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INDIANAPOLIS GASTROENTEROLOGY & HEPATOLOGY, INC.

GASTROPARESIS
What is gastroparesis?
Gastro-paresis" means "Stomach-Paralysis." Gastroparesis, also called delayed
gastric emptying, is a disorder in which the stomach takes too long to empty its contents.
The function of the stomach is abnormal but without any physical evidence of
obstruction.
The most common symptoms are a full feeling after eating only a small amount,
bloating, regurgitation, nausea and vomiting especially after eating. In some patients,
symptoms can be quite non-specific, such as persistent heartburn, abdominal pain or poor
glucose control in patients with diabetes.

The digestive system

What are the Major Causes of Gastroparesis?
Unfortunately, the exact cause of gastroparesis can not be found in approximately
60% of patients. The most common known cause of gastroparesis is diabetes. At least
20 percent of people with type I diabetes develop gastroparesis. It can also occur in
people with type 2 diabetes, although less often. Other causes of gastroparesis include a
prolonged post-viral syndrome, complications from stomach or ulcer surgery, certain
medications, immune diseases like Lupus or Scleroderma and other muscular and
neurological disorders in the body.

Nervous system diseases. Surgery on the stomach or vagus nerve 5. The vagus nerve controls the movement of food through the digestive tract. When this pacemaker malfunctions. What are the Symptoms of Gastroparesis? These symptoms may be mild or severe. Vomiting of undigested food. including hypothyroidism Gastroparesis happens when the nerves to the stomach are damaged or stop working. Diabetes mellitus 2. including abdominal migraine and Parkinson's disease 9. symptoms of gastroparesis get worse when the glucose control is poor. Some patients may have nausea when they get up in the morning. Gastroesophageal reflux disease (rarely) 7. There is a also a "pacemaker" in the stomach which regulates the stomach to contract 3 times per minute. Anorexia nervosa 4.Causes of Gastroparesis 1. In patients with diabetes. symptoms of gastroparesis can occur. depending on the person. Medications. 1. If the vagus nerve is damaged. Nausea especially after meals. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Smooth muscle disorders such as amyloidosis and scleroderma 8. the muscles of the stomach and intestines do not work normally. 2. particularly anticholinergics and narcotics (drugs that slow contractions in the intestine) 6. and the movement of food is slowed or stopped. Metabolic disorders. Regurgitation. Postviral syndromes 3. 3. They can be persistent or intermittent. . Diabetes can damage the vagus nerve if blood glucose (sugar) levels remain high over a long period of time.

4. your doctor may have special instructions about fasting. Bezoars can be dangerous if they block the passage of food into the small intestine. a person's blood glucose levels can be erratic and difficult to control. x-ray and endoscopy are usually normal. Normally.After fasting for 12 hours. If the x ray shows food in the stomach. Since gastroparesis makes stomach emptying unpredictable. When food that has been delayed in the stomach finally enters the small intestine and is absorbed. Abdominal bloating 8. you may need to repeat the test another day. a person with gastroparesis may digest a meal normally. Heartburn. Weight loss 7. "Functional" tests are usually needed to make a diagnosis. Gastroesophageal reflux 11. a slightly radioactive substance that will show up on the scan. giving a falsely normal test result. If the x ray shows an empty stomach but the doctor still suspects that you have delayed emptying. How do you Make a Diagnosis of Gastroparesis? Since gastroparesis is an abnormality of stomach function without any obstruction. Radioisotope Gastric-Emptying Scan . On any one day. Also. After eating. vomiting and obstruction in the stomach. blood glucose levels rise. the stomach will be empty of all food after 12 hours of fasting. Spasms of the stomach wall These symptoms may be mild or severe. Gastroparesis can make diabetes worse by adding to the difficulty of controlling blood glucose. you will drink a thick liquid called barium. gastroparesis is likely.You will eat food that contains a radioisotope. it can cause problems like bacterial overgrowth from the fermentation of food. 5. Erratic blood glucose levels 9. making it show up on the x ray. you will lie . Lack of appetite 10. If you have diabetes. What are the Complications of Gastroparesis? If food lingers too long in the stomach. The diagnosis of gastroparesis can be confirmed through one or more of the following tests: Barium Upper GI X Ray . which coats the inside of the stomach. An early feeling of fullness when eating 6. depending on the person. The dose of radiation from the radioisotope is small and not dangerous. the food can harden into solid masses called bezoars that may cause nausea.

