As diabetes cases skyrocket, another condition called gastroparesis is rapidly becoming a more common diagnosis. It reduces the ability of the stomach to empty its contents but does not involve a blockage. Nausea, vomiting, loss of appetite, bloating and chronic abdominal pain are the hallmark symptoms, according to gastroenterologist Michael Cline, DO.
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If you have diabetes, gastroparesis can cause it to be poorly controlled. Severe gastroparesis makes it difficult to manage your blood sugar.
Primary care physicians — and even gastroenterologists — frequently overlook and under-diagnose the condition, he says. Sometimes it is initially misdiagnosed as an ulcer, heartburn or an allergic reaction.
In non-diabetic patients, the condition may relate to acid reflux.
“In current data, up to 40 percent of people with acid reflux have some sort of delay in gastric emptying,” he says. “So that’s a fairly large number, when you look at the millions of Americans who have acid reflux,” Dr. Cline says.
Stomach motility either abnormal or absent
Gastroparesis, which means partial paralysis of the stomach, is a serious disease that prevents your stomach from digesting food and emptying properly. Damaged nerves and muscles don’t function with their normal strength and coordination. That slows the movement of contents through your digestive system.
Doctors don’t yet know how to reverse the damage, but there is a range of treatment options. And, early diagnosis helps, Dr. Cline says.
A look at what causes gastroparesis
The primary cause of gastroparesis is damage to or dysfunction of peripheral nerves and muscles.
In diabetic patients, Dr. Cline says, it appears as more of a neuropathy-based disease associated with damaged nerves. In patients who don’t have diabetes, it seems more muscular-based: The nerve endings are all right, but the muscles are not responding, he says.
In addition to diabetes, other sources of gastroparesis include:
- Lingering post-viral effects — You get a virus, but the nausea and vomiting from the virus don’t go away after the virus is gone.“Some of those cases will resolve, and we just have to wait and watch,” Dr. Cline says. “But a lot of times it doesn’t resolve, so we have to continue to treat the patients.”
- Connective tissue diseases — Gastroparesis may plague patients who have diseases such as multiple sclerosis or muscular dystrophy.
- Side effects from medication — Probably the most difficult group to treat, narcotic pain medicines and other drugs slow a patient’s intestinal motility, Dr. Cline says.“That can be very hard to treat, because the medications often override what we prescribe to treat the gastroparesis,” he says.
- Post-surgical effects — Some patients develop gastroparesis after the vagus nerve is damaged or trapped during a gastrointestinal surgical procedure.
A difficult disease to treat
Treatment sometimes begins with adjustments to diet and medication. If those approaches don’t work, surgical treatments are the next steps:
- Feeding tube — Because gastroparesis impairs proper nutrition, surgeons can insert a feeding tube through the patient’s nose that bypasses the stomach. Or a surgeon may place what is known as a J tube directly into the patient’s small bowel for feeding.If these don’t work, total patient nutrition (TPN) is the next step. The patient is fed through an IV.
- Gastric pacemaker — A surgeon also may use a minimally invasive laparoscopic procedure to implant a gastric pacemaker to treat this chronic digestive condition.The small device employs gentle electrical impulses to stimulate the stomach’s muscles to perform their usual functions. These impulses help move the stomach’s contents through the digestive tract and bring the patient relief from symptoms.“We’re moving towards not really curing gastroparesis — because we really don’t know how to reverse the neuropathies yet — but fixing it as best we can,” says Dr. Cline. “So patients and their families need to push for the diagnostic tests that we can do, because the earlier it’s diagnosed, the easier it is to treat.”
Treating psychological concerns
A neuropsychiatric specialist is sometimes called in to address mental health concerns that can accompany this chronic disease.
“If you wake up sick every day and vomiting all the time, this disease can quickly move from a purely physical one to a psychiatric one, so we treat the possible components of depression, anxiety, pain and so on, too,” Dr. Cline says.