Gastroparesis
Sutter Davis Hospital Gastroenterology

Definition
Gastroparesis is the failure of the stomach to empty because of decreased gastric motility. Normally, your stomach contracts slowly to squeeze solid food into small particles. Your stomach pushes these compressed solids and liquids into the small bowel. With gastroparesis, the stomach is paralyzed, so its function is greatly reduced or lost. Because the stomach isn’t moving the food into the small bowel, it stays in the stomach longer than normal.

Causes
The major causes are diabetes, vagotomy, gastric resection, and use of anticholinergic medications. For most patients the cause is unknown.

Symptoms
Typical symptoms of gastroparesis include nausea, frequent and uncontrollable vomiting, abdominal bloating, feeling of immediate fullness upon eating, and loss of appetite. In patients with diabetes, frequent vomiting can cause dehydration, which can lead to diabetic ketoacidosis, a toxic build-up of chemical compounds in the blood that can lead to coma in patients with diabetes. Prolonged vomiting can also make the lining of the stomach bleed. Vomiting usually occurs after meals. People with gastroparesis usually vomit undigested food eaten anywhere from 8 to 24 hours earlier. Some patients experience days of nausea, bloating, and little appetite, but no vomiting.

Treatment

• Lifestyle Changes:  Treatments for gastroparesis include eating small meals throughout the day and avoiding fatty foods and other foods that are difficult to digest, such as legumes, lentils, and citrus fruits.
• Medications:  If you have gastroparesis as a complication of diabetes, you may need to intensify insulin therapy to get better control of your blood glucose. A number of drug therapies are also used to treat gastroparesis. The most effective is metoclopramide, which helps the stomach to empty by stimulating stomach activity. It may also relieve nausea and vomiting. Common side effects include drowsiness and fatigue. Some people may also experience depression, movement disorders, anxiety, and breast tenderness or discharge. While the antibiotic erythromycin improves stomach emptying, its side effects of nausea, vomiting, and abdominal cramps limit its usefulness.
• Surgery:  If drugs do not work for you, your physician may recommend a jejunostomy tube, which allows food to bypass your stomach. Liquid nutrition, fluids, and medication are delivered directly to the small bowel through the tube during severe attacks of gastroparesis. In extremely severe cases of gastroparesis, patients may need a semi-permanent intravenous line that delivers nutrients and fluids directly into the bloodstream.