Treatment Options for GASTROPARESIS

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Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. Normally, the stomach contracts to move food down into the small intestine for digestion. The movement of food from the stomach through the digestive tract is controlled by the vagus nerve. Gastroparesis occurs 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.

The most common cause is diabetes; over time, high blood glucose can damage the vagus nerve. Some other less common causes are surgery on the stomach or vagus nerve, viral infections, smooth muscle disorders (such as amyloidosis and scleroderma) and nervous system diseases, including abdominal migraine and Parkinson’s disease. Some people have idiopathic gastroparesis (cause unknown).

Common symptoms can be very broad and may overlap with a significant number of other diseases. The most prevalent symptoms are related to retained food in the stomach. Many people with gastroparesis experience a wide range of symptoms, and sometimes the disorder is difficult for the physician to diagnose. The most accurate diagnostic test is a gastric-emptying study which is performed with radio labeled food. 

Treatment methods depend on the severity of the symptoms. In most cases, treatment does not cure gastroparesis – it is usually a chronic condition which treatment helps patients to manage. In addition to dietary changes, several medications are used – most are intended to improve contraction or motility of the stomach or to control the associated symptoms such as nausea. When gastroparesis does not respond to standard medical management, including drugs and dietary changes, the condition is said to be “refractory.”

For patients who have documented delayed gastric emptying with no evidence of abnormal obstruction, a gastric neurostimulator may be implanted to reduce or eliminate nausea and other symptoms. This device (Enterra™ Gastric Pacemaker) is a surgically-implanted, battery-operated device that releases mild electrical pulses to help control nausea and vomiting. This option is available to people whose nausea and vomiting do not improve with medications. It does not improve gastric motility; rather, it is solely used for the purpose of reducing the associated nausea. It is considered an experimental therapy and is not widely adopted. Authorized as a “compassionate use” device, its success is limited. Patients are highly selected and only a few centers in the U.S. offer this treatment.

If gastroparesis is related to an injury of the vagus nerve, patients may benefit from a procedure called pyloroplasty. This procedure widens and relaxes the pyloric valve, which separates the stomach from the upper part of the small intestine, permitting the stomach to empty more quickly.

In some cases,before deciding to perform the procedure, botulinum toxin (Botox®) will be injected at the pyloric valve to temporarily paralyze and relax it. The purpose is to determine if the patient would benefit from a pyloroplasty. While use of Botox has been associated with improvement in gastroparesis symptoms in some patients, further research is required to validate its efficacy.

For some patients who have severe gastroparesis associated with significant dilation of the stomach and normal intestinal function, a total gastrectomy can be indicated. A total gastrectomy is the removal or possibly just the bypass of the entire stomach, so that the esophagus empties directly into the small intestine. This has proven to be the most effective solution; however it is reserved for only specific cases that meet certain criteria.

Surgery is a treatment option, but may not resolve all symptoms. In deciding whether surgery is the best way to treat gastroparesis, a consultation with a gastrointestinal (GI) physician and GI surgeon is indicated.

Many people with gastroparesis experience a wide range of symptoms, and sometimes the disorder is difficult for the physician to diagnose.

 

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