Gastroparesis literally means “stomach paralysis”. Gastroparesis is a disorder in which the motility of the stomach is either abnormal or absent. A normally functioning stomach produces contractions which help to crush ingested food and pushes further into the small bowel where food is digested further, and absorption of nutrients occurs. In gastroparesis, this function of the stomach is lost and hence stomach is unable to contract normally hampering food digestion and its propulsion into the small intestine in the absence of mechanical obstruction.
There are many causes of gastroparesis. Diabetes is one of the most common cause. Other causes include viral infections, postsurgical, drug-induced, hypothyroidism, neuromuscular diseases or idiopathic (unknown) causes. In diabetics, gastroparesis is more common in patients who have had the disorder for more than five years and is seen in nearly 10% -18% of patients. Common drugs causing gastroparesis are antidepressant and calcium channel blockers which are common antihypertensive drug. Gastroparesis also needs to be differentiated from functional dyspepsia which has a similar presentation.
Symptoms of gastroparesis include bloating, nausea, early fullness while eating food or early satiety, belching and epigastric pain. These symptoms are more severe after ingestion of fatty foods or foods with high fiber content. Vomiting and weight loss can also occur. Vomiting undigested food many hours after the last meal is also common.
Diagnosis usually requires Upper GI Endoscopy which is performed by inserting a thin flexible tube through the mouth into the stomach to rule out an ulcer, infection, cancer or other abnormalities. Sometimes CT Abdomen is required to rule out any obstruction in the GI tract. Gastric emptying study is done to confirm delayed gastric emptying.
Treatment begins with dietary modification wherein a patient is advised to consume diet low-in-fat and non-digestible fibre. Hydration and vitamin supplements are advised. Patients are advised to avoid smoking, alcohol and carbonated beverages. Diabetes control is advised in patient with diabetes. In patients with drug-induced gastroparesis, culprit drug needs to be withdrawn. Few medications which increase gastric motility are added. Some patients with advanced disease require surgical or endoscopic interventions. Regular exercise is recommended.