Often, patients suffer for an extended period of time before they receive a diagnosis—and treatment options that may improve quality of life. “While there is no data on the incidence in central Virginia, I believe there is an increase in the diagnosis of this condition [gastroparesis],” says Daniel Pambianco, MD of Charlottesville Gastroenterology Associates.
What is gastroparesis?
The term ‘gastroparesis’ is a catch-all, descriptive term meaning the stomach is functioning abnormally and emptying slowly. [Pull quote] “Gastroparesis is a digestive disorder in which the propulsion of the stomach is either abnormal or absent, preventing the normal digestion and passage of food into the small intestine,” says Dr. Pambianco. [End pull quote] It is estimated that as many as five percent of the population has gastroparesis, though the degree that the condition disrupts a person’s life is variable. Patients may experience symptoms differently, but they can include nausea, vomiting, bloating, heartburn, abdominal pain, weight loss and what physicians call early satiety—meaning, you feel full after only eating a small amount of food. [Pull quote] The reason why patients run into dead ends before being diagnosed is because symptoms can mimic those of other conditions. Often, other causes are ruled out first, like gallbladder disease, pancreatitis, irritable bowel syndrome (IBS) or tumors.
The path to diagnosis
Imaging studies, along with a patient’s account of symptoms and their duration, can lead a physician to the diagnosis. “The most common tests performed for diagnostic evaluation are endoscopy of the upper digestive tract, gastric emptying study, and upper gastrointestinal x-ray,” says Dr. Pambianco. In an upper endoscopy, a thin, flexible tube is inserted through the mouth into the stomach. A tiny camera on the end of the tube provides pictures of the gastrointestinal tract, and can rule out causes whose symptoms might mimic gastroparesis. A patient may also undergo a gastric emptying study, which is a common procedure that measures the rate that food empties from the stomach and enters the small intestine. In the study, a patient eats a meal that is mixed with a small amount of radioactive material. A scanner is placed over the patient’s stomach, which reveals the rate that the stomach empties. Gastroenterologists might also use a wireless motility capsule—a small, non-invasive pill-like device that is swallowed, and gathers information about your digestive system as you go about daily activities.
The cause of gastroparesis varies by patient. Many cases are idiopathic, meaning an exact cause can’t be pinpointed. Some other causes, according to Dr. Pambianco, are viral infections such as influenza (the flu), diabetes, endocrine disorders like hypothyroidism, autoimmune conditions (like lupus), connective tissue disorders and eating disorders. Another risk factor for gastroparesis is previous surgery involving the esophagus, stomach or duodenum. “These types of surgeries may result in injury to the vagus nerve, which controls the sensation and muscles of the stomach and small intestine,” say Dr. Pambianco. “In addition, there are many medications that slow the function of the stomach such as narcotics, progesterone, and nicotine, to list a few.”
In diabetics, elevated blood sugar over a period of years affects the nerve endings in the body (including the stomach) and makes them dysfunctional. The damage to the stomach nerves creates a ripple effect, and the stomach no longer functions and empties property. Good blood sugar control does not guarantee that a patient won’t get gastroparesis, but could help prevent or delay its onset.
Treatment options for gastroparesis
There are treatments that can help, and they often depend on severity of symptoms. One of the most important management tools is diet, says Dr. Pambianco. It is usually helpful to have a dietician involved in caring for patients for guidance and support. [Pull quote] A common diet for gastroparesis is low fat, not very spicy, with limited caffeine and no raw fruits or vegetables, as the raw, fibrous material is difficult for the stomach to break down. Softer foods are easier on the stomach, such as pasta, cooked vegetables, oatmeal and low-fat yogurt.
A small percentage of patients are very symptomatic, and these patients may be treated with medications or with surgery. There are only a few FDA approved medications for gastroparesis, says Dr. Pambianco. Two surgical options exist for patients—one is a gastric stimulator, that has been FDA approved since 2000, and works much like a cardiac pacemaker, but for the stomach. It is wired to the stomach through a laparoscopic procedure, meaning incisions are tiny.
The other, newer surgical intervention is called pyloroplasty. This surgery can also be done with less-invasive techniques. Pyloroplasty involves permanently opening the valve at the end of stomach—leaving it open helps food move to the small intestine more efficiently. These surgical options may provide relief for the most symptomatic patients, drastically increasing quality of life.
Daniel Pambianco, MD is a gastroenterologist with Charlottesville Gastroenterology Associates. Dr. Pambianco is certified by the American Board of Internal Medicine and by the American Board of Gastroenterology.