what you should know about gastroparesis 62bc49c0a9b1a

What you should know about Gastroparesis

What is gastroparesis?

Gastric motility disorders are gastrointestinal conditions that affect digestion. One in 25 Americans have gastroparesis. Gastroparesis is a condition that occurs when the stomach takes too long to empty food. This disorder leads to a variety of symptoms that can include bloating, nausea, vomiting, feeling easily full, and a slow emptying of the stomach, known as delayed gastric emptying (see a list of other symptoms below). Gastroparesis can be temporary or chronic, have numerous causes, and often involves the vagus nerve. Reversible stressors, treatable infections/ medications, and working with the vagus may allow for improvement. Long term illnesses like diabetes, post-surgical changes, and autoimmune disease can result in more chronic problems.

 

 

What causes gastroparesis?

While the exact cause of gastroparesis isn’t known, it’s thought to have something to do with disrupted nerve signals in the stomach. It’s believed that when the nerves to the stomach become affected by a variety of factors, food can move through it too slowly. Other problems such as the stomach being overly sensitive to signals from the nervous system and the stomach not being able to react to a meal are believed to also have a role in this condition.

Most types of gastroparesis fit into one of these categories:

  • idiopathic, or unknown or possible from infection like a virus
  • diabetes-related or chronic disease related (autoimmune disease)
  • Postsurgical like a gastric sleeve gastrectomy or vagotomy for acid or ulcers

Almost 36 percent of people with gastroparesis aren’t found to an identifiable cause. This is known as idiopathic. Many times this condition occurs after a viral or other infectious illness, but it’s not fully understood.

A common cause of damage to the nervous system that affects digestion is diabetes, mainly found in long term poorly controlled diabetes. High blood sugar can damage nerves over time.

Surgeries that involve the stomach or other digestive organs can also change signals to the stomach. Specific weight reduction surgeries like sleeve gastrectomies where a part of the stomach is removed or vagotomies that were used to be done for acid or ulcers (now rarely done) are examples.  About 13 percent of people with gastroparesis have the type known as postsurgical.

Who’s at risk for developing gastroparesis?

Other health conditions are also associated with gastroparesis but are less common. These include:

  • viral infections
  • some cancers
  • cystic fibrosis
  • Parkinson’s disease
  • autoimmune diseases
  • amyloidosis, a condition that causes an abnormal protein buildup in organs
  • medications that make the stomach empty more slowly
  • thyroid disorders

 

What are the symptoms of gastroparesis?

The symptoms of gastroparesis can range from mild to severe. They occur more often in some people than others.

The symptoms of gastroparesis can include:

  • upper abdominal pain
  • nausea
  • vomiting
  • loss of appetite
  • bloating
  • feeling full after only eating a little
  • malnutrition
  • unintended weight loss

 

 

An evaluation of gastroparesis can consist of the following studies:

  • A careful history getting the story of your symptoms and carefully obtaining your medical history.
  • A physical exam.
  • An ultrasound. Ultrasounds use sound waves to create an image of your organs. It can be used to rule out liver disease, pancreatitis, and gallbladder disease.
  • Blood tests. Blood tests can check for diabetes and other conditions.
  • An upper endoscopy. In an upper endoscopy procedure, where a long, thin scope down your esophagus and into your stomach to check for blockages in the stomach and other conditions.
  • Once other possible causes of your symptoms have been excluded, further functional tests to see how well your stomach empties can be done. These tests can include a:
  • Gastric emptying study. A gastric emptying scan involves eating a small amount of food with a harmless radioactive substance so one can see how fast food is being digested and emptied from your stomach.
  • A SmartPill is a capsule that contains a device to track how fast food moves through your digestive tract.
  • Carbon breath test. In this test, carbon dioxide production is tracked through the digestive system.
  • A small intestinal bacterial overgrowth evaluation with a breath test or dried blood spot test.

 

 

General principles of  gastroparesis treatment

If the gastroparesis is caused by a condition like diabetes, the first step is to optimize the blood sugar levels with supplements/medications, diet/lifestyle changes, or procedure/ surgeries. If there is bacterial or fungal overgrowth then these conditions need to be treated with supplements, a low FODMAP diet, and other special probiotics/prebiotics.  

If you have gastroparesis, it’s important to focus on getting the nutrition that you need while eating small, frequent meals that are low in fat and easy to digest. This type of diet includes high-protein foods (such as eggs and nut butter) and easy-to-digest vegetables (such as cooked zucchini). If the food is easy to chew and swallow, that’s a good indication that you’ll have an easier time digesting it.

 

 

Traditional Medications

These medications may be used to treat gastroparesis.

