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What causes Gastroparesis? A Q&A with the specialists
Recent research into gastroparesis has dramatically improved outcomes for patients experiencing the symptoms of this uncomfortable, challenging condition. Here, our gastroparesis specialists Mr Sritharan Kadirkamanathan and Dr Ray Shidrawi at The Wellington Hospital, discuss the diagnostic process, the latest treatment options available and the prognosis.
What is gastroparesis?
Gastroparesis is a condition where food passes through the stomach more slowly due to the stomach muscles being weakened or paralysed. It’s one of several gastrointestinal motility disorders and is defined as delayed gastric (stomach) emptying where there is no mechanical obstruction.
What are gastroparesis symptoms?
The typical symptoms of gastroparesis include nausea, vomiting, upper abdominal discomfort or pain, and reflux. In particular, gastroparesis can make you feel uncomfortable after eating, cause you to feel full very quickly when eating (early satiety), leave you feeling full for a long time after eating (prolonged satiety) and lead to abdominal bloating.
The symptoms of gastroparesis can change over time, varying in severity from one day to the next. Patients may have an episode of nausea and vomiting that can last for a few months that then disappears before returning months or years later with greater severity.
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What does gastroparesis pain feel like?
Gastroparesis pain is often felt around the upper abdomen and can feel like a burning, cramping or aching pain. This pain often worsens during and after eating as food is unable to move through the stomach normally. Because of this, gastroparesis pain can last for a long time after eating, unlike other gastrointestinal conditions.
The location of gastroparesis pain can help to differentiate it from other gastrointestinal conditions. Gastro-oesophageal reflux disease (acid reflux) is more of a burning sensation felt in the middle of the chest, while constipation causes cramping pain in the lower abdomen.
What can people with gastroparesis do themselves to help their symptoms before seeing a professional?
Patients can manage less severe symptoms by eating smaller but more regular meals can help you not feel as full or bloated after eating, and can help the stomach empty more quickly — aim for four to six small meals per day.
Dietary changes can also help relieve the more moderate symptoms of gastroparesis.
Is there a recommended gastroparesis diet?
If you have gastroparesis, you should follow a low fibre, low fat diet. Both fat and fibre can slow down your digestion, which can make the symptoms of gastroparesis worse. Liquid meals are often better tolerated than solids, with soups being a good way to include vegetables in your diet and slow-cooked lean meats like stews for protein.
Few dietitians, other than specialists, are aware of how to correctly manage gastroparesis. There are now a number of cookbooks published by patients with gastroparesis that can offer a helpful guide as to what to eat.
The way you eat can also help to ease the symptoms of gastroparesis. You should try to chew your food well before swallowing to make sure it’s less solid before it reaches your stomach, and take sips of fluid while eating.
How is gastroparesis diagnosed?
Diagnosing gastroparesis relies on ruling out other similar gastrointestinal motility disorders, including rumination syndrome, SMA (superior mesenteric artery) syndrome and MALS (median arcuate ligament syndrome). One way of doing this is by using a gastroscopy. This involves passing a flexible tube (an endoscope) into your mouth, down your throat and into your stomach. A tiny camera on the end of the endoscope allows your consultant to examine your stomach and rule out other obstructions that might be causing symptoms.
Gastric emptying tests are another way to help diagnose gastroparesis, which measure how quickly your stomach empties. These include scintigraphy, which involves eating a light meal with a very small amount of radioactive material in it. An X-ray can then be used to follow the movement of the food through your stomach to see how long it takes to pass through. Another method is to use a small wireless capsule that can be tracked as it moves through your stomach after being swallowed.
A common misconception is that gastroparesis only causes weight loss. Many patients lose weight as eating becomes a challenge, but some might actually gain weight. Patients may present with classic symptoms but are misdiagnosed because they do not fit a particular stereotype.
What is the typical gastroparesis life expectancy?
Gastroparesis itself doesn’t shorten life expectancy, and people with it generally have a normal lifespan. However, if it’s unmanaged, it can have severe complications and can make existing conditions worse. The vomiting caused by gastroparesis can lead to severe dehydration, and its effects on digestion can cause malnutrition if patients don’t manage their diet and eating habits.
