Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. In anatomy, the stomach (in ancient Greek στομάχι) is an organ in the alimentary canal used to digest food. ... In anatomy, the stomach (in ancient Greek στόμαχος) is an organ in the gastrointestinal tract used to digest food. ...

Gastroparesis happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped. Nerves (yellow) Nerves redirects here. ... The vagus nerve (or pneumogastric nerve) is the tenth of twelve paired cranial nerves, and is the only nerve that starts in the brainstem (within the medulla oblongata) and extends, through the jugular foramen, down below the head, to the abdomen. ... For the Physics term GUT, please refer to Grand unification theory The gastrointestinal or digestive tract, also referred to as the GI tract or the alimentary canal or the gut, is the system of organs within multicellular animals which takes in food, digests it to extract energy and nutrients, and...

Major causes of gastroparesis

• Diabetes
• Postviral syndromes
• Anorexia nervosa
• Surgery on the stomach or vagus nerve
• Medications, particularly anticholinergics and narcotics (drugs that slow contractions in the intestine)
• Gastroesophageal reflux disease (rarely)
• Smooth muscle disorders such as amyloidosis and scleroderma
• Nervous system diseases, including abdominal migraine and Parkinson's disease
• Metabolic disorders, including hypothyroidism
• Idiopathic, the cause of the gastroparesis cannot be determined

Gastroparesis often occurs in people with type 1 diabetes or type 2 diabetes. Diabetes can damage the vagus nerve if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. This article is about the disease that features high blood sugar. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... The term narcotic, derived from the Greek word for stupor, originally referred to a variety of substances that induced sleep (such state is narcosis). ... Scleroderma is a rare, chronic disease characterized by excessive deposits of collagen. ... The nervous system of an animal coordinates the activity of the muscles, monitors the organs, constructs and also stops input from the senses, and initiates actions. ... Hypothyroidism is the disease state caused by insufficient production of thyroid hormone by the thyroid gland. ...

Signs and symptoms

• heartburn
• nausea
• vomiting of undigested food
• an early feeling of fullness when eating
• weight loss
• abdominal bloating
• erratic blood glucose levels
• lack of appetite
• gastroesophageal reflux
• spasms of the stomach wall

These symptoms may be mild or severe, depending on the person.

Complications of gastroparesis

If food lingers too long in the stomach, it can cause problems like bacterial overgrowth from the fermentation of food. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Gastroparesis can make diabetes worse by adding to the difficulty of controlling blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person's blood glucose levels can be erratic and difficult to control.

Diagnosis

The diagnosis of gastroparesis is confirmed through one or more of the following tests.

• Barium x-ray . After fasting for 12 hours, you will drink a thick liquid called barium, which coats the inside of the stomach, making it show up on the x ray. Normally, the stomach will be empty of all food after 12 hours of fasting. If the x ray shows food in the stomach, gastroparesis is likely. If the x ray shows an empty stomach but the doctor still suspects that you have delayed emptying, you may need to repeat the test another day. On any one day, a person with gastroparesis may digest a meal normally, giving a falsely normal test result. If you have diabetes, your doctor may have special instructions about fasting.

• Barium beefsteak meal. You will eat a meal that contains barium, thus allowing the radiologist to watch your stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working. This test can help detect emptying problems that do not show up on the liquid barium x ray. In fact, people who have diabetes-related gastroparesis often digest fluid normally, so the barium beefsteak meal can be more useful.

• Radioisotope gastric-emptying scan. You will eat food that contains a radioisotope, a slightly radioactive substance that will show up on the scan. The dose of radiation from the radioisotope is small and not dangerous. After eating, you will lie under a machine that detects the radioisotope and shows an image of the food in the stomach and how quickly it leaves the stomach. Gastroparesis is diagnosed if more than half of the food remains in the stomach after 2 hours.

• Gastric manometry. This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the throat into the stomach. The tube contains a wire that takes measurements of the stomach's electrical and muscular activity as it digests liquids and solid food. The measurements show how the stomach is working and whether there is any delay in digestion.

• Blood tests. The doctor may also order laboratory tests to check blood counts and to measure chemical and electrolyte levels.

To rule out causes of gastroparesis other than diabetes, the doctor may do an upper endoscopy or an ultrasound. General Name, Symbol, Number barium, Ba, 56 Chemical series alkaline earth metals Group, Period, Block 2, 6, s Appearance silvery white Atomic mass 137. ... In the NATO phonetic alphabet, X-ray represents the letter X. An X-ray picture (radiograph) taken by Röntgen An X-ray is a form of electromagnetic radiation with a wavelength approximately in the range of 5 pm to 10 nanometers (corresponding to frequencies in the range 30 PHz... A radionuclide is an atom with an unstable nucleus. ... In medicine, manometry is a study performed to examine the pression of one part of the body, generally the muscle function of the esophagus. ... An electrolyte is a substance that dissociates into free ions when dissolved (or molten), to produce an electrically conductive medium. ... Endoscopic images of a duodenal ulcer Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ... A baby in its mothers womb, viewed in a sonogram Ultrasound is sound with a frequency greater than the upper limit of human hearing, approximately 20 kiloHertz/20,000 Hertz. ...

