GASTROPARESIS AWARENESS MONTH

There is an increasing number of people diagnosed with gastroparesis yet this condition is still poorly understood by many. Gastroparesis Awareness Month aims to better understand gastroparesis to help patients and loved ones cope and manage this condition more effectively. As part of this campaign, we aim to contribute to acknowledging the existing challenges of living with gastroparesis, and its symptom burdens, finding the appropriate treatment option, and recommended lifestyle modifications.

In this article, we will start with the basics:

WHAT IS THE MAIN SYMPTOM OF GASTROPARESIS?

It is chronic nausea that can range from feeling like you need to vomit to feeling excessive fullness and bloating. There can also be associated stomachache and loss of appetite. Many health conditions can cause chronic nausea including intestinal blockage, infection, or some medications. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 1 out of 4 adults in the United States experience symptoms similar to gastroparesis.

WHAT IS GASTROPARESIS?

Gastroparesis is also called delayed gastric emptying wherein “gastric” refers directly to the stomach. This occurs when food stays in the stomach too long as the muscles that normally push food into the small intestine either work poorly or they don’t work at all. As a result, food and oral medications leave the stomach slowly, or they may stay trapped in the stomach wherein they can never be absorbed through the intestine.

This condition is characterized by the presence of a web of common long-term symptoms together with delayed stomach emptying without any physical obstruction or blockage. Through the years of diagnosing gastroparesis, it has been clear that it affects many people with a wide range of symptoms with differing severity.

HOW COMMON IS GASTROPARESIS?

The incidence and prevalence of gastroparesis are still yet to be defined but there is an estimated 5 million people in the United States affected by it. It isn’t deemed common and out of 100,000 people, about 10 men and 40 women have gastroparesis. Although 1 out of 4 adults in the US can manifest gastroparesis-like symptoms, some don’t get diagnosed with it and have other existing issues causing temporary to prolonged delayed gastric emptying.

WHO IS MORE LIKELY TO GET GASTROPARESIS?

• People with diabetes. Gastroparesis is found in 40% of diabetics. Elevated blood sugar can cause damage to the nerves controlling the feeling of nausea and stomach emptying.
• People who have had surgery on the esophagus, stomach, or small intestine which may have caused an injury to the vagus nerve.
• People who have had certain cancer treatments, including radiation therapy in the trunk or abdominal area.
• People who have autoimmune conditions or viral illness.

Stomach muscle dysfunction can result from damage to the nerves controlling the muscles secondary to the above conditions but in many cases, the cause is unknown. In our practice, only half of the patients have gastroparesis caused by diabetes.

WHAT ARE THE SIGNS AND SYMPTOMS OF GASTROPARESIS?

Symptoms are more common with meals and/or after meals which include:

• Nausea
• Vomiting
• Retching (dry heaving)
• Fullness and/or bloating (even after a small or normal-sized meal)
• Early satiety (feeling full) and unable to finish a meal
• Stomach pain and discomfort

There may also be associated heartburn, constipation, or decreased appetite that can result in weight loss.

HOW IS GASTROPARESIS DIAGNOSED?

Diagnosis will come from a doctor who will perform a physical exam and some tests. If there is suspicion of gastroparesis, a test, specifically a 4-hour gastric emptying study will be ordered to measure the speed of gastric emptying within 1-4 hours after eating to confirm the diagnosis.

Several medications can greatly affect gastric emptying and should also be discussed with the doctor before testing as some of them may interfere with the results.

Tests may include:

• Imaging (CT scans or X-rays) to check for blockages or other anatomical issues
• Blood tests which may show, for example, electrolyte imbalance that may also result in nausea and/or vomiting
• Upper endoscopy to assess for upper GI tract ulcers, lesions, or other problems preventing food from going down the tract
• Ultrasound can look for other nearby organ issues in the pancreas or gallbladder that may be causing the symptoms

If after a review of symptoms, medical history, and above tests, the doctor highly suspects gastroparesis, then a gastric emptying study will be required to confirm the diagnosis as slow gastric emptying alone does not correlate directly with a diagnosis of gastroparesis.

The 4-hour gastric emptying study is done in a hospital or a specialty center wherein a small amount of radioactive substance in food will be ingested and then monitored on how slowly it will move through the GI tract for 4 hours. The test will be most accurate if done for the full 4 hours but if nausea/vomiting prevents ingestion of the meal, then this should also be reported to the doctor ordering it. A diagnosis is confirmed when 10% or more of the meal is left in the stomach after a full 4 hours.

We will discuss in another article the treatment, medications, dietary and lifestyle modifications, and other available advanced procedures to manage gastroparesis. For now, we hope this blog provides more information in helping with possible early diagnosis of gastroparesis as part of the Gastroparesis Awareness Month.

We can work together to improve our understanding of gastroparesis. The more additional information, research, and enriched patient care for GI and motility disorders we provide, the more we can add to positive outcomes for this condition. Together, we can.

For more information on gastroparesis, contact your physician or health care provider who is familiar with the condition to address individual symptoms. Bonus tip: our office is always open to accept new patients who need help with this condition or suspected condition.

Author

Jenna Wishnew Dr Wishnew is a Board Certified General Surgeon practicing in the North Texas area She specializes in general surgery, gastroparesis, wound care, vein concerns and robotic surgery.