and. Blood Tests . Treatment helps you manage the condition so that you can be as healthy and comfortable as possible. the doctor passes a long. What are the Treatments for Gastroparesis? The primary treatment goal for gastroparesis related to diabetes is to regain control of blood glucose levels. Gastric Manometry .After giving you a sedative. Upper endoscopy . you may have an ultrasound test.To rule out gallbladder disease or pancreatitis as a source of the problem.under a machine that detects the radioisotope and shows an image of the food in the stomach and how quickly it leaves the stomach. The measurements show how the stomach is working and whether there is any delay in digestion. oral medications. .The doctor may also order laboratory tests to check blood counts and to measure chemical and electrolyte levels. your food is being absorbed more slowly and at unpredictable times. Through the endoscope. Gastroparesis is diagnosed if more than half of the food remains in the stomach after 2 hours. The tube contains a wire that takes measurements of the stomach's electrical and muscular activity as it digests liquids and solid food. Ultrasound . feeding tubes and intravenous feeding. in severe cases. To control blood glucose. Treatments include insulin. thin tube called an endoscope through the mouth and gently guides it down the esophagus into the stomach.This test measures electrical and muscular activity in the stomach. It is important to note that in most cases treatment does not cure gastroparesis—it is usually a chronic condition. The doctor passes a thin tube down the throat into the stomach. you may need to: • Take insulin more often • Take your insulin after you eat instead of before • Check your blood glucose levels frequently after you eat and administer insulin whenever necessary Your doctor will give you specific instructions based on your particular needs. changes in what and when you eat. the doctor can look at the lining of the stomach to check for any abnormalities. Insulin for blood glucose control If you have gastroparesis. which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.

Some physicians believe surgery to remove part or all of the residual stomach may be useful in patients who . liquids. If these symptoms occur. These medications are available in many forms: tablets. Your doctor may try different drugs or combinations of drugs to find the most effective treatment. Domperidone: a drug similar to metochropropamide (Reglan) but without the common side effects. Sometimes depression. It works by increasing the contractions that move food through the stomach.This medication is approved by the FDA for use in patients with chronic idiopathic constipation and constipation predominant irritable bowel syndrome. recent research has shown that it is an excellent prokinetic (stimulates muscle contraction) in the stomach. Side effects are nausea. Surgery for Gastroparesis In most cases. especially for patients with gastroparesis from diabetes. In smaller doses. Phenergan and Tigan. Several medications are reserved for those with severe nausea and vomiting. and injection formulations. However. domperidone is not available in the United States. However. or stiffness in up to 30% of patients who take it. suppository. Domperidone . vomiting. surgery is not helpful for gastroparesis. It is a promotility agent like metoclopramide.The Food and Drug Administration is reviewing domperidone. Tegaserod (Zelnorm) . It also helps reduce nausea and vomiting. tremors. twitching. anxiety and problems with physical movement occur. Certain pharmacies in Canada can fill prescriptions of domperidone and mail to the US. liquids. These medications include Zofran and Kytril. Studies have demonstrated that it can normalize gastric emptying at 2 and 4 hours after meals in diabetic patients. Medications for Nausea and Vomiting There are many medications for treating nausea. Reglan is available in tablet. Erythromycin . erythromycin can be effective for gastroparesis. intramuscularly injections and intravenous injections. The liquid forms have to be stored in the refrigerator. sleepiness. stop the reglan and contact your doctor.Medication Several drugs are used to treat gastroparesis. Erythromycin: a well known antibiotic. Side effects of this drug include fatigue. and abdominal cramps. Domperidone also helps with nausea. It can be very effect for gastroparesis. Prokinetic Medication (increase gastric emptying) Metoclopramide (Reglan) . Metoclopramide is taken 20 to 30 minutes before meals and at bedtime. agitation. Erythromycin is available in tablet and liquid formulation.This drug can relieve nausea and vomiting by working in the brain as well as improving the stomach by working on the stomach directly. which has been used elsewhere in the world to treat gastroparesis. The ones that are usually tried first include Compazine.This antibiotic also improves stomach emptying. Unfortunately. it is available in Canada and Europe.

