Gastroparesis

Gastro means stomach. Paresis means weakness. Gastroparesis is a weak stomach. This condition is very common. It can be the cause of a number of abdominal complaints. It is usually not a serious problem and there are effective gastroparesis treatments available.

Gastroparesis occurs when the rate of the electrical wave which contracts the stomach slows. Now the food just lays in the stomach relying on acid and digestive enzymes to break down the food and on gravity to empty the stomach. There are a number of causes for this condition: Diabetes is the most common known cause. Certain drugs weaken the stomach (tricyclic antidepressants such as Elavil, calcium blockers such as Cardizem and Procardia, L-dopa, hyoscyamine, Bentyl, Levsin, narcotics), previous stomach surgery, anorexia and bulimia, neurologic or brain disorders such as Parkinson’s disease, strokes and brain injury. In up to 40% of cases the cause of gastroparesis is not known.

Gastroparesis symptoms include a feeling of fullness after only a few bites of food, bloating, excessive belching, and nausea/vomiting. Heartburn and regurgitation of stomach fluid into the mouth may occur.

The diagnosis of gastroparesis starts with the medical history where the physician may suspect the diagnosis based on the symptoms. An upper GI barium x-ray and upper endoscopy are useful exam to diagnose gastroparesis. A gastric or stomach emptying test is presently the best method of making the diagnosis. In this test, a food, such as scrambled eggs, is labeled with a marker which can be seen by a scanner. A final test, which is not available everywhere, is the electrogastrogram (EGG). This test, like the EKG on the heart, measures the electrical waves that normally sweep over the stomach and precede each contraction. If there is an underlying disorder, it needs to be treated effectively such as control of diabetes and thyroid. Second, there may be a need to address diet and nutrition. A registered dietician can be very helpful in providing advice in severe cases.

Several medications are now available to stimulate the stomach to contract more normally. These drugs should be taken 20-40 minutes before eating to allow enough time for the drug to get into the blood stream where they can then act on the stomach.

Metoclopramide, domperidone, erythromycin, an old antibiotic and zelnorm are somewhat effective only. Gastric pace maker is coming up as the best treatment for gastroparesis.

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