*Gastroparesis is a condition characterized by
impaired transit of food from the stomach. There may also be a total loss of nerve and muscle movement in the stomach
and intestines; therefore gravity continues the path for the food through the gastrointestinal organs. Patients
may also be diagnosed with a more rare form of GP called- Idiopathic Gastroparesis in
which there is no known cause.
*Gastroparesis is most commonly caused by diabetes, but can also occur as
a result of surgery on the stomach, viral infections, medications that slow contractions in the intestine, gastric bypass/lapband,
smooth muscle disorders, gastroesophageal reflux disease, metabolic disorders, autoimmune, active Anorexia Nervosa and
Bulimia, or its cause can be unknown-Idiopathic Gastroparesis.
*Symptoms of Gastroparesis may include chronic
or intermittent nausea, heartburn, reflux of food and liquids into the esophagus, difficulty swallowing, hypoglycemia (low
blood glucose) after a meal following high blood glucose, constipation or diarrhea, weight loss, vomiting,
early satiety, abdominal distention(bloating) after eating that seems to linger due to hours or days of undigested food, abdominal
pain, hair loss, insomnia, acid reflux, GERD, dehydration, and malnutrition.
Other consequences and complications include the erratic absorption of medicines
taken by mouth, electrolyte imbalance (electrolytes include salts such as sodium and potassium), and potentially even coma or
death.
*Diagnosing Gastroparesis is commonly first with
the patients medical history. Any prior ulcer disease, gastric surgery, other medical illnesses or current medications can
be an effective first tool. The most valuable test to diagnose Gastroparesis is the Gastric Emptying
Scan (GES)-The test involves eating a small meal or an egg with a trace of radioactive material so that the rate
of the digestion can be observed. There are pictures taken by the radiologist every 15 minutes of so over a length of time(90
Mns-6 Hours). If the test shows a large amount of food left over in the stomach, indication of Gastroparesis is extremely
likely.
Gastric Manometry-A thin tube is
inserted through the mouth into the stomach. A wire in the tube takes measurements of the stomach's electrical and muscular
activity as it digests food, indicating whether the stomach is contracting in an efficient manner.
MRI (Magnetic Resonance Imaging)-A
body scan is done using a magnetic field and radio waves to take three dimensional pictures of the gastrointestinal tract.
Upper Scope (Gastroscopy)-After
sedation, a flexible, lighted instrument with a very small camera attached is inserted through the mouth to the stomach and
first part of the small intestine. This enables the doctor to see any abnormalities in the esophagus, stomach and small intestine.
This test can rule out causes of gastroparesis other than diabetes.
Barium X-Ray-After fasting for 12
hours, the person drinks a shake containing barium, which makes the stomach visible on the x-ray. The stomach is then x-rayed
to see if any food is present.
*There is neither known cure nor specific drug
for Gastroparesis due to poor medical study and research. Current medications that are available only help to eliminate
some symptoms but do not work for all patients. -Tranzyme Pharma is currently in
the second phase for new Gastroparesis drugs that may be used worldwide for all chronic and severe GP patients in the
near future. There are some types of treatments now available that may possibly help improve
and ease the symptoms suffered daily by all Gastroparesis patients.
Diet-Changing
what foods to eat can be helpful as well the portion sizes, large meals are not encouraged. Liquid meals are highly recommended
due to it is easier to pass through the stomach. Avoid high fats, fiber, spices and red meats due to they can remain
in the stomach too long and cause toxic backup. Diet is often trial and error to adjust what foods are more tolerable.
*Medications: Erythromycin- It
is an antibiotic that acts to stimulate the muscles of the stomach to contract.
Bethanechol (Urecholine)-Increases muscle
contractions in the gastrointestinal tract.
Cisapride (Propulsid)-Increases
the contractions of the gastrointestinal tract. In the United States, this drug is restricted to people who meet certain eligibility
requirements due to its effects on the heart.
Domperidone (Motilium)-Increases
stomach contractions, accelerating emptying of solid foods. This drug also lessens nausea and vomiting. There is a potential
undesired effect on the heart. This drug is only available in Europe, Mexico and Canada.
Metaclopramide (Reglan)-Normalizes
contractions, decreasing the amount of time the stomach needs to empty.
Octreotide (Sandostatin)-Improves
contractions of the gastrointestinal tract. May also enhance effects of erythromycin.
Botulinum Toxin-An injection given into
the pyloric sphinctor muscle at the end of the stomach which can help to improve some Gastroparesis symptoms-still under research
by Johns Hopskins Bayview Medical Center.
**DRUG CURRENTLY PULLED OFF THE MARKET
BY FDA (APRIL 2007)Tegaserod (Zelnorm)-Increases stomach emptying time, moving food into
the intestine and reducing the chance of bezoar formation.
*All listed drugs are not 100 percent totally
effective and without unwanted side effects.
*Surgery is seldom done for Gastroparesis but
one option is a feeding tube that can be placed surgically. The tube goes through the skin of the abdominal wall bypassing
the mouth, esophagus and stomach to allow immediate nutrition.
TPN (Total Parenteral
Nutrition)-People who do not improve with medicines and who cannot get the proper nutrition through eating are
often hospitalized so they can benefit from intravenous fluids that provide calories, minerals, vitamins and nutrients. A
tube may be threaded through the person's nose into the stomach to drain fluid and air.
Enternal Nutrition-An alternative
to total parenteral nutrition is enteral nutrition, in which the necessary medicines and nutrients are provided directly into
the gastrointestinal tract via a tube placed into the stomach or small intestine. The tube can also be used to drain liquid
and air from the gastrointestinal tract. Both treatments may last for a long time, depending on when the stomach is able to
handle solid food again.
Botox-Injections of Botulinum toxin
(Botox) at the connection between the stomach and small intestine have recently been used to increase the emptying of food
from the stomach. This method works because the muscle that controls the opening of the stomach into the small intestine,
when injected with Botox, becomes paralyzed by the Botox and allows food to pass through continuously.
Gastric Pacemakers-
In 2000 for only "Compassionate Use". This electrical device is implanted in the abdomen and functions like the a pacemaker
would for the heart forcing the stomach to contract by electric stimulation. Potential side effects include infection,
unwanted movement of the device, a hole in the gastrointestinal tract, an undesirable change in stimulation due to movement
of the electrodes, bleeding, bruising, pain at the site of an electrode, allergic reaction, pneumonia and dehydration.
*EXPERIMENTAL TREATMENTS- One treatment
for Gastroparesis that is currently investigation is the use of nitric oxide to normalize the movements of the gastrointestinal
tract. Acupressure therapy is also being considered as a way to relieve the nausea, vomiting and bloating is caused by Gastroparesis.
