Gastroparesis
Encyclopedia
Gastroparesis, also called delayed gastric emptying, is a medical condition consisting of a paresis
(partial paralysis
) of the stomach
, resulting in food remaining in the stomach for a longer period of time than normal. Normally, the stomach contracts to move food down into the small intestine
for digestion. The vagus nerve
controls these contractions. Gastroparesis may occur 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.
, bulimia and other abnormal eating patterns.
Chronic gastroparesis is frequently due to autonomic neuropathy. This may occur in people with type 1 diabetes or type 2 diabetes. The vagus nerve becomes damaged by years of high blood glucose or simply by having diabetes for a long time, resulting in gastroparesis. Gastroparesis has also been associated with various connective tissue diseases, such as Scleroderma
and Ehlers-Danlos syndrome
, and neurological conditions, such as Parkinson's disease
. It may also occur as part of a mitochondrial disorder.
Chronic gastroparesis can also be caused by other types of damage to the vagus nerve, such as abdominal surgery
.
Idiopathic gastroparesis (gastroparesis with no known cause) accounts for a third of all chronic cases; it is thought that many of these cases are due to an autoimmune response triggered by an acute viral infection. "Stomach flu", mononucleosis
, and others have been anecdotally linked to the onset of the condition, but no systematic study has proven a link.
Gastroparesis sufferers are disproportionately female. One possible explanation for this finding is that women have an inherently slower stomach emptying time than men. A hormonal link has also been suggested, as gastroparesis symptoms tend to worsen the week before menstruation, when progesterone levels are highest. Neither theory has been proven definitively.
Other symptoms include
Morning nausea may also indicate gastroparesis. It is important to note that vomiting may not occur in all cases, as sufferers may learn to adjust their diets to include only small amounts of food.
, and gastric emptying scans. The clinical definition for gastroparesis is based solely on the emptying time of the stomach and not on other symptoms, and severity of symptoms does not necessarily correlate with the severity of gastroparesis. Therefore, some patients may have marked gastroparesis with few, if any, serious complications.
Treatment includes dietary changes (low-fiber and low-residue diets
, and in some cases, restrictions on fat and/or solids), oral medications such as metoclopramide
(Reglan, Maxolon, Clopra), cisapride
(Propulsid)(no longer available in the US), erythromycin
(E-Mycin, Erythrocin, Ery-Tab, EES) and domperidone
(Motilium); adjustments in insulin dosage for those with diabetes, a jejunostomy
tube, parenteral nutrition, implanted gastric neurostimulators ("stomach pacemakers"), or botulinum toxin
.
Viagra, which increases blood flow to the genital area, is also being used by some practitioners to stimulate the GI tract in diabetic gastroparesis.
The antidepressant mirtazapine
has also proven effective in the treatment of gastroparesis unresponsive to conventional treatment. This is due to its anti-emetic and appetite stimulant properties. Mirtazapine acts on the same serotonin receptor (5-HT3) as the popular anti-emetic ondansetron
.
Paresis
Paresis is a condition typified by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it also can be used to describe the muscles of the eyes , the stomach , and also the vocal cords...
(partial paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
) of the stomach
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
, resulting in food remaining in the stomach for a longer period of time than normal. Normally, the stomach contracts to move food down into the small intestine
Small intestine
The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...
for digestion. The vagus nerve
Vagus nerve
The vagus nerve , also called pneumogastric nerve or cranial nerve X, is the tenth of twelve paired cranial nerves...
controls these contractions. Gastroparesis may occur 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.
Causes
Gastroparesis may be chronic or transient; transient gastroparesis may arise in acute illness of any kind, with the use of certain cancer treatments or other drugs which affect digestive action, or due to anorexia nervosaAnorexia nervosa
Anorexia nervosa is an eating disorder characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Although commonly called "anorexia", that term on its own denotes any symptomatic loss of appetite and is not strictly accurate...
, bulimia and other abnormal eating patterns.
Chronic gastroparesis is frequently due to autonomic neuropathy. This may occur in people with type 1 diabetes or type 2 diabetes. The vagus nerve becomes damaged by years of high blood glucose or simply by having diabetes for a long time, resulting in gastroparesis. Gastroparesis has also been associated with various connective tissue diseases, such as Scleroderma
Scleroderma
Systemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
and Ehlers-Danlos syndrome
Ehlers-Danlos syndrome
Ehlers–Danlos syndrome is a group of inherited connective tissue disorders, caused by a defect in the synthesis of collagen . The collagen in connective tissue helps tissues to resist deformation...
, and neurological conditions, such as Parkinson's disease
Parkinson's disease
Parkinson's disease is a degenerative disorder of the central nervous system...
. It may also occur as part of a mitochondrial disorder.
Chronic gastroparesis can also be caused by other types of damage to the vagus nerve, such as abdominal surgery
Abdominal surgery
The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen. Surgery of each abdominal organ is dealt with separately in connection with the description of that organ Diseases affecting the abdominal cavity are dealt with generally under their own names The term...
.
Idiopathic gastroparesis (gastroparesis with no known cause) accounts for a third of all chronic cases; it is thought that many of these cases are due to an autoimmune response triggered by an acute viral infection. "Stomach flu", mononucleosis
Infectious mononucleosis
Infectious mononucleosis is an infectious, widespread viral...
, and others have been anecdotally linked to the onset of the condition, but no systematic study has proven a link.
Gastroparesis sufferers are disproportionately female. One possible explanation for this finding is that women have an inherently slower stomach emptying time than men. A hormonal link has also been suggested, as gastroparesis symptoms tend to worsen the week before menstruation, when progesterone levels are highest. Neither theory has been proven definitively.
