HEALTH EDUCATION MONTH TOPIC

Gastroparesis is also called delayed gastric emptying. The term “gastric” refers to the stomach.Normally, the stomach empties its contents in a controlled manner into the small intestines. In gastroparesis, the muscle contractions (motility) that move food along the digestive tract do not work properly and the stomach empties too slowly.Gastroparesis is characterized by the presence of certain long-term symptoms together with delayed stomach emptying in the absence of any observable obstruction or blockage. The delayed stomach emptying is confirmed by a test. There are a number of things that may contribute to or cause gastroparesis. In the majority of people with gastroparesis, the cause is unknown and is termed “idiopathic.” Some people with idiopathic gastroparesis report symptoms following a virus infection (post-infectious or post-viral gastroparesis).

 

Other possible causes include:

  • Diabetes

  • Surgeries

  • Medications

  • Other illnesses

  • Cellular change

  • Diabetes

 

Gastroparesis may occur as a complication of other conditions. Long-standing diabetes is the most common known cause of gastroparesis, although only a small percentage of people with diabetes develop gastroparesis. The cause of symptoms is probably due to damage to nerves that supply the stomach.

The vagus nerve transmits impulses to the stomach and intestines. Injury to the vagus nerve can impair gastric emptying.

 

Surgeries
 

Gastroparesis can also result as a complication from some surgical procedures. Most often these include nerve damage following esophageal or upper abdominal surgeries.

 

Medications
 

Less frequently, gastroparesis is seen to occur after the use of certain medications. Some medications can impair motility. Examples include:

  • narcotic pain relievers,

  • anticholinergic/antispasmodic agents,

  • calcium channel blockers,

  • some antidepressants, and

  • some medications for diabetes.

 

Other Illnesses
 

Sometimes gastroparesis is seen in association with other illnesses. Systemic illnesses, neurologic diseases, or connective disorders, such as multiple sclerosis, Parkinson’s disease, cerebral palsy, systemic lupus, and scleroderma are associated with gastroparesis. The cause and effect is unclear.

In a small number of people, gastroparesis symptoms appear to develop after onset of an apparent viral infection (post-infectious or postviral gastroparesis). The symptoms usually resolve or improve over time.

 

Cellular Changes
 

Much remains to be learned about what causes gastroparesis. In both idiopathic and diabetic gastroparesis a great deal of interest is being paid to changes in the cells which help control muscular contractions (motility) in the stomach. These are known as the interstitial cells of Cajal (ICCs). These cells probably represent the essential pacemakers of the entire gastrointestinal (GI) tract. In addition to ICCs, scientists are looking at changes in the structure and the number of nerve cells and immune cells as possible contributors to the disease process in gastroparesis.

 

How is Gastroparesis Treated?
 

The treatment for gastroparesis in an individual depends on the severity of symptoms. Treatments are aimed at managing symptoms over a long-term.

Treatment approaches may involve one or a combination of:

  • dietary and lifestyle measures,

  • medications, and/or

  • procedures that may include surgery, such as

  • enteral nutrition,

  • parenteral nutrition,

  • gastric electrical stimulation (Enterra), or

  • other surgical procedures

 

Some people with gastroparesis have mild symptoms that come and go, which can be managed with dietary and lifestyle measures.

Others have moderate to more severe symptoms that additionally may be treated with medications to stimulate motility and/or reduce nausea and vomiting.

Some people have severe symptoms that are difficult to treat or do not respond to initial treatment approaches. They may require additional procedures to maintain nutrition and/or reduce symptoms.

 

Goals of Treatment


The goals of treatment are to manage and reduce symptoms, maintain quality of daily living, and minimize related problems such as:

  • Severe dehydration due to persistent vomiting

  • Bezoars (solid collections of food, fiber, or other material), which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form

  • Difficulty managing blood glucose levels in people with diabetes

  • Malnutrition due to poor absorption of nutrients or a low calorie intake

 

Manage Risk and Benefit


No single treatment helps all persons with gastroparesis. All drugs and procedures have inherent risks, some more than others. Some of the risks are unavoidable, while others can be avoided and managed. For patients and families it is important to talk to the doctor or health care team about both benefit and risk. As a patient, in the context of your personal illness status, consider:

  • How severe is your own condition – what effect is it having on your life

  • What is the possible benefit from the treatment suggested or prescribed to you

  • What are the chances that you will receive benefit from the treatment

  • How much benefit should you reasonably expect

  • What possible side effects or complications might there be from the treatment

  • What are the chances that you will experience a side effect or serious adverse event from the treatment

  • What can you do to reduce the chances of side effects or complications

  • How will you know when a side effect occurs

  • Exactly what should you do if a side effect or complication occurs

There are lots of things that affect health and illness. Some you cannot control, but some you can. Beyond making healthy lifestyle choices, having gastroparesis will likely push you to always be looking for what does and does not help, hurt, and work best for you. It's not always easy, but sorting this out can help you improve your health-related quality of life. Here are some things to keep in mind when dealing with gastroparesis. Taking some preventative steps can help you ease symptoms, lessen the unwanted effects on your daily life, and enhance your well-being. Be Aware of Causes and Complications
Not only recognizing the symptoms, but also knowing the cause, and complications that can arise from gastroparesis, can help prevent delays in obtaining appropriate treatment. 
Although most commonly the cause is unknown (idiopathic), in about 1 in 4 people with gastroparesis it occurs as a complication of long-standing diabetes.

 

Gastroparesis can also arise:

  • As a problem after some surgical procedures (particularly esophageal or upper abdominal surgeries)

  • After use of certain medications, such as narcotic pain killers, anticholinergic/antispasmodic agents, calcium channel blockers, some antidepressants, and some diabetes medications

  • In association with illnesses that affect the whole body, the nervous system, or connective tissue, such as multiple sclerosis, Parkinson's disease, cerebral palsy, systemic lupus, and scleroderma

Gastroparesis can lead to:

  • Severe dehydration due to persistent vomiting

  • Difficulty managing blood glucose (blood sugar) levels in individuals with gastroparesis associated with diabetes

  • The formation of clumps of undigested food (bezoars), which can cause nausea, vomiting, or obstruction

  • Malnutrition due to poor absorption of nutrients or a low calorie intake

  • Adverse events caused by drug interactions (treatments often may involve taking different classes of drugs to treat several symptoms, such as to reduce nausea, reduce pain, and lower blood glucose levels)

Prevention and Management Tips

  • Work with a registered dietician (RD) or nutrition support specialist (nurse or doctor) to design a dietary plan to meet your individual needs; understand how to use and maintain dietary and nutritional therapies.

  • Eat frequent, small meals that are low in fat and fiber. Fat, fiber, and large meals can delay stomach emptying and worsen symptoms.

  • Keep hydrated and as nutritionally fit as possible.

  • If you have diabetes, maintain good glucose control. Irregular stomach emptying can negatively affect blood sugar levels. Keeping your blood sugar under control may help stomach emptying.

  • Before having surgery, ask your doctor, surgeon, or health care team about risks involved and weigh these against the benefits. Ask about alternatives.

  • Let your doctor and pharmacist know about all medications you are taking – prescription and over-the-counter, as well as any supplements.

  • Be aware of possible drug interactions and discuss alternatives with your doctor.

  • Understand the possible side effects of your treatments, and know what to do if side effects occur.

  • Avoid or reduce alcohol and smoking tobacco. These can slow gastric emptying.

  • Engage in regular physical activity as you are able.

Seek appropriate care and take an active role in your health. Working along with your doctor or health care team will help control, reduce, or prevent symptoms and complications.

Page Last Updated 08/11/2020

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