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The Condition
Gastroparesis
A stomach that will not empty. What causes it, how it is diagnosed, and what can be done when diet and medication are not enough.
The stomach's job is to break solid food down into liquid and nutrients by mixing it with acid and pulverizing it. The job of the pylorus — the sphincter at the end of the stomach — is to stay closed so solid food stays in the stomach until it is broken down, then open to let liquid and nutrients through to the small intestine for absorption.
Gastroparesis (gastro = stomach, paresis = paralysis) is the result of damage to the nerves of the stomach and pylorus. When the stomach's nerves are damaged, it cannot pulverize food. When the pylorus's nerves are damaged, it no longer opens.
What is gastroparesis?
Living with gastroparesis can be debilitating, and it often means repeated trips to the emergency room for nausea, vomiting and pain. Treatment has changed significantly in recent years. Our team knows how to get you back to living a full life again.
Two failures, not one
Those are two separate problems, and they respond to two different operations. A stomach that cannot pulverize is a motility problem. A pylorus that will not open is a door problem. Which symptoms you have tells us which one to address first.
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:
- Bloating in the upper abdomen as the stomach gets bigger. It gets bigger even if you do not eat or drink, because you unconsciously swallow air and your stomach makes fluid filled with acid.
- Feeling full after only small bites of food (early satiety), because the stomach is already full of air and fluid.
- Heartburn, because stomach acid decompresses up into your esophagus.
- Upper abdominal pain, as the stomach wall gets so tight that its muscles cramp when they cannot get enough blood and oxygen.
- Nausea and vomiting, because your brain wants to decompress all of that pressure.
Getting to a diagnosis
See your general practitioner or gastroenterologist if you have these symptoms and are concerned. They will need to rule out a stomach blockage first, typically with an upper gastrointestinal series (UGIS, an x-ray study) or an esophagogastroduodenoscopy (EGD, a scope procedure). After that, a gastric emptying study showing delayed emptying for solids at two and four hours confirms the diagnosis.
How did I get gastroparesis?
There is no simple answer, and for most people the cause cannot be determined. What we do know is that women, diabetics, and people with hypothyroidism, Parkinson's, multiple sclerosis, or other autoimmune disorders are more susceptible. It can also follow abdominal or esophageal surgery, or result from certain medications such as narcotic pain medicines.
What if gastroparesis goes untreated?
Left untreated, severe complications can occur:
- Severe dehydration from ongoing vomiting.
- Malnutrition, since you are likely not getting enough calories into your body.
- Bacterial growth. Food remaining in the stomach can ferment. It can also harden and prevent other food from passing through the small intestine.
- Worsening diabetes, as blood sugar becomes harder to control.
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 not enough, they will try to manage your symptoms with medication:
- Prokinetics to help the stomach move food more effectively — metoclopramide, erythromycin, and domperidone.
- Antiemetics to reduce nausea — promethazine and ondansetron.
- Antacids to reduce stomach acid production — omeprazole, pantoprazole, and several others.
What if diet and medication do not work?
This is where Dr. Hughes and Vanguard Surgical can help, with two surgical options: pyloroplasty and gastroelectrical stimulation (a gastric stimulator).
Which operation comes first depends on whether bloating and upper abdominal pain are part of your picture.
If you have significant bloating and/or epigastric (upper abdominal) pain, we start with outpatient laparoscopic pyloroplasty. For most patients, that is all they need. For a minority, the nausea persists and they may benefit from outpatient laparoscopic gastric stimulation. Having had the pyloroplasty first, these patients do not typically need the stimulator turned up as much as they would have otherwise.
If you do not have significant bloating or epigastric pain, we start with gastric stimulation. For most patients, that is all they need. For those who do not improve significantly, or who later develop bloating or epigastric pain, outpatient laparoscopic pyloroplasty could help.
Treatment Options
The two operations we perform
Both are outpatient and laparoscopic. Both are done at an ambulatory surgical center rather than a hospital, which keeps costs down. Patients go home the same day.
Option One
Pyloroplasty
Opens the pylorus so the stomach can empty. It is the operation most Vanguard patients have first, and for roughly two in three, it is the only operation they need.
Read about pyloroplasty →
Option Two
Gastric stimulation
An implanted device that sends mild electrical signals to the stomach nerves. It targets the nausea and vomiting that persist when emptying alone is not the whole problem.
Start with the seminar. Decide afterwards.
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Questions? Call (502) 912-8300, Monday–Friday 8:00 am – 4:00 pm ET.