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 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 mealtime. It must be horrible! Sadly, that is the kind of life that most people with gastroparesis have to endure daily. Though some patients experience symptoms intermittently, the cycling of flare-ups can go on for years.
What is Gastroparesis?
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 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 diseases, gastroparesis is often overlooked and underdiagnosed. Sometimes, it is misdiagnosed as a gallbladder attack, ulcer, allergic reaction, or heartburn. The delay in getting an 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 the hardening of food into solid masses called bezoars. This condition significantly impacts the quality of life and can lead to chronic disease, including gallbladder disease. Early gastroparesis diagnosis is crucial to its management.
Diagnosing Gastroparesis
There are several ways that a general practitioner or a gastroenterologist can make a gastroparesis diagnosis. 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 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. Doctors can check the GI tract for ulcerations, infection, inflammation, or any other irregularities through this.
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 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. The causes of the first two types are clearer than the last.
1. Diabetic Autonomic Neuropathy
Diabetic gastroparesis happens 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 stomach of a person with diabetes and gastroparesis 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 makes the absorption of oral hypoglycemic agents unpredictable because of delayed gastric emptying. It also means that the food is absorbed slowly, causing 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
On the other hand, post-surgical gastroparesis 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 involve 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 a significant effect on 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 the 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 gastroparesis patients, most those diagnosed with gastroparesis are said to have it for unspecified reasons. It is also worth noting 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:
Lingering Post-Viral Causes
Some patients catch a virus and experience the classic symptoms of gastroparesis. Unfortunately, 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 afflicted with specific viruses such as cytomegalovirus, Epstein-Barr virus, or varicella may develop a form of autonomic neuropathy that can include or lead gastroparesis.
2. Connective Tissue or Neural Control Diseases
Gastroparesis may trouble patients with connective tissue diseases such as multiple sclerosis, muscular dystrophy, and scleroderma. Those with Parkinson’s, amyloidosis, and paraneoplastic diseases are also at risk.
3. Side-effects from Medication or Treatment
A possible side effect of certain prescription medicines is 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.
Gastroparesis Treatment
Since the possible causes of gastroparesis are diverse, there are also many options that can be done to treat symptoms or manage the condition as a whole. Sometimes, during diagnosis, the patient 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:
1. Medication
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 – an 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
2. Electrical Stimulation
If changes in diet and medication cannot improve the condition, gastrointestinal stimulation by surgically-implanting a battery-operated device under the belly’s skin 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 an infection, a hole through the stomach wall, or the device may also dislodge.
3. Feeding Tube
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.
4. Surgery
If all other solutions fail, procedures like gastroenterostomy and gastrojejunostomy may be advised. 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
10 Ways to Treat Gastroparesis Naturally1. Gastroparesis Diet
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 an IV liquid food mixture may be prescribed. This concoction may be supplied through a tube in the chest.
2. Lifestyle Change
Another example of non-pharmacological gastroparesis treatment is lifestyle modification, which includes discontinuing smoking and alcohol use, stress management and relaxation, and regular exercise. For natural help with stress management, try Premier Max B-ND.
3. Prokinetics
Prokinetics are highly effective in stimulating gastric emptying. Ginger and ginseng are potent in addressing symptoms like GERD, heartburn, gas and bloating, nausea and vomiting, and stomach pain – all classic signs of gastroparesis.
4. Vitamin D
Nutritional abnormalities are common among gastroparesis patients. Since they cannot ingest food and digest well, they may be deficient in vitamins and minerals. Studies show a close relationship between Vitamin D levels and delayed gastric emptying. This was tested among Parkinson’s patients and normal subjects. It was found 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 (available on Amazon)
. This gives you your recommended need for Vitamin D3 with a little K2 on the side.
5. Acupuncture
Whether gastroparesis is a condition caused by Diabetic Autonomic Neuropathy, vagus nerve damage, or other idiopathic causes, acupuncture can help. It means that in both diabetic and non-diabetic patients, regular acupuncture treatments can help improve quality of life and ease the symptoms of gastroparesis.
6. Massage
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, 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 to touch an aching stomach, many swear by the effectiveness of castor oil as a natural treatment for gastroparesis. Castor oil may be used as a massage oil by licensed therapists. Heating the oil is optional, but it is more relaxing and allows for deeper penetration. Another option is to use cold-pressed castor oil packs. We have dedicated an entire page with detailed instructions on using castor oil packs for gastroparesis, gallbladder pain, menstrual cramps, and many other conditions.
8. Enemas
Coffee enemas, as well as colonics, may also be of help.
9. Natural Anti-emetics
For nausea and vomiting, we recommend Phos Formula or Orthophosphoric Acid. A dropper full of this tincture mixed with water or apple juice can help provide relief wherever you are.
10. Digestive Aids for Absorption
In the meantime, helping your body 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.
References:
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.
