Monday, September 29, 2014

Gastroparesis - More Common Than You Think

Matthew Brengman, MD
Advanced Surgical Partners of Virginia
Parham Doctors' Hospital
Gastroparesis is a relatively common disorder in which the stomach has trouble emptying its contents properly, causing food to remain for an unusual amount of time. In a properly functioning digestive tract, the stomach muscles contract in a coordinated fashion to break up food and gradually move the food into the next portion of the intestine, requiring a coordinated action of the muscle of the stomach and the valve at the exit from the stomach.

In the digestive tract of a person suffering from gastroparesis, one or more of these processes are not functioning correctly, the food stalls, inducing common symptoms such as nausea, vomiting, abdominal pain, bloating, reflux, and a general feeling of being uncomfortably full. When severe, these symptoms can lead to little no food intake. This ongoing lack of nutrition resulting from gastroparesis can result in significant weight loss, hospitalization, dehydration and malnutrition.

Gastroparesis is generally a diagnosis suspected by the above symptoms and confirmed with x-ray, endoscopy and most commonly gastric emptying scans. The severity of the symptoms is highly variable, as two people with diagnosed gastroparesis can have vastly different presentations, health management needs, and quality of life.

Normally, three types of gastroparesis exist, idiopathic, diabetic, and postsurgical, and sufferers are usually female. Idiopathic gastroparesis is that of unknown origin and is the most common. Sometimes it can follow gastric illness or respiratory diseases, but most often is characterized by symptoms alone. Diabetic gastroparesis affects both type 1 and type 2 diabetics, with obesity being a major predictor of the disease in type 2 diabetes. Diabetic gastroparesis has multiple root causes, all involving the impairment of gastrointestinal motility and nerve functions. Postsurgical gastroparesis is considered a complication of routine procedures such as those to correct reflux, peptic ulcer disease and common weight loss surgeries.

Other defined causes of gastroparesis include radiation therapy, neurologic disorders (Parkinson’s, stroke, multiple sclerosis, spinal injuries), eating disorders, smoking, pregnancy, hormonal disruption diseases, Crohn’s disease, and other gastrointestinal afflictions. Children are rarely affected by gastroparesis, but may develop it as a result of viral infections.

There are many treatment options for gastroparesis. Most patients can be managed with dietary changes. When symptoms cannot be managed through dietary changes, medication management is indicated. The most common recommended dietary change is to eat smaller, more frequent meals, and avoid high fiber and high fat foods, as they naturally cause delays in stomach emptying. Your physician can help tailor your diet to meet your nutritional needs while addressing the symptoms of the disease. Common medication management for gastroparesis includes prokinetics (drugs that enhance gastrointestinal motility), insulin changes for those with diabetes.

Unfortunately, some patients with severe gastroparesis will fail these therapies. When the symptoms and nutrition cannot be managed through medical therapy, surgical therapies are considered.  Surgical therapies include feeding tubes, botox injected into the pylorus, pyloroplasty (surgical division of the muscle at the end of the stomach) and gastric stimulation (“gastric pacemakers”).

The combined therapies listed above commonly lead a person suffering from gastroparesis back to a more normal body function after treatment. These therapies have been shown to improve and stabilize nutrition, reduce hospitalizations and improve quality of life.

For further inquiries about surgical therapies for gastroparesis, diabetes, obesity, or other metabolic disorders, contact Matthew Brengman, MD, at Advanced Surgical Partners of Virginia at 804.360.0600.

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