Gastroparesis: Causes, Diagnosis, and Treatment
Gastroparesis is a chronic condition where food passes through the stomach slower than normal. It occurs because the nerves that trigger stomach emptying aren’t as effective as usual. There is no obstruction or structural abnormality.
The underlying cause behind gastroparesis isn’t known but it has been linked to diabetes, surgery, and viral illnesses. Patients with gastroparesis commonly experience nausea, vomiting, and stomach pain.
What is Gastroparesis?
Gastroparesis, or delayed gastric emptying, is a long-term condition where food moves through the stomach at a slower pace.
Usually, the muscles in the stomach are well co-ordinated and have the necessary strength to move stomach contents out of the stomach and into the small intestine. However, when this becomes impaired, stomach contents remain in the stomach longer than usual.
Gastroparesis is thought to affect around 13 per 100,000 people. It can occur in people of all ages but is more common in older people and women.
Gastroparesis Symptoms
Gastroparesis isn’t always experienced the same way in everyone. The symptoms can range from mild to severe.
Common gastroparesis symptoms include:
Nausea
Vomiting (especially undigested food)
Early satiety (feeling full quickly)
Bloating
Abdominal pain or discomfort – typically experienced in the upper stomach, representing a dull or sharp pain.
Loss of appetite
Weight loss
Acid reflux or heartburn
Erratic blood sugar levels (especially in diabetics)
In some cases, the person may have no symptoms at all (asymptomatic).
What Causes Gastroparesis?
The underlying cause behind gastroparesis is not known. Doctors understand that it’s connected to the nerve supply. However, why this nerve supply becomes damaged or dysfunctional isn’t clear.
Doctors classify gastroparesis causes into three categories:
Idiopathic, or unknown, simply means doctors cannot identify the cause. It’s believed that some people have a stomach that’s either overly sensitive to nerve signals or cannot react properly to a meal, playing a role in the condition. Around 36% of cases have no identifiable cause.
Diabetes is commonly linked to gastroparesis. Repeatedly high blood sugar levels can cause nerve damage throughout the body. If this affects the vagus nerve – which regulates your digestive system – it can cause permanent gastrointestinal (GI) dysfunction.
Post-surgical dysfunction occurs when GI surgery damages the nerves in the abdomen, leading to dysfunctional stomach contractions, and therefore gastroparesis. This accounts for about 13% of cases.
Usually, when medical professionals cannot provide a precise cause behind a condition they look for risk factors to determine the likelihood of an individual having the condition. The risk factors for gastroparesis include:
Diabetes (especially poorly controlled)
Previous abdominal surgery
Viral infections
Neurological disorders (e.g. Parkinson’s, MS)
Autoimmune diseases
Medications that slow digestion (e.g. opioids, anticholinergics)
Hypothyroidism
Eating disorders (e.g. anorexia, bulimia)
Gastroparesis Diagnosis
Gastroparesis can be difficult to diagnose. There is no obstruction or physical change that will show up on a scan. Your doctor will begin by asking questions about your medical history and performing an examination.
Next, your doctor will want to eliminate other potential causes. They may request:
An ultrasound to view your organs, ruling out liver disease, pancreatitis, and gallbladder disease.
Blood tests to assess for diabetes or other conditions.
An upper endoscopy to look for blockages and other conditions.
If these tests are negative, your doctor will consider a physiological problem like gastroparesis. It's important to distinguish gastroparesis from conditions like functional dyspepsia, which shares similar symptoms but often involves normal gastric emptying. These tests assess GI function and speed. You may undergo:
Gastric emptying scintigraphy involves eating a small portion of food with a harmless radioactive substance which shows up on x-rays. Your doctor can then see how fast the food is digested and emptied from your stomach.
Carbon-13 labelled breath test involves eating a small meal (often porridge) containing a carbon-13 labelled substance which can be measured in breath. Following the meal, you provide breath samples over a 4-hour period. The rate at which your breath no longer contains the carbon-13 substance can determine how quickly or slowly your stomach empties.
How is Gastroparesis Treated?
Gastroparesis cannot be cured. If the underlying cause is diabetes, the priority is to improve blood sugar control. This will prevent the condition from worsening. Otherwise, treatments typically involve dietary changes or medication.
Medication
People with gastroparesis often experience nausea and other symptoms. Certain medications can help to relieve these symptoms. For example, domperidone, metoclopramide, and erythromycin can help stimulate stomach muscles, ondansetron and prochlorperazine can control nausea and vomiting, and antidepressants like mirtazapine and bupropion affect the nerves themselves.
Dietary Changes
Recommended dietary changes for gastroparesis include:
Eating smaller, more frequent meals.
Eating softer foods and lots of fluids.
Avoid hard-to-digest foods such as raw vegetables, broccoli, or fruits with a skin.
Chew thoroughly before swallowing.
Limit fat intake.
Wait two hours after eating before lying down
Ready for Relief from Regurgitation?
If you’re dealing with symptoms of gastroparesis such as food or acid flowing back into your mouth (regurgitation), persistent heartburn, or unexplained throat pressure, don’t wait to get a diagnosis.
The Functional Gut Clinic offers expert diagnostic tests – like gastric emptying breath tests to diagnose gastroparesis, as well as 24-hour pH/impedance monitoring and esophageal manometry to identify any acid-reflux or swallowing-related issues.