Signs and symptoms
The most common symptoms of gastroparesis are- Chronic nausea
- Vomiting (especially of undigested food)
- Early satiety
Other symptoms include
- Palpitations
- Heartburn
- Weight loss
- Abdominal pain
- Abdominal bloating
- Erratic blood glucose levels
- Lack of appetite
- Gastroesophageal reflux
- Spasms of the stomach wall
Morning nausea may also indicate gastroparesis. It is important to note that vomiting may not occur in all cases, as sufferers may learn to adjust their diets to include only small amounts of food.
Diagnosis and treatment
Gastroparesis can be diagnosed with tests such as x rays, manometryManometry
Manometry refers to the evaluation of pressure .Forms include:* Esophageal motility study* Anorectal manometry* Rhinomanometry...
, and gastric emptying scans. The clinical definition for gastroparesis is based solely on the emptying time of the stomach and not on other symptoms, and severity of symptoms does not necessarily correlate with the severity of gastroparesis. Therefore, some patients may have marked gastroparesis with few, if any, serious complications.
Treatment includes dietary changes (low-fiber and low-residue diets
Low residue diet
A low residue diet is a diet designed to reduce the frequency and volume of stools while prolonging intestinal transit time. It is similar to a low fiber diet, but typically includes restrictions on foods that increase bowel activity, such as milk, milk products, and prune juice. A low residue diet...
, and in some cases, restrictions on fat and/or solids), oral medications such as metoclopramide
Metoclopramide
Metoclopramide is an antiemetic and gastroprokinetic agent. It is commonly used to treat nausea and vomiting, to facilitate gastric emptying in people with gastroparesis, and as a treatment for the gastric stasis often associated with migraine headaches.-Medical uses:Metoclopramide is commonly...
(Reglan, Maxolon, Clopra), cisapride
Cisapride
Cisapride is a gastroprokinetic agent, a drug which increases motility in the upper gastrointestinal tract. It acts directly as a serotonin 5-HT4 receptor agonist and indirectly as a parasympathomimetic. Stimulation of the serotonin receptors increases acetylcholine release in the enteric nervous...
(Propulsid)(no longer available in the US), erythromycin
Erythromycin
Erythromycin is a macrolide antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins. For respiratory tract infections, it has better coverage of atypical organisms, including mycoplasma and...
(E-Mycin, Erythrocin, Ery-Tab, EES) and domperidone
Domperidone
Domperidone is an antidopaminergic drug, developed by Janssen Pharmaceutica, and used orally, rectally or intravenously, generally to suppress nausea and vomiting, or as a prokinetic agent...
(Motilium); adjustments in insulin dosage for those with diabetes, a jejunostomy
Jejunostomy
Jejunostomy refers to an artificial opening into the jejunum. It is performed to allow feeding tube placement. Jejunostomy is an alternative to gastrostomy when the stomach is unsuitable for a feeding tube....
tube, parenteral nutrition, implanted gastric neurostimulators ("stomach pacemakers"), or botulinum toxin
Botulinum toxin
Botulinum toxin is a protein produced by the bacterium Clostridium botulinum, and is considered the most powerful neurotoxin ever discovered. Botulinum toxin causes Botulism poisoning, a serious and life-threatening illness in humans and animals...
.
Viagra, which increases blood flow to the genital area, is also being used by some practitioners to stimulate the GI tract in diabetic gastroparesis.
The antidepressant mirtazapine
Mirtazapine
Mirtazapine is a tetracyclic antidepressant used primarily in the treatment of depression. It is also sometimes used as a hypnotic, antiemetic, and appetite stimulant, and for the treatment of anxiety, among other indications...
has also proven effective in the treatment of gastroparesis unresponsive to conventional treatment. This is due to its anti-emetic and appetite stimulant properties. Mirtazapine acts on the same serotonin receptor (5-HT3) as the popular anti-emetic ondansetron
Ondansetron
Ondansetron is a serotonin 5-HT3 receptor antagonist used mainly as an antiemetic , often following chemotherapy. Its effects are thought to be on both peripheral and central nerves...
.
Complications
Primary complications of gastroparesis include:- Fluctuations in blood glucose due to unpredictable digestion times (in diabetic patients)
- General malnutrition due to the symptoms of the disease (which frequently include vomiting and reduced appetite) as well as the dietary changes necessary to manage it
- Severe fatigue and weight loss due to calorie deficit
- Intestinal obstruction due to the formation of bezoarBezoarA bezoar is a mass found trapped in the gastrointestinal system , though it can occur in other locations. A pseudobezoar is an indigestible object introduced intentionally into the digestive system....
s (solid masses of undigested food) - Bacterial infection due to overgrowth in undigested food
External links
- http://www.gastroparesis-awareness.com Gastroparesis Awareness
- http://www.gpawarenessfund.com Gastroparesis Awareness Campaign Organization
- G-PACT Gastroparesis Patient Association
- Overview from NIDDK National Institute of Diabetes, Digestive, and Kidney Diseases at NIH
- Overview at Mayo ClinicMayo ClinicMayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
- Overview at University of Chicago HospitalsUniversity of Chicago HospitalsThe University of Chicago Medical Center forms a major center for medical care and research in the Hyde Park neighborhood of Chicago, Illinois...
- Patient Perspective at the icarecafe
- http://www.emedicine.com/pmr/TOPIC40.HTM Diabetic Neuropathy (emedicine.com)]
- http://www.livingwithgastroparesis.com Patient Blog: Living with Gastroparesis
- http://www.crystalsaltrelli.com Health & Nutrition Counseling Services for Gastroparesis Patients