The term gastroparesis refers to a disorder of the motility of the stomach. Paralysis of the stomach causes pain, nausea, or vomiting.
What is gastroparesis?
Gastroparesis is a condition in which gastric motility is impaired. Motility disorders are disturbances in the healthy movement patterns of the digestive organs. Much of the musculature of the stomach consists of smooth muscle. In gastroparesis, there is decreased motility. This means that the smooth muscle of the stomach no longer moves and contracts sufficiently. Thus, the motility of the stomach is reduced or even completely eliminated. As a result of this gastric paralysis, emptying of the stomach is disturbed. Synonymous to the term gastroparesis, the term gastric atony is also used. Atony means as much as flaccidity, whereas a paresis is an incomplete paralysis. Paralysis of the stomach can have various causes. For example, damage to the enteric nervous system may be responsible for the paralysis. Gastroparesis often significantly affects the quality of life of the affected person and, in serious cases, can also lead to severe complications. Various medications are used to treat gastroparesis. Surgery or artificial feeding are also possible treatment options.
Causes
The most common cause of gastroparesis is diabetic neuropathy. Diabetic neuropathy is damage to the nerves caused by permanently elevated blood glucose levels. It is one of the most common secondary diseases of diabetes. Every third patient with diabetes mellitus suffers from sensory disturbances of the peripheral nerves. Frequently, however, the autonomic nervous system is also affected. It controls the activity of many organs, including the activity of the stomach. If the nerves within the muscles of the stomach are disturbed or even destroyed, motility is severely impaired. Damage to the enteric and autonomic nervous systems is also known as autonomic neuropathy. However, the nervous system can also be damaged by autoimmune diseases. Damage can also be inflammatory or hormonal. Hereditary diseases such as hereditary sensorimotor neuropathy type IV can also result in gastroparesis. Less commonly, the nerves are damaged by alcohol or nicotine abuse or by surgery. Most iatrogenic gastroparesis is caused by vagotomy. Vagotomy is a procedure used to treat gastric and duodenal ulcers. The surgical procedure involves cutting the branches of the tenth cranial nerve, the vagus nerve. This should reduce the production of acid gastric secretions. Because of the very effective proton pump inhibitors now on the market, vagotomy is not often performed today. Gastroparesis may also accompany a migraine attack. However, the exact pathomechanisms are still unknown in this case. However, gastroparesis does not only occur after nerve damage. The smooth muscles of the stomach can also be responsible for the paralysis. Thus, there are many different muscle diseases that can cause gastroparesis. One of these, for example, is progressive muscular dystrophy. In this disease, muscle weakness and wasting are the main symptoms.
Symptoms, complaints, and signs
The symptoms of gastric paralysis are caused by impaired emptying. Patients experience a feeling of fullness after eating. They suffer from nausea and vomit undigested food components. Patients have little appetite and lose weight accordingly. A common complication of gastroparesis is reflux esophagitis. In gastroparesis, the sphincter of the stomach is also paralyzed. Thus, the stomach and esophagus are not adequately separated. Food components and stomach acid get back into the esophagus. Patients regurgitate gastric juice especially at night, after meals, or when bending over or lifting weights. The stomach acid irritates the mucous membranes of the esophagus, causing burning pain in the chest area. The irritation can also cause laryngitis gastrica. Another typical symptom of reflux esophagitis is chronic cough. This is often misinterpreted as asthma.
Diagnosis
If reflux esophagitis is suspected, gastroscopy is performed.During the examination, the doctor inserts a special endoscope, called a gastroscope, into the stomach via the esophagus. The endoscope is usually equipped with a camera so that the doctor can directly assess the condition of the organs on a monitor. Gastroparesis is posed by determining the gastric emptying time. Octanoic acid and sodium acetate are used for this purpose.
Complications
In the setting of gastroparesis, various complications can occur due to impaired emptying of the stomach. First, patients experience a strong feeling of fullness that is often associated with nausea and vomiting. This sometimes leads to severe weight loss. If the gastroparesis persists over a longer period of time, further gastrointestinal complaints may develop that intensify the original clinical picture of gastroparesis. A typical complication, for example, is reflux esophagitis, in which food components and stomach acid get back into the esophagus. This causes belching, especially after meals or when lifting weights. If reflux disease is not treated promptly, inflammation can develop in the throat. In the worst case, reflux esophagitis develops into pneumonia. More commonly, laryngitis or the development of chronic cough occurs. Allergies and intolerances may occur during drug treatment of gastroparesis. The prescribed prokinetics and antiemetics can also lead to cardiac side effects (cardiac arrhythmias) as well as sweating and physical restlessness. Treatment via endoscope may rarely cause injury to the gastric mucosa. If parenteral nutrition must be initiated, further complications may occur.
When should you go to the doctor?
