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Gastroparesis
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Gastroparesis involves sluggishness in the stomach so that it doesn't empty normally. It is a lack of the ordinary strong muscles of the stomach that propel food from the stomach to the rest of the digestive tract. The muscles weaken so that food sits into the stomach and doesn't go on to be digested in the rest of the intestinal tract. This results in nausea and vomiting and can cause blood sugar fluctuations in diabetics. Gastroparesis has no cure but it can be managed with dietary restrictions and better control to the diabetes so the condition doesn't get worse.
Signs and symptoms of gastroparesis involve feelings of nausea and vomiting, feeling of fullness after eating a small amount of food, being bloated, alterations in blood sugar, a lack of appetite, heartburn or GE reflux symptoms, weight loss and obvious malnutrition, especially if severe.
Gastroparesis is caused by some sort of damage to the vagus nerve, which supplies the heart and stomach, among other things. When the vagus nerve affects the stomach muscles, they become weak and don't allow food to pass into the duodenum. Damage to the vagus nerve can happen for a variety of reasons, the most common of which is diabetes. Other risk factors for gastroparesis besides diabetes include having abdominal surgery, taking certain medications that lower the rate of stomach emptying (antidepressants and narcotic pain medications), taking cancer treatments, being anorexic or having bulimic, and having scleroderma, Parkinson's disease or low thyroid conditions.
Complications of gastroparesis include losing weight and having malnutrition. This is because the body doesn't absorb certain nutrients and vomiting can cause poor absorption of food nutrition. Bacteria can overgrow within the stomach due to fermentation of food. Bad bacteria can grow out of control. Undigested food can be stored in the stomach and can harden, leading to what's known as a bezoar. This can further nausea and vomiting and can contribute to stomach fullness when eating. Inconsistencies in food absorption can cause blood sugar levels to become significantly erratic.
There are several different tests to help doctors diagnose gastroparesis. Doctors can use a gastric emptying study that measures how long the food remains in the stomach and when it goes through to the duodenum. This is done using mildly radioactive food that is eaten and then watched with a scanner to see how it goes through the stomach. Doctors can also use an endoscope to determine whether or not there is muscle weakening of the stomach muscles. Other abnormalities of the stomach can be diagnosed using an endoscope.
Treating gastroparesis depends on treating the underlying syndrome which causes the disease. You can change your diet to include food that is easy to digest. You need to eat smaller meals more often and stick to low fiber foods such as fruit that is well-cooked and cooked vegetables. Low fat foods should be avoided or eaten in small quantities. Broccoli and oranges are bad because they can lead to bezoars. Pureed foods are a good thing to eat and you should drink water to push things through the stomach as you are eating. Mild exercise after eating will help push food through the stomach.
If no food is tolerated through the stomach, then a jejunostomy tube is recommended, which puts food into the jejunum for digestion. Only liquid processed foods are used in that situation. All food goes through the feeding tube in such a situation.
Medications used to treat gastroparesis include medications for nausea and vomiting, such as prochlorperazine (Compazine), Zofran, and Benadryl. A medication called Reglan is used to stimulate the muscles of the stomach. Surgery can staple or completely bypass the lower part of the stomach, which keeps food going through the stomach easier.
Other ways of treating gastroparesis include the use of a botulinum toxin which paralyzes the stomach muscles and allows it to "release" the food easier. It relaxes the pyloric muscles and can be given using an endoscope. An electrical device can be used on the stomach muscles that acts much like a heart pacemaker. It allows the stomach to contract at specific times to force the food through the stomach.