| Gastroparesis | |
|---|---|
| Classification and external resources | |
| ICD-10 | K31.8 |
| ICD-9 | 536.3 |
| DiseasesDB | 32575 |
| MedlinePlus | 000297 |
| MeSH | D018589 |
Gastroparesis, also called delayed gastric emptying, is a medical condition consisting of a paresis (partial paralysis) of the stomach, 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. The vagus nerve controls these contractions. Gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.
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Gastroparesis may be chronic or transient; transient gastroparesis may arise in acute illness of any kind, with the use of certain cancer treatments or other drugs which affect digestive action, or due to anorexia nervosa, bulimia and other abnormal eating patterns.
Chronic gastroparesis is frequently due to autonomic neuropathy. This may occur in people with type 1 diabetes or type 2 diabetes. The vagus nerve becomes damaged by years of high blood glucose, resulting in gastroparesis. Gastroparesis has also been associated with various autoimmune diseases and syndromes, such as fibromyalgia and Parkinson's disease, and may occur as part of a mitochondrial disorder.
Chronic gastroparesis can also be caused by other types of damage to the vagus nerve, such as abdominal surgery.[1]
Idiopathic gastroparesis (gastroparesis with no known cause) accounts for a third of all chronic cases; it is thought that many of these cases are due to an autoimmune response triggered by an acute viral infection. "Stomach flu", mononucleosis, and others have been anecdotally linked to the onset of the condition, but no systematic study has proven a link.
Gastroparesis sufferers are disproportionately female. One possible explanation for this finding is that women have an inherently slower stomach emptying time than men.[2] A hormonal link has also been suggested, as gastroparesis symptoms tend to worsen the week before menstruation, when progesterone levels are highest.[3] Neither theory has been proven definitively.
The most common symptoms of gastroparesis are[4]
Other symptoms include
Morning nausea may also indicate gastroparesis. It is important to note that vomiting may not occur in all cases, as sufferers may learn to adjust their diets to include only small amounts of food.[5]
Gastroparesis can be diagnosed with tests such as x rays, manometry, and gastric emptying scans. The clinical definition for gastroparesis is based solely on the emptying time of the stomach and not on other symptoms, and severity of symptoms does not necessarily correlate with the severity of gastroparesis. Therefore, some patients may have marked gastroparesis with few, if any, serious complications.
Treatment includes dietary changes (low-fiber and low-residue diets, and in some cases, restrictions on fat and/or solids), oral medications such as Metoclopramide (Reglan, Maxolon, Clopra), Cisapride (Propulsid), Erythromycin (E-Mycin, Erythrocin, Ery-Tab, EES) and Domperidone (Motilium); adjustments in insulin dosage for those with diabetes, a jejunostomy tube, parenteral nutrition, implanted gastric neurostimulators ("stomach pacemakers"), or botulinum toxin.
Viagra, which increases blood flow to the genital area, is also being used by some practitioners to stimulate the GI tract in diabetic gastroparesis.
The antidepressant Mirtazapine has also proven effective in the treatment of gastroparesis unresponsive to conventional treatment. This is due to its anti-emetic and appetite stimulant properties. Mirtazapine acts on the same serotonin receptor (5-HT3) as the popular anti-emetic Ondansetron[6].
Primary complications of gastroparesis include:
| • | Gastroparesis is a condition in which the muscles in your stomach don't function normally. | &bull | But in gastroparesis, the muscles in the wall of your stomach work poorly or not at all, preventing your stomach from emptying properly. | &bull | Dietary changes and certain medications sometimes help control symptoms of gastroparesis, but they're not effective in every case. | |
| • | Gastroparesis is a stomach disorder in which the stomach takes too long in emptying its contents. | &bull | Gastroparesis is caused when the vagus nerve, which controls the movement of food through the digestive tract, is damaged or stops working. | &bull | The following are the most common symptoms of gastroparesis. | |
| • | Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. | &bull | Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. | &bull | The most common cause of gastroparesis is diabetes. | |
| http://www.emedicine.com/pmr/TOPIC40.HTM">Diabetic Neuropathy (emedicine.com) - Diabetic Neuropathy: eMedicine Physical Medicine and Rehabilitation |
| http://www.icarecafe.com/index.php?page_id=1107&group_id=70">Patient Perspective |
| • | Gastroparesis is a condition of abnormal gastric motility characterized by delayed gastric emptying without evidence of mechanical outlet obstruction. | &bull | This is the first report to show that mirtazapine may be an effective alternative when gastroparesis is refractory to conventional measures. | &bull | This report describes a patient who suffered from diabetic gastroparesis with severe recurrent nausea and vomiting. | |
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