What is Gastroparesis? The Mysterious Disease Explained
Aside from being a source of nourishment, eating brings comfort and joy to many. It’s one of life’s pleasures most of us can’t do without. So just imagine a life of constant vomiting, with the inability to eat due to perpetual bloating and nausea, with the feeling of fear instead of bliss whenever it’s meal time. It must be horrible! Sadly, that is the kind of life that most people with gastroparesis have to endure on a daily basis. Though some patients experience symptoms intermittently, the cycling of flare-ups can go on for years.
Gastroparesis is a partial paralysis of the stomach. Some refer to it as delayed gastric emptying, though this term does not capture the complete essence of what the disease does. Gastroparesis is a serious disease that disables the stomach from digesting food and moving it to the small intestine for nutrient absorption and eventually, elimination. This explains typical symptoms such as heartburn or GERD, poor appetite, throwing up undigested food, and early fullness while eating.
Since these symptoms are general and can mimic the manifestation of other related gastrointestinal or biliary disease, gastroparesis is often overlooked and underdiagnosed. Sometimes, it is misdiagnosed as a gallbladder attack, ulcer, allergic reaction, or heartburn. The delay in accurate diagnosis can lead to aggravated symptoms such as epigastric pain, weight loss, malnourishment, unstable sugar levels, bacterial overgrowth (SIBO) from delayed gastric emptying and food fermentation, or the hardening of food into solid masses called bezoars. This condition significantly impacts quality of life and can lead to chronic disease, including gallbladder disease. Early gastroparesis diagnosis on is crucial to its management.
There are a number of ways that gastroparesis diagnosis can be done by a general practitioner or a gastroenterologist. After discussing your symptoms, getting your medical history and arranging for some blood tests, you may be asked to undergo any of the following diagnostic tests:
1.Ultrasound – ultrasound is often used to determine and rule out other diseases that may be causing similar symptoms as gastroparesis. Through the use of a transducer, it may be confirmed if a patient is suffering from a gallbladder disease, pancreatitis, or other conditions apart from gastroparesis.
2.Barium X-Ray – This process entails swallowing liquid containing barium, a chemical that shows up on x-ray, highlighting the passage of food through the digestive system.
3.Gastric Emptying Scintigraphy – This test involves ingesting a small mean that contains a small amount of radioactive material. This allows external cameras to scan the abdomen and measure the rate of gastric emptying a few hours after the meal.
4.Upper Endoscopy – This procedure requires the insertion of an endoscope through the mouth and into the stomach. Through this, the GI tract can be checked for ulcerations, infection, inflammation, or any other irregularities.
5.Wireless Monitoring Capsule Test – This technology (also known as the SmartPill) using a non-digestible capsule that tracks and records pH levels, temperature, and pressure changes as it travels into the GI system, can be a good determinant of GI motility. It transmits information to a receiver worn by the patient. The data will be able to help determine how fast or slow the stomach empties.
6.Gastroduodenal Manometry – This test measures the contraction and relaxation of the smooth muscle of the stomach during fasting and eating states.
What are the known Gastroparesis Causes?
There are three types or subdivisions of gastroparesis – diabetic, post-surgical, and idiopathic gastroparesis. The causes of the first two types are clearer than the last.
1.Diabetic Autonomic Neuropathy
Diabetic gastroparesis happen in people who have diabetes or poorly-controlled blood sugar levels. Studies show that it is often caused by diabetic autonomic neuropathy, wherein some nerve endings get damaged and certain muscles become unresponsive to stimulus. Oftentimes, diabetic gastroparesis in its early stages is overlooked among patients with unstable blood sugar since it shows very similar symptoms to diabetes mellitus. Examples are vomiting, constipation, incontinence, and diarrhea.
The gastroparetic stomach of a diabetic also has low blood glucose levels at bedtime, with very high blood sugar in the morning. Gastroparesis is just one of the manifestations of diabetic autonomic neuropathy. Others include cardiovascular irregularities, genitourinary disorders, metabolic diseases, metabolic dysfunctions, and pupillary conditions. It can also cause damage to the vagus nerve. Diabetic gastroparesis make the absorption of oral hypoglycemic agents unpredictable because of delayed gastric emptying. It also means that the food is absorbed slowly, making blood sugar control and monitoring even more difficult.
Management of diabetic gastroparesis is slightly different from the other gastroparesis causes. For those with diabetic autonomic neuropathy, the primary treatment goals are improved gastric emptying and regaining control of blood glucose levels. This entails the adjustment of a patient’s insulin regimen.
