|
|
|
|
|
|
|
Gastroparesis |
|
|
What is
gastroparesis?
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.
What causes gastroparesis?
The most common cause of gastroparesis is diabetes. People with
diabetes have high blood glucose, also called blood sugar, which
in turn causes chemical changes in nerves and damages the blood
vessels that carry oxygen and nutrients to the nerves. Over time,
high blood glucose can damage the vagus nerve.
Some other causes of gastroparesis are
* surgery on the stomach or vagus nerve
* viral infections
* anorexia nervosa or bulimia
* medications—anticholinergics and narcotics—that slow
contractions in the intestine
* gastroesophageal reflux disease
* smooth muscle disorders, such as amyloidosis and scleroderma
* nervous system diseases, including abdominal migraine and
Parkinson’s disease
* metabolic disorders, including hypothyroidism
Many people have what is called idiopathic gastroparesis, meaning
the cause is unknown and cannot be found even after medical tests.
What are the symptoms of gastroparesis?
* heartburn
* pain in the upper abdomen
* nausea
* vomiting of undigested food—sometimes several hours after a meal
* early feeling of fullness after only a few bites of food
* weight loss due to poor absorption of nutrients or low calorie
intake
* abdominal bloating
* high and low blood glucose levels
* lack of appetite
* gastroesophageal reflux
* spasms in the stomach area
Eating solid foods, high-fiber foods such as raw fruits and
vegetables, fatty foods, or drinks high in fat or carbonation may
contribute to these symptoms.
The symptoms of gastroparesis may be mild or severe, depending on
the person. Symptoms can happen frequently in some people and less
often in others. Many people with gastroparesis experience a wide
range of symptoms, and sometimes the disorder is difficult for the
physician to diagnose.
What are the complications of
gastroparesis?
If food lingers too long in the stomach, it can cause bacterial
overgrowth from the fermentation of food. Also, the food can
harden into solid masses called bezoars that may cause nausea,
vomiting, and obstruction in the stomach. Bezoars can be dangerous
if they block the passage of food into the small intestine.
Gastroparesis can make diabetes worse by making blood glucose
control more difficult. When food that has been delayed in the
stomach finally enters the small intestine and is absorbed, blood
glucose levels rise. Since gastroparesis makes stomach emptying
unpredictable, a person’s blood glucose levels can be erratic and
difficult to control.
How is gastroparesis diagnosed?
After performing a full physical exam and taking your medical
history, your doctor may order several blood tests to check blood
counts and chemical and electrolyte levels. To rule out an
obstruction or other conditions, the doctor may perform the
following tests:
*
Upper endoscopy. After giving you a sedative to help you become
drowsy, the doctor passes a long, thin tube called an endoscope
through your mouth and gently guides it down the throat, also
called the esophagus, into the stomach. Through the endoscope, the
doctor can look at the lining of the stomach to check for any
abnormalities.
*
Ultrasound. To rule out gallbladder disease and pancreatitis as
sources of the problem, you may have an ultrasound test, which
uses harmless sound waves to outline and define the shape of the
gallbladder and pancreas.
*
Barium x ray. After fasting for 12 hours, you will drink a thick
liquid called barium, which coats the stomach, making it show up
on the x ray. If you have diabetes, your doctor may have special
instructions about fasting. Normally, the stomach will be empty of
all food after 12 hours of fasting. Gastroparesis is likely if the
x ray shows food in the stomach. Because a person with
gastroparesis can sometimes have normal emptying, the doctor may
repeat the test another day if gastroparesis is suspected.
Once other causes have been ruled out, the doctor will perform one
of the following gastric emptying tests to confirm a diagnosis of
gastroparesis.
*
Gastric emptying scintigraphy. This test involves eating a bland
meal, such as eggs or egg substitute, that contains a small amount
of a radioactive substance, called radioisotope, that shows up on
scans. The dose of radiation from the radioisotope is not
dangerous. The scan measures the rate of gastric emptying at 1, 2,
3, and 4 hours. When more than 10 percent of the meal is still in
the stomach at 4 hours, the diagnosis of gastroparesis is
confirmed.
*
Breath test. After ingestion of a meal containing a small amount
of isotope, breath samples are taken to measure the presence of
the isotope in carbon dioxide, which is expelled when a person
exhales. The results reveal how fast the stomach is emptying.
*
How is gastroparesis treated?
Treatment of gastroparesis depends on the severity of the
symptoms. In most cases, treatment does not cure gastroparesis—it
is usually a chronic condition. Treatment helps you manage the
condition so you can be as healthy and comfortable as possible.
Dietary Changes
Changing your eating habits can help control gastroparesis. Your
doctor or dietitian may prescribe six small meals a day instead of
three large ones. If less food enters the stomach each time you
eat, it may not become overly full. In more severe cases, a liquid
or pureed diet may be prescribed.
