Gastroparesis

Gastroparesis is a weak stomach, a common condition that can cause abdominal complaints. It is usually not a serious problem and effective treatments are available.

The Stomach's Pacemaker

The upper part of the stomach has a pacemaker that creates an electrical wave that sweeps across the organ. This causes the muscles in the stomach to contract, grinding up food to expel into the small bowel. Gastroparesis occurs when the rate of the electrical wave slows and the stomach contracts less frequently. This causes food to remain in the stomach relying on acid and digestive enzymes to break down the food and on gravity to empty the stomach.

Causes for Gastroparesis

Not all of the following disorders affect the pacemaker of the stomach. Some disorders weaken the stomach muscle itself so it can’t respond to the pacemaker. In either case, the result is the same – Gastroparesis.

• Diabetes is the most common known cause.
• Adrenal and thyroid gland problems are infrequent causes.
• Viral infections can sometimes cause Gastroparesis. This type of Gastroparesis usually resolves over time like most other viral infections.
• Scars and fibrous tissue from ulcers and tumors can block the stomach outlet and mimic Gastroparesis.
• Certain drugs weaken the stomach (tricyclic antidepressants such as Elavil, calcium blockers such asCardizem and Procardia, L-dopa, hyoscyamine, Bentyl, Levsin, narcotics).
• Previous stomach surgery.
• Anorexia and bulimia and other forms of malnutrition.
• Neurologic or brain disorders such as Parkinson’s disease, strokes and brain injury.
• Certain diseases such as lupus, erythematosus and scleroderma.
• In up to 40% of cases the cause of Gastroparesis is not known.

Symptoms

• Feeling of fullness after only a few bites of food
• Bloating
• Excessive belching
• Nausea
• Vague, nagging ache in the upper abdomen
• Vomiting
• Heartburn
• Regurgitation of stomach fluid into the mouth

Diagnosis

Diagnosis starts with the medical history where the physician may suspect Gastroparesis based on the symptoms. In severe cases, the physical exam and blood tests may show evidence of malnutrition, but usually the exam is normal. Possible tests include:

• Upper GI barium X-ray – Measures how liquid barium leaves the stomach. Often this exam is normal.

• Upper endoscopy -  Visually examines the stomach using a lighted flexible tube.

• A Gastric or stomach emptying test - Tracks the time it takes for the food to leave the stomach.

• Electrogastrogram (EGG) – Measures the electrical waves that normally sweep over the stomach and precede each contraction (Test not available everywhere).

Treatment

The first step will be treating any underlying disorder, such as blood sugar control in diabetic patients or thyroid medicine for someone with an underactive thyroid. Treatment will also aim to address diet and nutrition, especially if there is a marked delay in stomach emptying, then attention to the diet is necessary. This may involve:

• Avoiding foods that delay stomach emptying like high-fat or high-fiber choices.
• Increasing liquid foods like low-fat milkshakes that leave the stomach fast might be used.
• Eating frequent small feedings, 4 – 6 times a day, instead of larger meals, 2 or 3 times a day. A registered dietitian can be very helpful in providing advice in severe cases.

Medications

Several medications are now available to stimulate the stomach to contract more normally.

• Metoclopramide ( Reglan) - This is an effective drug although it may have side effects such as restlessness, fatigue, agitation and depression.
• Bethanechol (Urecholine) - Bethanechol and erythromycin, an old antibiotic, are occasionally used but cannot be used long-term.

Gastric Pacing

Gastric pacing can be thought of like heart pacing. Electrodes are implanted into the stomach and a current then stimulates the stomach. Gastric pacing is still limited to research institutions because it is riddled with potential problems. Still, it is an option for patients with severe and persistent Gastroparesis.

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This content was last medically reviewed in May 2022 by Sharlotte Manley, MSN, FNP, Erlanger Gastroenterology.