Gastroparesis

The Invisible Pain

Important Information

  I highly recommend that you visit the website for Gastroparesis Patients Association for Cures and Treatments (G-PACT) a Legal Non-Profit leading the way in Raising Awareness of Gastroparesis and other Digestive Tract Paralysis Conditions.

What is Gastroparesis?

     Gastropasreis, also known as delayed gastric emptying, is a medical condition where the stomach does not contract normally, resulting in food remaining in the stomach for a longer period of time than normal. Normally, the stomach contracts to move food down into the small intestine for digestion within a short time of eating The vagus nerve controls the contractions in the stomach and gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. This results in food moving slowly through the digestive tract, causing a myriad of problems.

 

What causes Gastroparesis?

     Gastroparesis is often associated with Diabetes (since neuropathies can be common in diabetes) but it can also be caused by smooth muscle disorders (such as Lupus and Scleroderma), other neuropathies (such as MS and ALS) Myopathies (such as Shy Dagger Syndrome) or may be caused by a viral infection.  In many cases the cause of the Gastroparesis is never found and the condition is called Idiopathic Gastropareses.  Other things that can cause Gastroparesis are chemotherapy, radiation therapy and opiate based pain killers such as morphine and codine.

In some cases (such as cancer treatment or the use of pain killers) Gastroparesis may get better or go away when the treatment is done, but in the other cases it is likely permanent.

What are the common symptoms?

     Some of the more common symptoms are:

  • Early satiety (feeling full early in a meal or after just a few bites)
  • Heartburn
  • Weight loss (unintentional)
  • Weight gain (unintentional)
  • Abdominal bloating
  • Abdominal pain
  • Diarrhea
  • Constipation
  • Erratic blood glucose levels (mainly in Diabetes)
  • Lack of appetite
  • Gastroesophageal reflux
  • Spasms of the stomach wall
  • Chronic nausea
  • Vomiting (especially of undigested food)
  • Inability to tolerate dietary fats

 

Testing for Gastroparesis

     Getting a diagnosis for Gastroparesis can be very frustrating and time consuming because so many of the symptoms mimic simple dyspepsia (upset stomach) and common food intolerances as well as GERD, IBS and many other conditions.

     Testing usually begins with x-rays and trying certian OTC and prescription medications to aleviate the symptoms then moving on to EGD (endoscope of the stomach) and colonoscopy as the doctor trues to find the root cause of the symptoms.  If no root cause is found your doctor might then decide to have you do a gastric emptying test.

     The gastric emptying test is a simple non-invasive test where you fast for 8 to 12 hours then they give you a small meal (usually eggs or oatmeal) in which a small ammount of a radioactive tracer is placed.  (Don't worry, this tracer breaks down and is flushed from the body with no danger to you and does not contain dyes or iodine)  You eat the small meal then have pictures taken with a specialized camera in the Nuclear medicine lab of your hospital.  In some hospitals they have you lay on a table for 90 minutes while the camera monitors your stomach activity, in other hospitals they take an immage then have you return at certian intervals over the next few hours to take follow-up immages.  Thanks to the raidioactive tracer in the meal they are able to see how long it takes for the meal to leave your stomach.  In the average healthy stomach it takes about 60 minutes for half the food to leave the stomach.

     There are things that you will need to know before getting the gastric emptying test, such as to avoid caffine and cigarettes prior to testing because they can alter the results, so make sure that you go over everything with your doctor before going for your test.

How rare is Gastroparesis?

     You might be suprised to learn that Gastroparesis is not rare at all!  It is esitmated (by the National Institute of Health) that over 5 million Americans have been daignosed with Gastroparesis and there are probably millions more that have the condition but have not been diagnosed.  To put it into perspective, the population of South Carolina (in the 2008 census) was just under five million people, meaning that more people have been diagnosed with this condition that the population of South Carolina!

     Click HERE to see the minutes of the Digestive Diseases Interagency Coordinating Committee meeting minutes at the National Institute of Health in Bethesda, Maryland from April of 2004.

     Some estimates now put the number as high as 10 million Americans suffering from this horrible condition!

     Though this is not a rare condition, many health professionals have a very poor understanding of the condition and few test for it without being pressed to do so.  For this reason it is very important to find a specialist in the field of Gastrointerology or Internal Medicine that not only knows about Gastroparesis but treats it so that you can get the best care possible.

     The sad fact is that many Doctors, when hearing of this condition, assume that it is not a common problem and because of that they do not take the added effort to educate themselves on it.  Who can really blame them when they must see so many patients in a day with varying conditions, but the truth is that they do need to educate themselves more on a condition that could very well be troubling some of their patients without their knowledge.

