Gastroparesis – More Common Than You Think
Matthew Brengman, MD, FACS, is a nationally-recognized, advanced gastroparesis specialist near Richmond, Va.
Gastroparesis is a relatively common disorder in which the stomach has trouble emptying its contents properly, causing food to remain for an unusual amount of time. In a properly functioning digestive tract, the stomach muscles contract in a coordinated fashion to break up food and gradually move the food into the next portion of the intestine. The process requires a coordinated action of the muscle of the stomach and the valve at the exit to the stomach.
In the digestive tract of a person suffering from gastroparesis, one or more of these processes are not functioning correctly, the food stalls, inducing common symptoms such as nausea, vomiting, abdominal pain, bloating, reflux, and a general feeling of being uncomfortably full. When severe, these symptoms can lead to little no food intake. This ongoing lack of nutrition resulting from gastroparesis can result in significant weight loss, hospitalization, dehydration, and malnutrition.
Gastroparesis Patient Seminar
Gastroparesis is difficult to diagnose, and is often misunderstood or mistaken for something else. Because of this common confusion, Dr. Brengman hosts a recorded seminar on YouTube for his patients to understand the background of gastroparesis, what causes it, how physicians identify the condition, and ultimately, the options for treatment. Please watch his seminar linked below, and contact his office at (804) 360-0600 with any further questions or to schedule a consultation.
Diagnosis of Gastroparesis
Gastroparesis is generally a diagnosis suspected by the above symptoms and confirmed with x-ray, endoscopy and most commonly gastric emptying scans. Other tests for the disease include wireless motility capsules, breath testing, upper GI endoscopy (a test that uses a fiberoptic scope to examine the esophagus, throat, stomach, and upper part of the small intestines), and esophagogastroduodenoscopy (a test to examine the lining of the esophagus, stomach, and first part of the small intestine). Affecting mostly women, the severity of the symptoms is highly variable, as two people with diagnosed gastroparesis can have vastly different presentations, health management needs, and quality of life.
Idiopathic gastroparesis is that of unknown origin and is the most common. Sometimes it can follow gastric illness or respiratory diseases, but most often is characterized by symptoms alone, including fullness, bloating, and pain - when eating, at night, and interfering with sleep. Idiopathic gastroparesis tends to improve over time and appears mostly in young to middle-aged women.
Diabetic gastroparesis affects both type 1 and type 2 diabetics, with obesity being a major predictor of the disease in type 2 diabetes. Diabetic gastroparesis has multiple root causes, all involving the impairment of gastrointestinal motility and nerve functions. Frequent retching and vomiting are the most common symptoms for this group.
Postsurgical gastroparesis is considered a complication of routine procedures such as those to correct reflux, peptic ulcer disease (vagotomy), and common weight loss surgeries.
Other defined causes of gastroparesis include radiation therapy, neurologic disorders (Parkinson’s, stroke, multiple sclerosis, spinal injuries), eating disorders, smoking, pregnancy, hormonal disruption diseases, Crohn’s disease, and other gastrointestinal afflictions. Children are rarely affected by gastroparesis but may develop it as a result of viral infections.
Watch Dr. Brengman Discuss the Diagnosis of Gastroparesis >>
Non-Surgical Treatment of Gastroparesis
There are many treatment options for gastroparesis. Most patients can be managed with dietary changes. The most common recommended dietary change is to eat smaller, more frequent meals, and avoid high fiber and high fat foods, as they naturally cause delays in stomach emptying. Your physician can help tailor your diet to meet your nutritional needs while addressing the symptoms of the disease.
When symptoms cannot be managed through dietary changes, medication management is indicated. Common medication management for gastroparesis includes prokinetics (drugs that enhance gastrointestinal motility), insulin changes for those with diabetes.
Watch Dr. Brengman Discuss the Non-Surgical Treatments for Gastroparesis >>
Surgical Treatment of Gastroparesis
Unfortunately, some patients with severe gastroparesis will fail these therapies. When the symptoms and nutrition cannot be managed through medical therapy, surgical therapies are considered.
Enteral feeding tubes are devices by which patients can receive a complete dietary complement (protein, amino acids, carbohydrates, fiber, fat, water, minerals, and vitamins) directly into the gut. The tube is placed via a jejunostomy, which is the surgical creation of an opening through the skin in the front wall of the abdomen. With this device, patients can maintain good nutritional and diabetic control, but also may suffer from pain, issues with the tube, persistent symptoms, and poor quality of life due to tube maintenance.
Botox injected directly into the pylorus (the opening from the stomach into the small intestine) has been shown to assist in both gastric emptying and symptoms of gastroparesis, though the results are mild and not as effective as other treatments.
Pyloroplasty is the surgical widening of the muscle in the lower part of the stomach to allow for increased emptying into the duodenum (small intestine). The pylorus is a thick muscular area, and when it has thickened, food cannot pass through. The procedure is performed laparoscopically (a minimally-invasive technique by which the surgeon uses small incisions and a camera), and 80%+ of patients have an improvement in gastroparesis symptoms post-operatively.
Gastric stimulation is a treatment by which a gastric “pacemaker” is implanted in the patient. It is most effective in treating diabetic and post-surgical gastroparesis patients, and comes with relatively few complications. The mild electrical pulses the device sends to the nerves and smooth muscles of the lower stomach help to decrease nausea and vomiting in patients.
Watch Dr. Brengman Discuss the Surgical Treatments for Gastroparesis >>
The combined therapies listed above commonly lead a person suffering from gastroparesis back to a more normal body function after treatment. These therapies have been shown to improve and stabilize nutrition, reduce hospitalizations and improve quality of life.