2.Vagus Nerve Damage
Post-surgical gastroparesis, on the other hand, develops after surgical procedures like bariatric surgery, gastrectomy, gallbladder removal, heart or lung transplant, or pancreatic surgery. During operation, especially within the digestive and biliary area, it is possible for the vagus nerve to be damaged or severed, affecting the GI system. Gastroparesis may also be a complication and consequence of vagotomy, a procedure involving the removal of a portion of the vagus nerve. Since the introduction of laparoscopic techniques for GERD treatment, gastroparesis has become a recognized complication of fundoplication (surgery for GERD and hiatal hernia) or other surgeries that involves gastroplasty or bypass procedures. In a previous post , we discussed the connection and importance of the vagus nerve to gallbladder function. Now, we will also see how it is one of the known gastroparesis causes.
The vagus nerve, the longest cranial nerve, sends out 75% of all parasympathetic outflows. This means that it is a crucial player in carrying out tasks such as heart rate regulation, blood pressure within the respiratory passage, blood flow and movement of the digestive tract, breathing, and promotion of excretion. The vagus connects the brain to the gut and vice versa, so much so that 80% of the vagus nerve fibers deliver information from the enteric nervous system (in the gut) to the brain. It has significant effect over GI functions like motility (movement), secretion, and absorption. It is therefore not surprising that gastroparesis can happen when the vagus nerve is damaged.
Note to gallbladder patients: Aside from surgeries affecting the vagus nerve, studies also show that patients who have undergone cholecystectomy or gallbladder removal are likely to develop gastroparesis. In fact, gastroparesis has very similar symptoms and manifestation as dumping syndrome, a very common repercussion of gallbladder surgery. This happens because the bile is no longer controlled and regulated by the gallbladder. The loss of the bile reservoir also affects the normal digestive cycle and disrupts normal movement of food along the GI tract. The common occurrence of gastroparesis among cholecystectomy patients makes them a high-risk group – more reason to watch the diet, lifestyle, and supplementation choices even after going under the knife.
3. Gastroparesis due to Unknown Reasons (Idiopathic Gastroparesis)
Though diabetics are a significant population among gastroparetic patients, the majority of those diagnosed with gastroparesis are said to have it for unspecified reasons. It is also worthwhile to note that women are at higher risk of developing this type of condition. In fact, 80% of those with idiopathic gastroparesis are females.
Some of the hypothesized causes include:
1.Lingering Post-Viral Causes – Some patients catch a virus and experience the classic symptoms of gastroparesis. Unfortunately, the nausea, vomiting, and early satiety don’t go away after the virus is gone. Usually, this type of gastroparesis resolves within a year. On the other hand, a minority of patients who are afflicted with specific viruses such as cytomegalovirus, Epstein-Barr virus, or varicella, may develop a form of autonomic neuropathy which can include or lead to gastroparesis.
2.Connective Tissue or Neural Control Diseases - Gastroparesis may trouble patients who have connective tissue diseases such as multiple sclerosis or muscular dystrophy, and scleroderma. Those with Parkinson’s, amyloidosis, and paraneoplastic diseases are also at risk.
3.Side-effects from Medication or Treatment – Possible side effect of certain prescription medicines include slower intestinal motility. This makes the medication-caused gastroparesis difficult to treat. This is since some painkillers and antidepressants used to help ease the symptoms may be the very drugs that are aggravating the condition. Medications associated with impaired gastric emptying include narcotics, tricyclic antidepressants, calcium channel anti-blockers, clonidine, dopamine agonists, lithium, nicotine, and progesterone.
4.Autoimmune Diseases – Autoimmune diseases are typically associated with neuropathy among other complications. This makes it a probable cause for the development of gastroparesis. Aside from that, GI dysmotility can also be an autoimmune manifestation, thus the term Autoimmune GI Dysmotility (AGID), a recently coined clinical entity. With AGID, the presumption is that the innervation within the GI tract is being targeted by immune cells, resulting in altered digestive movement.
Since the possible gastroparesis causes are diverse, there are also a number of options that can be done to treat symptoms or manage the condition as a whole. Sometimes, during diagnosis, the patients is classified as having Grade 1 (mild gastroparesis), Grade 2 (compensated gastroparesis), or Grace 3 (gastric failure). Depending on the severity, the popular gastroparesis treatments are as follows:
Prescribing medication is the most common route taken by medical practitioners when treating gastroparesis. However, the efficacy of individual medicines is relatively limited.
- Anti-Emetics – medication to help control nausea and vomiting
- Erythromycin – antibiotic that helps contract the stomach and improve the movement of food along the GI tract.
- Domperidone – similar to the latter, this is used to contract the stomach muscles and help move food along
If changes in diet and medication cannot improve the condition, gastrointestinal stimulation by surgically-implanting a battery-operated device under the skin of the belly, may be used. This device sends electrical impulses to help stimulate the muscles involved in controlling the passage of food. The use of this option should only be within a limited time. Otherwise, the patient would be at risk of developing infection, a hole through the stomach wall, or the device may also dislodge.
