Gastroparesis, or delayed gastric emptying, is a condition in which the stomach takes longer than it should to pass its contents to the small intestine.

This “stomach paralysis” results in a host of uncomfortable symptoms that can greatly reduce the quality of life for someone with the condition.

Signs and symptoms

Gastroparesis symptoms can range from mild to severe, depending on the individual. The most common symptoms are nausea, vomiting and feeling full early after eating just a few bites during a meal.

Since food doesn’t move through the stomach at a normal pace, many patients report feeling full and bloated after eating. This feeling can result in inadequate food intake, which can lead to malnutrition and vitamin and mineral deficiencies.

The nausea and vomiting in some patients is so severe that it makes getting the right nutrition difficult.

Also, food remaining in the stomach for extended periods can ferment and cause bacterial overgrowth. This can lead to the food hardening into masses called bezoars, which cause nausea and vomiting and can lead to a stomach obstruction.

In some cases, the bezoars can block food’s passageway into the small intestine.

Causes

Many conditions can lead to gastroparesis, but diabetes is one of the most common causes. Neuropathy, a common diabetes complication, can damage the vagus nerve. The nerve is one of the primary automatic controls for gastric emptying in your body.

Hyperglycemia occurs when blood sugar levels are too high. It also can cause delays in gastric emptying. When glucose rises in diabetes patients, it slows stomach emptying and can make them more likely to have gastrointestinal symptoms. This can lead to a vicious cycle of delayed gastric emptying and trouble controlling glucose levels.

The American Diabetes Association says people with diabetes and gastroparesis may need to administer insulin more often. This means they must administer insulin after eating, instead of before, and closely monitor blood sugar levels throughout the day.

A January 2013 study published in the American Journal of Gastroenterology estimates the prevalence of gastroparesis is approximately 5% in type 1 diabetes patients and 1% in type 2 patients.

Diagnosis

Medical providers diagnose gastroparesis in several ways. If patients show symptoms consistent with the disease, they’re likely to first undergo an upper endoscopy.

This rules out any mechanical obstruction or ulcer. If no obstruction is present, the next step is usually a scintigraphy. This is a diagnostic test considered to be the gold standard for measuring the rate at which solids and liquids empty from the stomach in a four-hour period.

During this test, patients consume solid foods and liquids with a small amount of radioactive material, and examiners identify the rate of gastric emptying at one-hour intervals. If the study is positive, which is usually defined by gastric retention of more than 10% in four hours, then that would help to confirm our diagnosis.

Food choices

Food choices are just as important as reducing the amount of food eaten at each meal. I emphasize low-fat foods, because high-fat foods have a longer gastric emptying time. In addition, low-fiber foods are recommended because fiber is known to slow gastric emptying. Gastroenterologists also suggest patients eat low-residue foods such as refined breads, white rice and white pasta, plus cooked vegetables and canned fruit, because they’re better tolerated than fresh fruits and vegetables.

It is also recommended patients avoid carbonated beverages, alcohol and smoking, which can slow down gastric emptying.

References

Gastroparesis. American College of Gastroenterology. patients.gi.org/topics/gastroparesis. Updated December 2012

Roger Polsky is a nurse practitioner at MUSC Health-Gastroenterology on the campus of MUSC Health-Florence Medical Center. He is accepting new patients. For more information, call 843-674-1530 or visit muschealth.org/florence.