Gastroparesis

Gastroparesis, also known as delayed gastric emptying, is a long-term condition where the stomach muscles do not function properly, resulting in delayed emptying of food into the small intestine. This disorder can cause significant discomfort and interfere with daily life due to symptoms like nausea, vomiting, bloating, and early satiety. Though it is relatively uncommon, it can severely impact nutritional health and quality of life.

Understanding gastroparesis involves recognising its multifactorial causes, such as diabetes, nerve damage, and post-surgical complications. It often requires a comprehensive treatment approach involving dietary changes, medications, and sometimes surgical interventions.

Gastroparesis is a condition characterised by the stomach's inability to contract properly to push food into the small intestine. The stomach retains food longer than normal, leading to various gastrointestinal symptoms. Unlike blockages or obstructions, gastroparesis is caused by dysfunction in the muscles or nerves controlling stomach movement, particularly the vagus nerve.

This disorder is considered a form of motility disorder and is often associated with other chronic illnesses like diabetes mellitus.

India

In India, the exact prevalence of gastroparesis is not well-documented, but studies indicate an increasing trend, particularly among individuals with long-standing diabetes. A study published in the Journal of the Association of Physicians of India (JAPI) estimated that up to 20-30% of diabetic patients may experience gastroparesis symptoms.

Worldwide

Globally, gastroparesis affects an estimated 10 men and 40 women per 100,000 people. It is significantly more common in females and diabetic patients. As diagnostic techniques improve, more cases are being identified.

• Idiopathic Gastroparesis: No identifiable cause, more common in women.
• Diabetic Gastroparesis: Associated with type 1 or type 2 diabetes.
• Post-Surgical Gastroparesis: Occurs after surgeries that affect the vagus nerve.
• Medication-Induced Gastroparesis: Caused by drugs that slow gastric motility.
• Neurological Disorders: Conditions like Parkinson’s disease or multiple sclerosis can also contribute.

Gastroparesis occurs due to impaired movement of the stomach muscles, often linked to nerve damage. Major causes include:

• Diabetes Mellitus: High blood sugar damages the vagus nerve over time.
• Surgical Injury: Surgeries near the stomach or oesophagus can affect nerve function.
• Medications: Opioids, antidepressants, calcium channel blockers.
• Neurological Conditions: Parkinson’s disease, multiple sclerosis.
• Viral Infections: Certain infections can temporarily or permanently damage gastric nerves.
• Autoimmune Disorders: The immune system attacking nerve tissue.
• Hypothyroidism: Can slow down bodily functions, including digestion.

• Nausea and Vomiting
• Early Satiety (feeling full quickly)
• Bloating
• Abdominal Pain
• Heartburn or GERD
• Loss of Appetite
• Weight Loss
• Malnutrition

Symptoms can vary in severity and may mimic other digestive conditions like peptic ulcers or acid reflux.

• Gastric Emptying Study: Measures the time it takes for food to leave the stomach.
• Upper Endoscopy: Rules out blockages or ulcers.
• Ultrasound or CT Scan: To detect structural problems.
• SmartPill Test: A capsule measures pH, temperature, and transit time.
• Electrogastrography: Detects stomach electrical activity.
• Blood Tests: Rule out infections, thyroid dysfunction, or glucose control issues.

Early diagnosis is crucial to prevent complications like dehydration or severe malnutrition.

Lifestyle and Dietary Changes

• Small, Frequent Meals: Easier for the stomach to handle.
• Low-Fibre, Low-Fat Diet: Reduces gastric workload.
• Liquid Meals: Nutritional shakes and soups may be better tolerated.
• Avoid Carbonated Drinks: Reduces bloating and gas.

Medications

• Prokinetics: Stimulate stomach muscle activity (Clomet 10mg Tablet).
• Antiemetics: Control nausea and vomiting (Baxond 50mg Tablet).
• Erythromycin: An antibiotic that also promotes motility. (Erocin 100mg Tablet)
• Botulinum Toxin: Injected into the pylorus to ease stomach emptying in severe cases.

Surgical and Device-Based Interventions

• Gastric Electrical Stimulation (GES): Device implanted to stimulate stomach contractions.
• Feeding Tubes (Jejunostomy): For severe cases where oral feeding is not feasible.
• Parenteral Nutrition: Intravenous feeding in extreme situations.

Treatment must be tailored based on the severity and underlying cause.

• Acupuncture: May relieve nausea and improve motility.
• Yoga and Breathing Exercises: Helps reduce stress-induced symptoms.
• Ginger Supplements: Natural antiemetic properties.
• Homeopathy and Ayurveda: Used by some, but evidence is limited and not widely accepted in medical practice.

These should always be used in conjunction with conventional treatments.

• Diabetes (especially uncontrolled)
• Previous Abdominal Surgeries
• Neurological Conditions
• Autoimmune Disorders
• Certain Medications
• Female Gender
• Infections

• Severe Dehydration: From persistent vomiting.
• Malnutrition: Inability to absorb essential nutrients.
• Bezoars: Undigested food masses in the stomach.
• Blood Sugar Fluctuations: Especially in diabetics.
• Poor Quality of Life: Due to persistent symptoms and dietary restrictions.

• Meal Planning: Work with a dietitian.
• Monitor Weight and Nutritional Intake
• Stay Hydrated
• Track Symptoms and Food Triggers
• Use Support Groups
• Schedule Regular Medical Check-Ups
• Exercise Mildly After Meals: Encourages digestion.

• "It’s Just Indigestion": It's a chronic disorder requiring medical care.
• "Only Diabetics Get It": While common in diabetics, others can develop it too.
• "Surgery Always Cures It": Surgery is only used in severe cases.
• "Medications Alone Are Enough": Diet and lifestyle changes are equally important.

• Persistent nausea and vomiting
• Unexplained weight loss
• Severe bloating and discomfort
• Poor control of diabetes despite medication
• Frequent episodes of hypoglycaemia

• What tests are needed to confirm gastroparesis?
• What is the underlying cause in my case?
• What treatment options are best suited for me?
• Will I need surgery or a feeding tube?
• Can I manage this condition through diet alone?
• Are there any new or emerging treatments available?

• Educate Yourself: Learn about the condition.
• Be Patient: Understand their dietary needs and limitations.
• Help with Meal Prep: Assist in preparing suitable meals.
• Offer Emotional Support: Be a listening ear.
• Attend Appointments: Help them keep track of medical advice.

Gastroparesis is a complex, often chronic condition that disrupts normal digestion and greatly impacts daily living. With appropriate medical intervention, lifestyle changes, and emotional support, many individuals can manage their symptoms effectively. Early diagnosis and consistent care are key to preventing complications like malnutrition and dehydration. As awareness grows, so do the treatment options and resources available for those affected by this debilitating condition.