• Upper endoscopy. After giving you a sedative, the doctor passes a long, thin tube called an endoscope through the mouth and gently guides it down the esophagus into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.

• Ultrasound. To rule out gallbladder disease or pancreatitis as a source of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.

Treatment

The primary treatment goal for gastroparesis related to diabetes is to regain control of blood glucose levels. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding. Insulin is not chemically related to inulin; the similarities in name do not relate to any similarity in form or function. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ...

It is important to note that in most cases treatment does not cure gastroparesis--it is usually a chronic condition. Treatment helps you manage the condition so that you can be as healthy and comfortable as possible.

Insulin for blood glucose control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To control blood glucose, you may need to:

• Take insulin more often
• Take your insulin after you eat instead of before
• Check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Doctors will give specific instructions based on particular needs.

Medication

Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment.

• Metoclopramide (Reglan). This drug stimulates stomach muscle contractions to help empty food. It also helps reduce nausea and vomiting. Metoclopramide is taken 20 to 30 minutes before meals and at bedtime. Side effects of this drug are fatigue, sleepiness, and sometimes depression, anxiety, and problems with physical movement. The Food and Drug Administration advises: "Tardive Dyskinesia, a syndrome consisting of potentially irreversible, dyskinetic movements may develop in patients treated with metoclopramide...Both the risk of developing the syndrome and the liklihood that it will become irreversible are believed to increase with the duration of treatment and the total cumulative dose." As with any medication, you should discuss all potential benefits, potential risks, and potential side effects with your physician.

• Erythromycin. This antibiotic also improves stomach emptying. It works by increasing the contractions that move food through the stomach. Side effects are nausea, vomiting, and abdominal cramps.

• Domperidone. The Food and Drug Administration is reviewing domperidone, which has been used elsewhere in the world to treat gastroparesis. It is a promotility agent like metoclopramide. Domperidone also helps with nausea.

• Dexloxiglumide. Rotta Research Lab is currently looking for subjects for Phase III clinical studies using the (R)-isomer of loxiglumide, which is a selective and highly potent CCK1 receptor antagonist.

• Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, an antiemetic can help with nausea and vomiting. Antibiotics will clear up a bacterial infection. If you have a bezoar, the doctor may use an endoscope to inject medication that will dissolve it.

Metoclopramide (INN) (IPA: ) is a potent dopamine receptor antagonist used for its antiemetic and prokinetic properties. ... Erythromycin is a macrolide antibiotic which has an antimicrobial spectrum similar to or slightly wider than that of penicillin, and is often used for people who have an allergy to penicillins - this is not necessarily a good idea , as after all , erythromycin is itself a penicillin derivative. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... Domperidone (Motilium®) is an antidopaminergic drug used orally or intravenously, generally to suppress nausea and vomiting. ... An antiemetic is a drug that is effective against vomiting and nausea. ...

Meal and food changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis is corrected. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

The doctor may also recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion--a problem you do not need if you have gastroparesis--and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars. A bezoar or enterolith is a sort of calculus or concretion, a stone found in the intestines of mostly ruminant animals. ...

Feeding tube

If other approaches do not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy tube, is inserted through the skin on your abdomen into the small intestine. The feeding tube allows you to put nutrients directly into the small intestine, bypassing the stomach altogether. You will receive special liquid food to use with the tube. A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream. By avoiding the source of the problem--the stomach--and putting nutrients and medication directly into the small intestine, you ensure that these products are digested and delivered to your bloodstream quickly. A jejunostomy tube can be temporary and is used only if necessary when gastroparesis is severe.

Parenteral nutrition

Parenteral nutrition refers to delivering nutrients directly into the bloodstream, bypassing the digestive system. The doctor places a thin tube called a catheter in a chest vein, leaving an opening to it outside the skin. For feeding, you attach a bag containing liquid nutrients or medication to the catheter. The fluid enters your bloodstream through the vein. Your doctor will tell you what type of liquid nutrition to use.

This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult spell of gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.

New treatments

A gastric neurostimulator has been developed to assist people with gastroparesis. The battery-operated device is surgically implanted and emits mild electrical pulses that help control nausea and vomiting associated with gastroparesis. This option is available to people whose nausea and vomiting do not improve with medications.

The use of botulinum toxin has been shown to improve stomach emptying and the symptoms of gastroparesis by decreasing the prolonged contractions of the muscle between the stomach and the small intestine (pyloric sphincter). The toxin is injected into the pyloric sphincter. Botulin toxin or botox is the toxic compound produced by the bacterium Clostridium botulinum. ... A sphincter is a ring-like muscle which normally maintains constriction of a natural body passage or orifice and which relaxes as required by normal physiological functioning. ...

See also

• Cyclic Vomiting Syndrome

This article or section contains information that has not been verified and thus might not be reliable. ...

References

• NIH Publication No. 04-4348, December 2003: National Digestive Diseases Information Clearinghouse. Retrieved April 20, 2004 from http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/
• [Informatation on Metoclopramide and tardive dyskinesia] Reglan PC4445B 11/02 RTA otsrt. Retrieved April 20, 2004 from http://www.fda.gov/medwatch/SAFETY/2003/03APR_PI/Reglan_PI.pdf