Gastroparesis Fast Facts
In honor of Gastroparesis Awareness Month, I have put together a compilation of important facts related to the condition. Gastroparesis, also called delayed gastric emptying, is a stomach disorder characterized by the inability of the stomach to empty itself of food within a reasonable amount of time. Because gastroparesis causes food to sit in the stomach for too long, it can cause a variety of symptoms. Nausea is considered the hallmark symptom of gastroparesis. Other common symptoms of it include abdominal pain, bloating, vomiting, constipation, and weight fluctuation. In this piece, I will describe some of the causes of gastroparesis, some of the ways to diagnose it, and some of the ways to treat it.
1. Gastroparesis, also called delayed gastric emptying, is caused by dysfunction of the nerves or muscles that control the stomach.
The most common known cause of gastroparesis is nerve damage due to diabetes. Other conditions, such as autoimmune disease, connective tissue disorders, and hypothyroidism can cause gastroparesis through nerve or muscular damage. Abdominal surgery, such as the Nissen fundoplication, can cause post-surgical gastroparesis if nerves are damaged during the surgery. Gastroparesis can also be “idiopathic,” meaning that a cause cannot be found. Women make up the majority of patients with idiopathic gastroparesis. During the only epidemiological study conducted on gastroparesis, researchers found that the prevalence of gastroparesis was four times higher in women than in men.
2. Gastroparesis is most commonly diagnosed using a gastric emptying study.
During a gastric emptying study, a patient is given a pre-measured amount of radioactive food, usually eggs and toast, to eat. A technician will then take a series of images, usually over the course of four hours, to track the movement of the radioactive food throughout the digestive system. A normally functioning stomach will usually empty all of the food within four hours. Gastroparesis is typically diagnosed when at least 10% of the food remains at the four hour mark. Some doctors will also tentatively diagnose gastroparesis if food is present in the patient's stomach during an endoscopy despite the patient fasting prior to the procedure.
3. There is only one FDA approved drug for gastroparesis available in the United States.
Metoclopramide, also known by its brand name Reglan, is the only approved medication for gastroparesis that is available in the United States. Many doctors are hesitant to prescribe metoclopramide because of its ability to cause permanent neurological side effects, such as tardive dyskinesia. Some medications are prescribed off-label for gastroparesis, such as the antibiotics erythromycin and azithromycin. Other drugs that have been proven to be effective in treating gastroparesis, such as domperidone, are banned in the United States. All of the prokinetic drugs used to treat gastroparesis can cause cardiac side effects, such as long-QT syndrome. Because of this side effect risk, many people with gastroparesis need to get periodic EKG testing.
Gastroparesis can also be managed through diet. Some patients can manage their condition with diet alone, and some use diet in conjunction with medication or surgery. The most common diet used to manage gastroparesis is a low fiber, low fat diet. Fiber and fat both empty from the stomach slowly, so they are particularly difficult for patients with gastroparesis to digest. Liquids are also easier for the stomach to empty than solids. Because of this, some patients with gastroparesis predominately get their nutrition through liquids.
4. More invasive treatment options include feeding tubes, total parenteral nutrition (TPN), botox injections, and surgery.
Diet and medication are sometimes not enough to manage a patient’s gastroparesis. Many gastroparesis patients cannot tolerate the medications that are used to treat it, often due to the neurologic and cardiac side effects. Some of the medications used to treat gastroparesis, such as erythromycin and azithromycin, can lose their efficacy overtime. Because of these variables, invasive treatments are sometimes needed to help a patient control their gastroparesis. Some of these options include providing a patient with nutrition without requiring them to eat. This can be achieved with a feeding tube or with total parenteral nutrition. Another option available is to get a surgically implanted gastric pacemaker, which helps manage symptoms like nausea. Botox injections, which are administered to the pyloric sphincter during an endoscopy, can also be used to aid the stomach in emptying its contents.
5. Gastroparesis is increasingly becoming a more common diagnosis.
While the exact prevalence of gastroparesis is not currently known, experts estimate that about 4% of people within the United States experience symptoms of gastroparesis. Because gastroparesis shares symptoms with many other digestive conditions, this does not mean that all people who have symptoms of gastroparesis actually have it. The reported prevalence of gastroparesis has increased significantly during recent years. The prevalence of gastroparesis in 2007 was found to be over three times higher than its average prevalence during the years 1996 through 2006. Part of the increase in diagnoses is due to greater awareness of the condition. The prevalence is also thought to be increasing due to Type-2 Diabetes becoming more common and due to more people having abdominal surgery.
I hope you found this information helpful,
[Thumbnail image, which depicts the text "August is Gastroparesis Awareness Month, Be An Advocate" made by Christina Castillo.]