Symptoms

You may have:

• Heartburn or gastroesophageal reflux disease (GERD)
• Upset stomach
• Throwing up undigested food
• A feeling of fullness quickly when you eat
• Bloating
• Lack of appetite and weight loss
• Trouble controlling blood sugar
• Belly pain

The symptoms associated with gastroparesis, such as vomiting and decreased appetite, can cause dehydration and malnutrition. Dehydration and malnutrition can cause numerous problems, including:

• electrolyte imbalances
• decreased blood pressure
• increased heartbeat
• rapid breathing
• decreased urine output
• a weakened immune system
• poor wound healing
• muscle weakness

Since gastroparesis causes food to stay in the stomach for too long, it can also cause an overgrowth of bacteria. The food can also harden into masses called bezoars that cause nausea, vomiting, and obstruction in the stomach.

Diagnosis

To diagnose gastroparesis, a GP will ask about your symptoms and medical history, and may arrange a blood test for you.

barium X-ray – where you swallow a liquid containing the chemical barium, which can be seen on an X-ray and highlights how the liquid is passing through your digestive system

gastric emptying scan – you eat a food (often eggs) containing a very small amount of a radioactive substance that can be seen on the scan. Gastroparesis is diagnosed if more than 10% of the food is still in your stomach 4 hours after eating

wireless capsule test – you swallow a small, electronic device which sends information about how fast it is moving through your digestive tract to a recording device

endoscopy – a thin, flexible tube (endoscope) is passed down your throat and into your stomach to examine the stomach lining and rule out other possible causes

Causes

In many cases of gastroparesis, there is no obvious cause. This is known as idiopathic gastroparesis.

Known causes of gastroparesis include:

• poorly controlled type 1 diabetes or type 2 diabetes
• a complication of some types of surgery – such as weight loss (bariatric) surgery or removal of part of the stomach (gastrectomy)

Other possible causes of gastroparesis include:

• medicine – such as opioid painkillers (for example, morphine) and some antidepressants
• Parkinson’s disease – a condition where part of the brain becomes progressively damaged over many years
• scleroderma – an uncommon disease that results in hard, thickened areas of skin, and sometimes problems with internal organs and blood vessels
• amyloidosis – a group of rare but serious diseases caused by deposits of abnormal protein in tissues and organs throughout the body

Prevention

If you have diabetes (type 1 or 2), the best way to prevent gastroparesis is to effectively manage your blood glucose levels through diet, insulin or medication. Improving your diet is always the best way to prevent or manage most gastrointestinal disorders or problems. Quitting cigarette smoking can also be beneficial to your overall condition.

Typical treatment 

If your gastroparesis is caused by a condition like diabetes, the first step is to improve control of that underlying condition. After that, your doctor may recommend medications, diet changes, and even surgery in some cases.

Medication

Your doctor may prescribe one or more medications to treat your gastroparesis. Medications to control nausea and vomiting caused by gastroparesis like prochlorperazine , ondansetron , promethazine 

Other medications stimulate the stomach muscles and help with digestion like metoclopramide 

However, these drugs can cause side effects. Talk with your doctor to weigh the pros and cons of each medication to find out which one is right for you.

Surgery

If your malnutrition or vomiting remains an issue even with the use of medications, your doctor may decide that surgery on your stomach is necessary. The goal of surgery for gastroparesis is to help your stomach empty more effectively.

A stomach stimulator known as a GES (gastric electrical stimulator) can be implanted into the stomach. This device is FDA approved for individuals who do not respond to medications. Studies have shown that in the first year after this surgery, up to 97 percent of people with a GES have less nausea and vomiting and are able to gain weight. The device may also improve life expectancy related to gastroparesis.

Diet changes

Seeing a dietitian — an expert on food and nutrition — is a common part of treatment for gastroparesis. A dietitian can suggest foods that your body can digest more easily, allowing your body to absorb more nutrients. Your dietitian might make suggestions to you, such as:

• eat four to six meals per day
• drink high-calorie liquids
• limit alcohol and carbonated beverages
• take a daily multivitamin, if tolerated
• limit certain meats and dairy
• eat well-cooked vegetables and fruit to lower the amount of fiber they contain
• eat mostly low-fat foods
• avoid foods that have a lot of fiber, like broccoli and oranges
• ensure there is adequate time after meals before lying down for bed
• substitute solid foods for pureed or liquid foods

If you have a severe case of gastroparesis, you might not be able to eat solid foods and drink liquids. In this case, you may need a feeding tube until your condition improves.

Botulinum toxin injections

More severe cases of gastroparesis may occasionally be treated by injecting botulinum toxin into the valve between your stomach and small intestine. This relaxes the valve and keeps it open for a longer period of time so food can pass through.

The injection is given through a thin, flexible tube (endoscope) which is passed down your throat and into your stomach.

This is a fairly new treatment and some studies have found it may not be very effective, so it is not recommended by all doctors.

Vagal nerve stimulation

The vagus nerve is important to digestion. In 2018, research is underway to study the use of vagal nerve stimulation for people with gastroparesis. This study is looking at the effectiveness of self-administered nerve stimulation twice a day.

The hope is that vagal nerve stimulation will help reduce inflammation and nerve problems associated with gastroparesis.

Conclusion

Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls the movement of food from the stomach through the digestive tract. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.