In severe cases of gastroparesis wherein normal ingestion and proper digestion of food is nearly impossible, a feeding tube may be recommended as gastroparesis treatment for proper nourishment while the dysmotility is addressed.
Certain procedures like gastroenterostomy and gastrojejunostomy may be advised if all other solutions fail. These can be used to create a new opening between the stomach and small intestine or the stomach may also be linked directly to the jejunum.
10 Ways to Treat Gastroparesis Naturally
Diet is the first one on the list of natural options for gastroparesis treatment. Eating small portions more frequently is often helpful in patients with manageable gastroparesis. Processed foods, typical allergens, high-sugar doses must be avoided. For those with severe conditions, a special gastroparesis diet made up of IV liquid food mixture may be prescribed. This concoction may be supplied through a tube in the chest.
Another example of non-pharmaclogical gastroparesis treatment is lifestyle modification which includes the discontinuation of smoking and alcohol use, stress management and relaxation, and regular exercise. For natural help with stress management, try Premier Max B-ND.
Prokinetics like BileCalm are extremely effective in stimulating gastric emptying. Ginger and ginseng, both ingredients found in BileCalm have been found to be potent. BileCalm addresses symptoms like GERD, heartburn, gas and bloating, nausea and vomiting, and stomach pain – all classic signs of gastroparesis.
Nutritional abnormalities are common among gastroparetic patients. Since they cannot ingest food and digest well, they maybe deficient in vitamins and minerals. Studies show that there is a close relationship between Vitamin D levels and delayed gastric emptying. This was tested among Parkinson’s patients and normal subjects. It was found out that people with low vitamin D levels have a higher risk of developing gastroparesis or suffering from related GI conditions. For your daily dose of Vitamin D, you may try Vitamin D3+K2 Nordic Naturals 60 Gummies. This gives you your recommended need for Vitamin D3 with a little K2 on the side.
Whether the gastroparesis is a condition caused by Diabetic Autonomic Neuropathy, vagus nerve damage or other idiopathic causes, acupuncture can help. This means that in both diabetic and non-diabetic patients, regular acupuncture treatments can help improve quality of life, and easing the symptoms of gastroparesis.
Massage for the whole body is not only relaxing but also moves the chi or energy which in turn can help to move everything else. But massage that is focused on the abdomen, intestines in particular, is something that you can do yourself. Start at the bottom right corner with gentle small circles and move up the ascending colon to about waist height and follow the transverse colon over to your left side, continuing down the ascending colon on the right. Repeat with deeper pressure. Even gentle large circles over this same area from bottom right to left can be helpful.
7.Castor Oil Packs
Though it seems counter-intuitive to want anyone or anything touch an aching stomach, many swear by the effectiveness of castor oil as natural treatment for gastroparesis. Castor oil may be used as massage oil by licensed therapists. Heating the oil is optional, but it makes it more relaxing and allows for deeper penetration. Another option is to use cold pressed castor oil packs. We have dedicated a full page with a detailed instruction on how to use castor oil packs for gastroparesis, gallbladder pain, menstrual cramps, and many other conditions.
Coffee enemas as well as colonics may also be of help.
Aside from BileCalm, Herbal Digestive Bitter s is another natural supplement that can help gastroparetic patients. This tincture is made up of a variety of bitter herbs to soothe upset stomach and nausea, support healthy blood sugar levels, relieve gas and bloating, and support the bile.
10.Digestive Aids for Absorption
In the meantime, helping your body to digest as quickly and efficiently as possible under the circumstances in whatever ways possible are to be employed. Betaine HCl, Bile Salts Booster and Digestive Enzymes are essential.
Camilleri, M., Parkman, H. P., Shafi, M. A., Abell, T. L., & Gerson, L. (2013). Clinical guideline: management of gastroparesis. The American journal of gastroenterology, 108(1), 18.
Feldman, M., & Schiller, L. R. (1983). Disorders of gastrointestinal motility associated with diabetes mellitus. Annals of Internal Medicine, 98(3), 378-384.
Kedar, A., Nikitina, Y., Henry, O. R., Abell, K. B., Vedanarayanan, V., Griswold, M. E., ... & Abell, T. L. (2013). Gastric dysmotility and low serum vitamin D levels in patients with gastroparesis. Hormone and metabolic research= Hormon-und Stoffwechselforschung= Hormones et metabolisme, 45(1), 47.
Masuda, Y., Tanaka, T., Inomata, N., Ohnuma, N., Tanaka, S., Itoh, Z., ... & Kangawa, K. (2000). Ghrelin stimulates gastric acid secretion and motility in rats. Biochemical and biophysical research communications, 276(3), 905-908.
Vinik, A. I., Maser, R. E., Mitchell, B. D., & Freeman, R. (2003). Diabetic autonomic neuropathy. Diabetes care, 26(5), 1553-1579.