The doctor may recommend that you avoid high-fat and high-fiber
foods. Fat naturally slows digestion—a problem you do not need if
you have gastroparesis—and fiber is difficult to digest. Some
high-fiber foods like oranges and broccoli contain material that
cannot be digested. Avoid these foods because the indigestible
part will remain in the stomach too long and possibly form
bezoars.
Feeding Tube
If a liquid or pureed diet does not work, you may need surgery to
insert a feeding tube. The tube, called a jejunostomy, is inserted
through the skin on your abdomen into the small intestine. The
feeding tube bypasses the stomach and places nutrients and
medication directly into the small intestine. These products are
then digested and delivered to your bloodstream quickly. You will
receive special liquid food to use with the tube. The jejunostomy
is used only when gastroparesis is severe or the tube is necessary
to stabilize blood glucose levels in people with diabetes.
Parenteral Nutrition
Parenteral nutrition refers to delivering nutrients directly into
the bloodstream, bypassing the digestive system. The doctor places
a thin tube called a catheter in a chest vein, leaving an opening
to it outside the skin. For feeding, you attach a bag containing
liquid nutrients or medication to the catheter. The fluid enters
your bloodstream through the vein. Your doctor will tell you what
type of liquid nutrition to use.
This approach is an alternative to the jejunostomy tube and is
usually a temporary method to get you through a difficult period
with gastroparesis. Parenteral nutrition is used only when
gastroparesis is severe and is not helped by other methods.
Gastric Electrical Stimulation
A gastric neurostimulator is a surgically implanted
battery-operated device that releases mild electrical pulses to
help control nausea and vomiting associated with gastroparesis.
This option is available to people whose nausea and vomiting do
not improve with medications. Further studies will help determine
who will benefit most from this procedure, which is available in a
few centers across the United States.
What if I have diabetes and gastroparesis?
The primary treatment goals for gastroparesis related to diabetes
are to improve stomach emptying and regain control of blood
glucose levels. Treatment includes dietary changes, insulin, oral
medications, and, in severe cases, a feeding tube and parenteral
nutrition.
Dietary Changes
The doctor will suggest dietary changes such as six smaller meals
to help restore your blood glucose to more normal levels before
testing you for gastroparesis. In some cases, the doctor or
dietitian may suggest you try eating several liquid or pureed
meals a day until your blood glucose levels are stable and the
symptoms improve. Liquid meals provide all the nutrients found in
solid foods, but can pass through the stomach more easily and
quickly.
Insulin for Blood Glucose Control
If you have gastroparesis, food is being absorbed more slowly and
at unpredictable times. To control blood glucose, you may need to
* take insulin more often or change the type of insulin you take
* take your insulin after you eat instead of before
* check your blood glucose levels frequently after you eat and
administer insulin whenever necessary
Your doctor will give you specific instructions for taking insulin
based on your particular needs.
Points to Remember
*
Gastroparesis is the result of damage to the vagus nerve, which
controls the movement of food through the digestive system.
Instead of moving through the digestive tract normally, the food
is retained in the stomach.
*
Gastroparesis may occur in people with type 1 diabetes or type 2
diabetes. The vagus nerve becomes damaged after years of high
blood glucose, resulting in gastroparesis. In turn, gastroparesis
contributes to poor blood glucose control.
*
Symptoms of gastroparesis include early fullness, abdominal pain,
stomach spasms, heartburn, nausea, vomiting, bloating,
gastroesophageal reflux, lack of appetite, and weight loss.
*
Gastroparesis is diagnosed with tests such as x rays, manometry,
and gastric emptying scans.
*
Treatment includes dietary changes, oral medications, adjustments
in insulin injections for people with diabetes, a jejunostomy
tube, parenteral nutrition, gastric neurostimulators, or botulinum
toxin.
|
|
|
|
Gastroparesis - treatment of Gastroparesis,
Gastroparesis types, Disease medicines, Gastroparesis symptoms,
Gastroparesis and Disease symptoms, Gastroparesis symptoms Disease and
diagnosis, Symptoms and Solutions, Signs and Symptoms, type of Gastroparesis,
cause common, common Gastroparesis, Gastroparesis List, causes list,
Infectious Gastroparesis, Causes, Diseases , Types, Prevention, Treatment
and Facts, Gastroparesis information, Gastroparesis: Definition,
Gastroparesis names, medical Gastroparesis, medical Gastroparesis and
disorders, cell Gastroparesis, Gastroparesis Worldwide, Gastroparesis
Research, Gastroparesis Control, Gastroparesis Center, Digestive
Gastroparesis Week, Information about Gastroparesis, causes of different
Gastroparesis, Gastroparesis Articles, Gastroparesis and conditions, Health
and Gastroparesis, Gastroparesis Patients, Gastroparesis and Sciences,
causes of alzheimer's Gastroparesis, Gastroparesis causes, alternative
medicine heart Gastroparesis, body ailments, Gastroparesis medicines,
medical antiques, type of blood Gastroparesis |
|
|