Gastroparesis

Typical symptoms include feeling sick or full when eating, bloating, and weight loss.

The cause is not a blockage, but thought to be a problem with the nerves or muscles controlling the emptying of the stomach. If the nerves are damaged, the muscles of your stomach and intestines do not work properly and the movement of food is slowed.

What causes this nerve damage?

In many cases, the cause is unknown – this is known as idiopathic gastroparesis.

When the cause of gastroparesis is known, it is usually poorly controlled

. The nerves to the stomach can be damaged by constantly high levels of blood glucose. Therefore if you have diabetes, it's important to keep your blood glucose levels under control.

Gastroparesis can also be a complication of some types of surgery, such as a gastrectomy (removal of part of the stomach).

Other possible causes are:

• medications such as narcotics and some antidepressants
• Parkinson's disease
• multiple sclerosis
• 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

What are the symptoms of gastroparesis?

The main symptoms of gastroparesis are:

• feeling sick and vomiting
• feeling full very quickly when eating
• weight loss
• bloating of the tummy
• fluctuations in blood glucose levels
• heartburn
• loss of appetite

These symptoms can be mild or severe, and tend to come and go.

If you think you may have gastroparesis you must see your doctor, as it can lead to dangerous complications, including:

• dehydration from repeated vomiting
• gastro-oesophageal reflux disease (GORD)
  , where stomach acid leaks out of your stomach and into your gullet
• malnutrition
  , when your body is not getting enough nutrients
• unpredictable blood sugar levels

How is it diagnosed?

To diagnose gastroparesis, your doctor will listen to your symptoms and medical history, and may order some blood tests.

You may be referred to hospital for the following diagnostic tests:

• a barium X-ray, where you swallow a liquid containing the chemical barium, which shows up on X-ray and allows radiologists to watch the passage of this solution through your digestive system
• a gastric emptying scan using scintigraphy, where you eat bland food (often eggs) containing a very small amount of a radioactive substance that is detected on the scan – gastroparesis is diagnosed if more than 10% of the food is still in your stomach four hours after eating
• gastric manometry, where a thin tube containing a wire is passed down your throat and into your stomach to measure electrical and muscular activity in your stomach as you digest food to determine your rate of digestion
• a smart pill, where you swallow a small electronic device that sends back information about how fast it is travelling as it moves through your digestive tract
• endoscopy
  , where a thin, flexible tube is passed down your throat and into your stomach to examine the stomach lining and rule out other possible causes
• ultrasound scan
  , which uses sound waves to build up a picture of your body organs (this rules out other possible diseases)

How is it treated?

Gastroparesis cannot usually be cured, but dietary changes and medical treatments can help you control the condition. These measures are summarised below.

Dietary changes

You may find these tips helpful:

• instead of three meals a day, try six smaller meals – there will be less food in your stomach and it will be easier to pass through your system
• try soft (well cooked) and liquid foods, which are easier to digest
• chew food well before swallowing
• drink non-carbonated liquids with each meal
• walk or sit for two hours following a meal, rather than lying down

Also, try avoiding:

• hard-to-digest foods like apples with their skin on, or high-fibre foods like oranges and broccoli
• foods high in fat (which can slow down digestion)

Medication

The follow medication may help to improve your symptoms:

• metoclopramide, which is taken before eating to contract your stomach muscles and move food along; it also reduces nausea and vomiting (but can cause diarrhoea and other side effects)
  • antiemetics, drugs that control nausea

Botox

More severe cases of gastroparesis can also be treated by injecting botulinum toxin (Botox) into the valve between your stomach and small intestine, to relax it and keep it open for a longer period of time so food can pass through.

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

This is a fairly new treatment that has had mixed results so far.

Electrical stimulation

This fairly new treatment may be tried if dietary changes and medication don't improve your symptoms.

Under a general anaesthetic, a battery-operated device is surgically implanted into your body. This works a bit like a pacemaker.

The device is made up of a neurostimulator and two leads. The stimulating electrode of each lead is fixed to the muscle of your lower stomach and the connector end of each lead is attached to the neurostimulator, which is implanted under the skin of your tummy.

When the neurostimulator is turned on using a handheld external control, electrical impulses are delivered to the stomach. The rate and amplitude of stimulation can be adjusted.

There is a small chance of this procedure leading to infection, the device dislodging and moving, or a hole forming in your stomach wall, which would mean removing the device. Speak to your surgeon about these possible risks.

A feeding tube

If you have extremely severe gastroparesis that is not improved with dietary changes and medication, you may benefit from a feeding tube.

Many different types of feeding tube are available – some only temporary, and others permanent.

A temporary feeding tube called a nasojejunal tube may be offered to you first, which is inserted through your nose to pass nutrients directly into your small intestine.

A feeding tube can also be inserted into your bowel surgically, via an incision made in your tummy. This is known as a jejunostomy. Liquid food containing nutrients can be poured into the tube, which goes straight to your bowel to be absorbed, bypassing your stomach.

Speak to your doctor about the risks and benefits of each type of feeding tube.

An alternative feeding method for severe gastroparesis is intravenous (parenteral) nutrition, where liquid nutrients are passed straight into your bloodstream via a catheter (a tiny flexible tube) that is fed into a large vein.

Surgery

You may benefit from having a surgical procedure to create an opening between your stomach and small intestine, to allow food to move through more easily. This is known as a gastroenterostomy.

Your doctor will explain this procedure to you in detail, and explain the possible risks.