. Metoclopramide may have serious adverse effects. Erythromycin may have undesirable side effects, such as diarrhoea, and lose its effectiveness with time.

A more contemporary medication with fewer side effects, domperidone, is also available in certain restricted amounts.

Pharmaceuticals to stop nausea and vomiting. Among the drugs that lessen nausea and vomiting are ondansetron (Zofran) and diphenhydramine (Benadryl). Prochlorperazine (Compro) is recommended if the vomiting and nausea don't go away.

Surgical procedure

Some people with gastroparesis may never be able to eat or drink anything. Doctors may recommend the insertion of a jejunostomy tube, or feeding tube, into the small intestine in specific situations. Alternatively, physicians may recommend a gastric venting tube to relieve pressure from the contents of the stomach.

Your mouth, nose, or skin can be used to implant feeding tubes straight into your small intestine. When other methods of regulating blood sugar levels are not effective or in cases of severe gastroparesis, the tube is frequently used temporarily. For certain people, an IV (parenteral) feeding tube—which goes into a vein in the chest—might be required.

Treatments under investigation

Research on new medications to treat gastroparesis is still ongoing.

One example is the innovative medicine relamorelin, which is currently being developed. Results from a phase II trial suggest that the drug may reduce vomiting and speed up emptying of the stomach. The Food and Drug Administration (FDA) has not yet authorised the medication for use in the US, even though a larger clinical trial is currently in progress.

Many innovative medicines are being tested with the help of endoscopy, a procedure that involves inserting a tiny tube, or endoscope, down the oesophagus.

The pylorus, a muscle ring that acts as a valve between the stomach and small intestine, is severed during a procedure known as endoscopic pyloromyotomy (gastric peroral endoscopic myotomy, or G-POEM). The stomach and small intestine are then connected by a channel.

This relatively new approach seems promising, but further research is needed.

To preserve the opening between the stomach and the duodenum, or small intestine, a different type of endoscopic surgery involves implanting a thin tube known as a stent.

Pacing and electrical stimulation of the stomach

Using a surgically implanted device, gastric electrical stimulation electrically stimulates the stomach muscles to better move food. However, people who have diabetic gastroparesis seem to gain the most from the device.

The FDA has granted a compassionate use exception for the use of the device for those who are unable to manage their gastroparesis symptoms through dietary changes or medicines. However, a more extensive investigation is necessary.

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Complications Of Gastroparesis

There are several potential side effects from a gastroplasty, such as:

• Severe dehydration: Dehydration could occur if vomiting persists.
• Malnutrition: An insufficient appetite could mean that you are not getting enough calories, or vomiting could be keeping you from getting enough nutrients.
• Food that remains in your stomach after being partially digested: Unfinished food in your stomach might harden into a mass called a bezoar. A bezoar can be deadly and cause nausea and vomiting if it prevents food from getting into your small intestine.
• Blood sugar fluctuations are unpredictable: Gastroparesis can not cause diabetes; rather, regular variations in the amount and speed of food that enters the small intestine might lead to unanticipated blood sugar fluctuations.
• These variations in blood glucose worsen diabetes: As such, poor control of blood sugar makes gastroparesis worse.
• Reduced living standards: When symptoms are present, it could be difficult to work and take care of other commitments.

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