If there is pain in the stomach area, repeated nausea or vomiting, a doctor should be consulted. If the pain increases in intensity or spreads further, a doctor is needed. Consultation with a medical professional is required before taking any pain medication. There may be further complications or discomfort that must be prevented. If the affected person suffers from a feeling of fullness, a loss of appetite or if there is a reduced food intake, a doctor should be consulted. If severe weight loss occurs or eating disorders develop, a doctor is also needed. If undigested food can be detected during bowel movements, this observation should be discussed with a physician. If discomfort of the larynx develops and a change in phonation can be perceived, this is considered unusual and should be medically examined. If there is persistent coughing or noises in breathing, a physician should be consulted. If there is an inner restlessness, a feeling of illness or if psychological problems occur, a doctor should be consulted. If the affected person suffers from continuous unpleasant belching shortly after eating, this should be investigated. In addition, if leftover food is regularly carried back into the food tube when lifting or bending over, a doctor should be consulted.
Treatment and therapy
In cases of newly diagnosed or mild gastroparesis, nutritional counseling is initially given. Symptoms can be alleviated, especially in early stages, by a good supply of fluids and vital nutrients. In addition, patients should prefer a low-fat diet with little fiber. The diet should be divided into several small meals daily. Prokinetics and antiemetics are used for drug treatment. Prokinetics stimulate the activity of the stomach and intestinal muscles, causing the stomach to empty more quickly. Antiemetics act in the vomiting center and suppress vomiting and nausea. However, they do not affect gastric motility. In cases of severe or prolonged paresis, artificial feeding may be necessary. This involves giving liquid nutrients through a tube into the stomach or small intestine. Nutrients may also be administered parenterally. For this, a nutrient solution is injected into the patient’s vein. Parenteral nutrition is chosen when enteral nutrition is not well tolerated. Parenteral nutrition is also given if not enough energy can be supplied via enteral nutrition.
Outlook and prognosis
Whether gastroparesis is caused by another disease that is curable or well controlled, or whether the cause is irreversible, plays a major role in the prognosis. If the cause is not treatable, gastroparesis will persist in the majority of cases. This risk also exists when treatment is theoretically possible but the patient refuses or does not comply with therapy. In both cases, it is possible for gastroparesis to worsen. Gastroparesis may occur as a result of diabetes and other diseases. In this case, the prognosis improves if the patient makes lifestyle changes and the diabetes is well controlled overall. Patients who smoke and give up this addiction also increase their chances of improving symptoms as a result. Diabetic gastroparesis does not appear to affect mortality rates (Chang, Rayner, Jones, & Horowitz, 2013). However, the overall treatment of diabetic gastroparesis is considered complicated. Physicians often recommend a special diet plan for this and other forms of gastroparesis that focuses on frequent and small meals. A dietitian can help put recommendations into practice.
Prevention
The most common cause of gastroparesis is diabetic neuropathy. This can be prevented by keeping blood sugar well controlled in diabetics.
Follow-up
In most cases, there are no special aftercare options available to the affected person with gastroparesis. The focus is on medical treatment of the disease to prevent further complications and discomfort. As a rule, self-healing cannot occur, so that treatment by a physician is essential. In general, a healthy lifestyle with a balanced diet has a very positive effect on the further course of gastroparesis and can significantly accelerate healing. The affected person should avoid fiber as much as possible and eat a healthy diet. Furthermore, it is also necessary to take medication. The affected person should always ensure that they take their medication regularly, and possible interactions with other medications should also be taken into account. Especially in the case of children, parents should ensure that the medication is taken regularly. In some cases, regular examinations of the stomach are also useful in order to identify and treat damage to the stomach before it occurs. Whether the life expectancy of the affected person is reduced by gastroparesis cannot be universally predicted. Contact with other affected persons can also be useful in this context, as it leads to the exchange of information, which can make everyday life much easier.
What you can do yourself
In the case of gastroparesis, a doctor should be consulted in any case. With the help of some self-help measures and home remedies, the medical therapy can be supported. First of all, it is important to adapt the diet to the disease. Foods with a high fat content should be avoided at all costs, because these foods slow down digestive activity. Low-fat alternatives such as lean meat, low-fat milk, cottage cheese, egg whites and yogurt are better. In general, a balanced, low-fiber diet with plenty of fish, tofu, white bread and canned vegetables is recommended. To speed up digestion, these foods can be pureed and consumed. Those who do not want to give up solid food should chew every bite well and drink plenty of water. Protein shakes, clear soups and broths, and electrolyte-rich drinks have also proven effective. A proven home remedy is ginger tea. The healthy medicinal root promotes the formation of gastric juice and supports intestinal activity. Equally effective is peppermint tea, which relaxes the stomach muscle and promotes the production of bile. In addition to these dietary measures, sufferers should record the triggers for complaints in a diary. In this way, a suitable diet plan can be compiled together with a nutritionist.