Medications to control nausea and vomiting caused by gastroparesis can include:

  • prochlorperazine (Compazine)
  • ondansetron (Zofran)
  • promethazine (Phenergan)

Other medications stimulate the stomach muscles to contract for motility include:

  • metoclopramide (Reglan)
  • erythromycin (EES)
  • domperidone (Motilin)

It should be noted that these drugs can cause side effects so a thorough discussion and consultation is needed to determine if any of these would have benefits that outweigh the risks.

Diet / Lifestyle changes

Certain foods are more easily digested by the body.  Certain foods, such as fatty foods, can delay the transit of food or increase the movement of food out of the stomach.  The timing of food to allow at least 3-4 hours in between eating allows for an automatic sweeping function of the GI tract, the migrating motor complex, naturally occur to keep the stomach empty.  The following dietary and lifestyle changes may be helpful:

  • eat four to six meals per day
  • drink high-calorie liquids
  • limit alcohol and carbonated beverages
  • take a daily multivitamin like mitomax
  • limit certain meats and dairy
  • eat well-cooked vegetables and fruit to lower the amount of fiber they contain
  • eat mostly low-fat foods
  • avoid foods that have a lot of fiber, like broccoli 
  • ensure there’s adequate time after meals before lying down for bed (3-4 hours)
  • substitute solid foods for pureed or liquid foods
  • Quitting cigarette smoking can also be beneficial to your overall condition.

Why eating a low FODMAP diet helps patients with gastroparesis: The term FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols, which are short-chain carbohydrates which are hard for the GI system to digest. By eliminating foods that can irritate the stomach or cause delayed emptying, you have a better chance at being able to tolerate foods.

 

Sample food lists:

Foods that may be tolerated (portion controlled):

  • eggs
  • peanut butter
  • bananas
  • breads, hot cereals, and crackers
  • fruit juice
  • vegetable juice (spinach, kale, carrots)
  • fruit purees

Foods to avoid if you have gastroparesis

  • carbonated beverages
  • alcohol
  • beans and legumes
  • corn
  • seeds and nuts
  • broccoli and cauliflower
  • cheese
  • heavy cream
  • excess oil or butter

 

Recipes

Your food options might feel limited when you have gastroparesis, but you can still enjoy some delicious recipes.

Peach banana smoothies and green smoothies with peanut butter contain the nutrition you need and taste great.

For savory options, garlic mashed potatoes and gastroparesis-friendly vegetable soup have little fiber but lots of taste.

 

Supplements

Supplements with certain extracts such as ginger, can help. One supplement that has a ginger extract and other natural vegetable extracts that help with motility for gastroparesis and small intestinal bacterial overgrowth is ProMotil.

 

Stimulation of the vagus nerve

There are essentially 3 ways to stimulate the vagus nerve. One can do vagus nerve exercises, receive non-invasive energy medicine and frequencies to activate the vagus, or do invasive surgery to place a gastric electrical stimulator (GES) that is implanted in the stomach. The goal of all these modalities for gastroparesis is to help your stomach empty more effectively

 

 

 

What are the complications of gastroparesis?

The symptoms associated with gastroparesis, such as vomiting and decreased appetite, can cause dehydration and malnutrition. Dehydration and malnutrition can cause numerous problems, including:

  • electrolyte imbalances
  • decreased blood pressure
  • increased heartbeat
  • rapid breathing
  • decreased urine output
  • a weakened immune system
  • poor wound healing
  • muscle weakness

By definition, as gastroparesis causes food to stay in the stomach for too long, it can also cause an overgrowth of bacteria. The food can also harden into masses called bezoars that cause nausea, vomiting, and obstruction in the stomach.

Managing blood glucose levels is essential for people with diabetes. Gastroparesis can make it harder to manage those levels.

Final Thoughts

If you suspect you have gastroparesis, we can provide a functional GI evaluation to formulate treatment based on your individual needs.  For a functional GI evaluation of bloating or other GI problems email info@jeffreymarkmd.com, visit www.allfunctionalhealth.com, or call (925) 736-9828.

 Take care and stay healthy.

 

Jeffrey Mark, M.D.

 

 

Our offices are conveniently accessible from San Francisco / Bay Area, Silicon Valley, Palo Alto, Los Altos, Menlo Park, Cupertino, Atherton, Hillsborough, Burlingame, Berkeley, Piedmont, Orinda, Lafayette,  Walnut Creek, Alamo, Danville, Pleasanton, Dublin, Livermore, Fremont, Marin County, Napa, Sonoma County, and the Central Coast.  Telemedicine appointments make our services easily accessible to virtually anywhere you have internet or cell phone access to utilized our HIPPA compliant video chat telehealth appointments.

Author
Jeffrey Mark, M.D.


Helping clients with compassionate and comprehensive medical care for over 25 years with 4 board certifications in functional medicine, gastroenterology, internal medicine, and anti-aging/ regenerative medicine . IFMCP, ABIM Gastroenterology, NPAS Internal Medicine, ABAARM.

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