Living with gastroparesis can be debilitating and result in frequent visits to the emergency room for nausea, vomiting and pain. The good news is treatment of gastroparesis has evolved significantly in recent years and our team knows how to get you back to living a full life again.
WHAT IS GASTROPARESIS?
The role of the stomach in digesting food is to break solid food down into liquid and nutrients by mixing it with acid and pulverizing it. The role of the pylorus (sphincter at the end of the stomach) is to close to keep solid food in the stomach until it is broken down. The pylorus then opens to let liquid and nutrients into the small intestine for absorption.
Gastroparesis (gastro = stomach and paresis = paralysis) results from damage to the nerves of your stomach and pylorus. When stomach nerves are damaged, it cannot pulverize food. When pylorus nerves are damaged, it no longer opens.
How do I know if I have gastroparesis?
When the stomach cannot effectively pulverize food and empty it into the small intestine, you may experience some combination of the following symptoms:
- As the stomach gets bigger, you may feel bloating in your upper abdomen. Even if you don’t eat or drink, your stomach gets bigger because you unconsciously swallow air, and your stomach makes fluid-filled with acid.
- You may feel full after eating even small bites of food (early satiety) as the stomach is already full of air and fluid.
- You may get heartburn because your stomach acid decompresses up into your esophagus.
- You may get upper abdominal pain as the stomach wall gets so tight that its muscles cramp when they cannot get enough blood and oxygen.
- You may develop nausea and vomiting because your brain wants to decompress all this pressure.
See your general practitioner or gastroenterologist if you have these symptoms and are concerned. He or she will need to make sure you do not have any stomach blockage, typically with an upper gastrointestinal series (UGIS, an x-ray study) or esophagogastroduodenoscopy (EGD, a scope procedure). After this, a gastric emptying study showing delayed emptying for solids at 2 and 4 hours confirms the diagnosis.
How did I get gastroparesis?
Unfortunately, there is no simple answer and for most people the cause cannot be determined. What we do know is that women, diabetics and those with hypothyroidism, Parkinson’s, multiple sclerosis, or other autoimmune disorders are often more susceptible to the disease. It can also result from abdominal or esophageal surgery or from certain medications such as narcotic pain medicines.
What if gastroparesis goes untreated?
If left untreated severe complications can occur including:
- Severe dehydration due to ongoing vomiting.
- Malnutrition since you are likely not getting enough calories in your body.
- Food remaining in the stomach can ferment and lead to the growth of bacteria. It can also harden and prevent other foods from passing through your small intestine.
- Blood sugar changes can make diabetes worse.
What can be done for gastroparesis?
Your medical provider will first work with you to adjust your diet to help control your symptoms.
If dietary modification is ineffective, then he or she will try to manage your symptoms with various medications:
- Prokinetics to help your stomach move food more effectively (such as metoclopramide, erythromycin, and domperidone).
- Antiemetics to decrease nausea (such as promethazine and ondansetron).
- Antacids to decrease stomach acid production (such omeprazole, pantoprazole, and several others).
What if dietary modification and medical management do not work?
This is where Dr. Hughes and Vanguard Surgical can help with the surgical options of pyloroplasty and gastroelectrical stimulation (gastric stimulator).
Most patients with gastroparesis have nausea, and many have vomiting (including dry heaving, belching, and burping). The best surgical approach is determined by whether or not the stomach is under pressure.
If the stomach is under pressure (nausea +/- vomiting with fullness and bloating +/- upper abdominal pain), we start with outpatient laparoscopic pyloroplasty. This decompresses the stomach to alleviate symptoms. For about 2/3 patients, this all they need. For about 1/3 of patients, the nausea persists, and they could benefit from outpatient laparoscopic gastric stimulation. Having had the pyloroplasty first, these patients do not typically need the gastric stimulator turned up as much as they would have if they had not first had the pyloroplasty.
If the stomach is not under pressure (nausea +/- vomiting without fullness and bloating +/- upper abdominal pain), we start with gastric stimulation. For these patients, their stomach is not under pressure, and they do not need it decompressed with pyloroplasty.
