Gastroparesis

The common symptoms of gastroparesis are:

• Heartburn 
• Gastric reflux
• Nausea and vomiting
• Feeling full instantly while eating
• Bloating of the abdomen
• Loss of appetite
• Weight loss
• Fluctuating blood sugar
• Abdominal pain and discomfort

If gastroparesis is not treated, it can lead to several problems, some of which include:

• The person can have dehydration due to repeated vomiting
• The person can suffer from malnutrition as the body is unable to get enough nutrients
• The person can suffer from gastro-oesophageal reflux disease (GERD) as the stomach acid leaks out from the stomach into the food pipe (oesophagus).
• The person can also experience a sudden spike in their blood glucose levels when the food finally leaves the stomach and enters the small intestine. This can be harmful to diabetics. 
• Food that stays in the stomach for too long can ferment and allow bacteria to grow in there. This food can also harden into a solid mass called a bezoar, which can later cause blockage in the stomach thus preventing the food from passing into the small intestine

Gastroparesis is typically caused due to an injury or damage to the vagus nerve. In most cases, diabetes is the reason for the damage to the vagus nerve as well as other nerves which supply the wall of the stomach. The vagus nerve is one of the nerves that control the muscles of the stomach and small intestine. 

When the vagus nerve gets damaged, the muscles of the stomach and small intestine stop functioning normally, thus the food is unable to move through the digestive tract. Other causes of gastroparesis include:

• Disorders that involve the smooth muscles of the stomach can lead to gastroparesis. These diseases include amyloidosis (deposit of protein fibres in tissues and organs) and scleroderma (a skin disorder which affects the skin, blood vessels, skeletal muscles and internal organs).
• Eating disorders such as anorexia or bulimia can lead to gastroparesis.
• Surgery related to the stomach and vagus nerve can also result in gastroparesis.
• Extreme tiredness without any underlying medical condition, such as chronic fatigue syndrome can result in gastroparesis.
• Long-term use of medications such as narcotics can result in gastroparesis.
• People with nervous system disorders such as abdominal migraine and Parkinson's disease or those with metabolic disorders such as hypothyroidism may be at risk of gastroparesis.
• Viral infections such as viral gastroenteritis can eventually lead to gastroparesis.

Gastroparesis cannot be prevented as the exact cause is still unknown. However, people with diabetes should keep their sugar levels under control to prevent the condition. Avoid strong medications such as narcotics as it can trigger gastroparesis.

After taking a proper medical history and doing a physical examination, the doctor would prescribe certain blood tests to diagnose the condition. The tests that are used to diagnose gastroparesis include:

• 4-hour solid gastric emptying study: This test is done to determine the time that food takes to move through a person’s stomach. In this test, the technologist asks the person to eat a meal tagged with a radioactive isotope. After having the meal, a one-minute image of the stomach is taken. The scans are done again after one hour, two hours and four hours. 
• SmartPill: SmartPill is a capsule that contains a small electronic device which has a receiver that is worn on the hand. The pill is ingested with special food. As the pill moves through the digestive tract, it sends information to the receiver on how quickly the food is travelling through the digestive tract.
• Blood test: Complete blood count is done to find out the cause behind dehydration, malnutrition, infection and blood sugar levels.
• Barium X-ray: Barium X-ray is done by making the patient drink barium, which coats the oesophagus, stomach, and small intestine. Then the doctor takes an X-ray of the entire region to look for any abnormalities.
• Gastric emptying breath test: Gastric emptying breath test is a non-radioactive test that helps in measuring the rate at which the stomach empties after having a meal that has a chemical element called the 13C isotope added to it.
• Gastric manometry: Gastric manometry is done to check the electrical and muscular activity of the stomach, and also to figure out the rate at which the food is digested.
• Electrogastrography: In electrogastrography, the doctor measures the electrical activity in the stomach by using electrodes on the skin.
• Ultrasound: Ultrasound is done to look at any problems inside the stomach.
• Endoscopy: Endoscopy is done to look at the lining of the stomach—it uses a small camera at the end of an endoscope (a thin tube that is guided down the patient's throat) to look inside the organ.

Most treatment options for gastroparesis focus on managing the condition and keeping it under control. These are the main treatment plans used to treat and manage gastroparesis:

1. Maintain blood sugar levels to manage gastroparesis
2. Changes in diet and lifestyle for gastroparesis
3. Drug therapy for gastroparesis
4. Per oral pyloromyotomy (POP) for gastroparesis
5. Surgical treatment of gastroparesis
6. Parenteral nutrition in gastroparesis