     Lets do a little math to put things into perspective...

     -The Population of the United States of America (Per census.gov) is 308,011,709 people.

     -The National Institute of Health estimated that 5 million Americans had Gastroparesis in 2004.

     -This would mean that 1.6% or 2 in every 125 people (about 1 in every 62 people) have Gastroparesis!

     A more current article in Medscape places the number of people affected at 4% of the population, breaking down to 1 in every 25 people or about 13 Million Americans!

How is it treated?

     There are a few drugs on the market to treat Gastroparesis as well as an implant called the Enterra Implant that is much like a pacamaker for the stomach that are used to treat the symptoms of Gastroparesis.

     Common drugs used are:

  • Metoclopramide. This prokinetic drug affects your stomach in several ways: It lowers the pressure threshold for the peristalsis reflex, it increases the strength and frequency of muscle contractions, and it relaxes the pyloric valve that releases food from the stomach into your small intestine. Metoclopramide also acts on the part of the brain that controls nausea and vomiting, helping relieve these symptoms in some people.

    But for all this, metoclopramide has serious drawbacks, including side effects such as agitation, depression, severe muscle twitching (tardive dyskinesia) and painful breast swelling in both men and women. It's not intended for long-term use. Domperidone, a drug that's similar to metoclopramide but without many of its side effects, is available in Canada and Europe.

  • Erythromycin. a common antibiotic that produces short bursts of strong stomach contractions. The drawbacks: Most people develop a tolerance to the drug fairly quickly; it can cause nausea, vomiting, diarrhea and, in some cases, hearing loss; and it may have significant drug interactions. For these reasons, erythromycin is usually used only intermittently or when symptoms become worse.
  • Cisapride. Commonly used to treat severe cases of gastroesophageal reflux, cisapride has been linked to fatal heart arrhythmias and is not appropriate for anyone with heart disease or kidney problems. Cisapride also has the potential to cause serious drug interactions. The drug has limited availability in the United States because of these risks.

    

Emerging therapies
Although not usually life-threatening, gastroparesis can profoundly affect quality of life and make diabetes more difficult to control, which is why researchers are looking at better ways to manage it. Some emerging therapies include:

  • Botulinum toxin (Botox). Once used exclusively to treat migraines and wrinkles, botulinum toxin is now being tried for a variety of problems, including gastroparesis. In trials, researchers have found that Botox relaxes the pyloric muscle in some people, thereby allowing the stomach to release more food. The benefits are temporary, however, and more studies are needed to determine the overall usefulness of this treatment since this seems to be only effective for those with a structural cause. 
  • Electrical gastric stimulation. Another new treatment for gastroparesis uses an electric current to stimulate stomach contractions. Working much like a heart pacemaker, a stomach pacemaker, consisting of a tiny generator and two electrodes, is placed in a pocket that surgeons create on the stomach's outer edge. Stomach pacemakers have been shown to improve stomach emptying and reduce nausea and vomiting. It takes time for the pacemaker to produce these effects, however, and the procedure isn't widely available.

      Most of what is being done is focusing on keeping the symptoms of the disease in check and not trying to control the underlying reason for the symptoms.  It is like having a broken foot and having the Dr's treat you for the pain of the break but not putting you in a cast to heal the break.

Is there a cure?

     No...other than Gastroparesis that is caused by cancer tratment or narcotic pain killers there is no cure for Gastroparesis, only ways to control the symptoms.

     The truth of the matter is that there are very few studies going on when it comes to Gastroparesis and most of those are aimed at better ways to control the symptoms.

     With the prevelance of Gastroparesis in the population it is shocking that more is not being done and that more people do not know about this condition. 

     If this was something as simple as acne or an upset stomach it would be one thing, but this is a condition that can vastly effect the quality of life of the sufferer and their families.  Because this is a condition that does not manifest in an outward show of illness (other than getting thinner and thinner or fatter and fatter) people that suffer from this condition often hear "but you don't look sick".

Think you might have Gastroparesis?

     We have prepared a PDF to help you prepare to talk with your Doctor about Gastroparesis that you can get by clicking here.

     To save it to your computer, simply wait for the PDF file to open then click on File then save as and choose a location on your computer that you wish to keep it in.

Gastroparesis Overview

     We have created an overview of Gastroparesis that you can save on your computer as a PDF file.  You can then print the information to share with family, friends or your Healthcare Provider if needed.

     Simply click here and wait for the PDF to open then click on file and 'save as' to choose the location on your computer you wish to save it to.

-----Gastroparesis----- The Invisible Pain

Created October 7, 2009

The condition may be invisible, but you don't have to be.

Advocate for better research

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Remember-- You have Gastroparesis but it does not have YOU!

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