GASTROPARESIS
Gastroparesis, also called delayed gastric emptying, is a medical condition consisting of a paresis (partial paralysis) of the stomach, resulting in food remaining in the stomach for a longer period of time than normal in the absence of obstruction. This condition is thought to affect about 4% of the population. Approximately 40% of patients have no definite cause for their condition and are classified as Idiopathic. About 33% of patients have long-standing diabetes. The remaining patients have either a history of gastric surgery resulting in a vagal nerve injury or other unusual medical conditions.
SYMPTOMS:
- Nausea
- Vomiting, especially vomiting undigested food a few hours after eating
- Feeling of fullness even after eating very little
- Acid reflux or heartburn
- Abdominal pain and/or bloating
- Changes in blood sugar levels
- Lack of appetite and malnutrition
- Weight loss
DIAGNOSING GASTROPARESIS:
Gastric emptying study
This is the most important test used in making a diagnosis of gastroparesis. It involves eating a light meal, such as eggs and toast, that contains a small amount of radioactive material. A scanner that detects the movement of the radioactive material is placed over your abdomen to monitor the rate at which food leaves your stomach.
You’ll need to stop taking any medications that could slow gastric emptying. Ask your doctor if any of your medications might slow your digestion.
Upper gastrointestinal series
This is a series of X-rays in which you drink a white, chalky liquid (barium) that coats the digestive system to help abnormalities show up.
Upper gastrointestinal (GI) endoscopy
This procedure is used to visually examine your upper digestive system — your esophagus, stomach, and beginning of the small intestine (duodenum) — with a tiny camera on the end of a long, flexible tube (Video-endoscopy). This test can also diagnose other conditions, such as peptic ulcer disease or pyloric stenosis, which can have symptoms similar to those of gastroparesis.
TREATMENT:
LAPAROSCOPIC PYLOROPLASTY:
A sub-group of gastroparesis patients may benefit from a simple pyloroplasty procedure to cut the outlet of the stomach. Patients with idiopathic or post-gastric surgery gastroparesis undergo an EGD and pyloric botox injection as a trial of therapy. If they experience subjective improvement in their symptoms and normalization of their gastric emptying on a repeat gastric emptying study, then a pyloroplasty procedure may be sufficient to treat their condition.
LAPAROSCOPIC GASTRIC STIMULATOR “ENTERRA THERAPY”:
This option is well-suited for patients who are either underweight or normal weight with diabetic gastroparesis who have predominantly nausea and vomiting symptoms. It has been associated with about 80% improvement in patient symptom scores. Idiopathic gastroparesis patients, in general, don’t respond as well as diabetic patients. In particular, the stimulator typically does not improve pain symptoms. Patients are specifically selected for this procedure to maximize outcomes.
LAPAROSCOPIC SUB-TOTAL GASTRECTOMY:
This is the most aggressive and reliable option to manage all sub-groups of gastroparesis. Patients with gastroparesis have a difficult time eating due to the symptoms associated with meals. The surgery enables them to eat small amounts with minimal or no nausea. Most patients experience benefit from this surgery. This is a minimally invasive option lessening the surgical risk. Patients typically leave the hospital within two days and are back to their normal lives in one to two weeks.