leaving an opening to it outside the skin. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis is corrected. A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream. Feeding Tube If other approaches do not work. The fluid enters your bloodstream through the vein. The doctor may also recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion—a problem you do not need if you have gastroparesis—and fiber is difficult to digest. The doctor places a thin tube called a catheter in a chest vein. The feeding tube allows you to put nutrients directly into the small intestine. Parenteral Nutrition Parenteral nutrition refers to delivering nutrients directly into the bloodstream and bypassing the digestive system. surgery is not recommended. The tube called a jejunostomy tube is inserted through the skin on your abdomen into the small intestine. you attach a bag containing liquid nutrients or medication to the catheter. you ensure that these products are digested and delivered to your bloodstream quickly. What are the Diet Recommendations for Gastroparesis? Changing your eating habits can help control gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.develop severe gastroparesis as a complication from previous surgery. However. For feeding. bypassing the stomach altogether. but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat. you may need surgery to insert a feeding tube. What are the New Treatments for Gastroparesis? Electrical Stimulation for Gastroparesis . Liquid meals provide all the nutrients found in solid foods. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Your doctor will tell you what type of liquid nutrition to use. By avoiding the source of the problem—the stomach—and putting nutrients and medication directly into the small intestine. in most patients. This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult spell of gastroparesis. A jejunostomy tube can be temporary and is used only if necessary when gastroparesis is severe. it may not become overly full. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars. but can pass through the stomach more easily and quickly. You will receive special liquid food through the tube. Your doctor or dietitian will give you specific instructions.

vomiting. The toxin is injected into the pyloric sphincter. quality of life and weight gain have been shown in patients 1 year after placing the Enterra device. vomiting and weight loss despite medical therapy in patients with diabetic and idiopathic gastroparesis. FDA has approved the Enterra device under Humanitarian Device Exemption (HDE) status. At this time. The indications for Enterra therapy are chronic nausea. . Significant improvement in nausea. patients with gastroparesis from surgery do not qualify for the Enterra device. Botulinum Toxin Injection of the Pylorus The use of botulinum toxin has been shown to improve stomach emptying and the symptoms of gastroparesis by decreasing the prolonged contractions of the muscle between the stomach and the small intestine (pyloric sphincter).Electrical stimulation (Enterra made by Medtronic) of the stomach is an option for patients with gastroparesis who are losing weight.

. Power Aid. You can eat lean meats such as turkey. Angelfood cake is a good source of carbohydrates. 1. Try Gasto Aid. fruit & juice bars & juices. boullion. PRINCIPLES OF THE GASTROPARESIS DIET PRINCIPLE RECOMMENDATIONS What NOT to do. GASTROPARESIS DIET Since gastroparesis (literally “paralysis of the stomach”) is a condition in which the stomach does not empty properly. stick to a liquid diet until you are able to add solids back into your diet. miso & wonton soups. Jell-O. If you are having problems. low fat broth. Avoid red meats. Reduce fat in the diet because fat delays gastric emptying. egg whites and eggbeaters. chicken (without the skin). popsicles. fish (without the skin) that is baked or broiled. INC. Eat small meals frequently (5 to 6 times per day) 2. Don’t eat the typical two or three meals per day. Don’t overload the stomach. Liquids empty better from the stomach than solids. Try clear soups (not cream).INDIANAPOLIS GASTROENTEROLOGY & HEPATOLOGY. Do not eat any fried foods. Avoid greasy foods and oils. Don’t eat solids if you are having problems. RECOMMENDATIONS What to do. this diet is designed to provide foods that are most likely to be better tolerated and to avoid foods that further delay gastric (stomach) emptying. 3. Good sources of protein that are well tolerated include tofu.

The old adage. use Lactaid. or drink soymilk or rice milk. cabbage & celery.4. Do not eat beans unless they have been pureed in a blender or food processor. you should supplement your diet. be sure to check the lable to be certain they are low fat. Supplement your diet with vitamin & mineral supplements. however. 5. Do not use supplements in pill form since these may not empty well from the stomach. or raw fruits. pear sauce. “If a little is good. Since you may not be able to ingest enough food containing sufficient micronutrients. especially the skins. . Try to maintain &/or gain weight. If you are lactose intolerant. like apples.” Eat applesauce. more is better. Don’t eat raw vegetables Avoid broccoli. 6. cauliflower. Use Carnation Instant Breakfast and substitute skim milk. The stomach Avoid raw fruits. Cook all vegetables to “death..” is simply not true! Use only chewable or liquid forms of supplements. You can eat oranges and grapefruit if the skins are removed and the pulp is pureed in a food processor. does not produce cellulase the enzyme necessary to digest cellulose (the main starch in fruits & vegetables). Use supplements like Ensure or other nutritional supplements. Do not take mega doses of vitamins or minerals. low fat yogurt and baby foods.