If someone with diabetes has gastroparesis, its effects on digestion can make their diabetes worse by causing unpredictable changes in their blood sugar levels. Blood sugar levels can remain low after eating as food remains in the stomach, but can then suddenly rise once it reaches the intestines.
What causes gastroparesis?
Gastroparesis is classified into three main groups, and the causes of each can vary:
- In diabetic gastroparesis patients, poorly managed blood sugar levels damage the vagus nerve, which helps regulate stomach movement and digestion.
- Patients with non-diabetic gastroparesis are more likely to have an underlying hypermobility syndrome such as Ehlers-Danlos syndrome. Further research is needed to understand the relationship and causation.
- Patients with post-surgical gastroparesis develop the condition after their vagus nerve is damaged during procedures like weight loss or anti-reflux surgeries.
Most gastroparesis patients will fall into one of the three groups, but we need a lot more education and awareness of the symptoms to improve diagnosis. Many clinicians currently do not recognise gastroparesis as a disability or even as a discrete condition, believing it to be solely a symptom of diabetes.
Other causes of gastroparesis include:
- Immune responses to gastrointestinal viral infections like norovirus and rotavirus, which can damage the nerves in the stomach.
- Rare connective tissue disorders
- Parkinson’s disease, multiple sclerosis and the overuse of opioid painkillers
- An emerging cause is weight-loss injections like Mounjaro and Ozempic, which slow down gastrointestinal motility.
But in around 40% of cases, there’s no one identifiable cause of gastroparesis. This is called idiopathic gastroparesis.
How common is gastroparesis?
Gastroparesis is a fairly uncommon condition in the general population. In the UK, the prevalence of diagnosed gastroparesis is 13.8 per 100,000 people. Around 40% of cases are idiopathic, while 37.5% of cases are diabetic gastroparesis.
However, it’s difficult to identify gastroparesis across the general population. For every patient diagnosed with gastroparesis, there may be many more who go undiagnosed. Consultants and the general public are now becoming increasingly aware of the disorder, and our knowledge of gastric conditions as a field means we’re now in a much better position to distinguish it from other gastrointestinal conditions. This is especially important given the possibility that more people may develop gastroparesis due to the increased use of weight-loss injections.
Can Mounjaro and Ozempic cause gastroparesis?
Yes, weight-loss drugs like Mounjaro and Ozempic can cause gastroparesis. Weight-loss injections work by mimicking the hormones that delay gastric emptying, which increases feelings of fullness and promotes weight loss. But by doing this, Mounjaro and Ozempic can cause food to build up in the stomach, potentially leading to gastroparesis.
How to avoid gastroparesis on Mounjaro and Ozempic
There are a number of steps you can take to avoid gastroparesis while taking Mounjaro or Ozempic. When starting weight-loss drugs, take the lowest dose and up your dosage gradually to help your gastrointestinal system adapt to the medication. Your diet is also an important factor – try and follow a balanced diet that has lots of whole grains, vegetables and lean protein to look after your gut health. If you’re concerned, a dietitian can help develop a personalised plan for you to address any symptoms. Staying hydrated is also important to help digestion.
Is gastroparesis from Mounjaro and Ozempic reversible?
Unlike some other causes of gastroparesis, which are caused by irreversible changes, gastroparesis caused by Mounjaro and Ozempic is reversible. As weight-loss drugs don’t cause a permanent change to your stomach and gastric emptying, any gastroparesis symptoms should improve or resolve once you stop taking the injections.
How to treat gastroparesis
At HCA UK, we offer a combined medical and surgical approach to gastroparesis treatment. The key to success is early diagnosis and improving quality of life through a range of different treatment options and symptom management strategies.
Treatment is always tailored to the individual. However, we also use an algorithm to rule out other conditions such as rumination disorders.
Milder cases of gastroparesis can usually be managed with dietary changes.
For moderate cases, medical management using anti-sickness medications such as ondansetron or cyclizine can greatly improve symptoms. Prokinetic medications can also be used to improve stomach emptying.
For more severe cases, or where prokinetic therapy isn’t successful, we offer endoscopic treatment with botulinum injections to relax the valve between your stomach and intestines, balloon dilatation of the pylorus or gastric peroral endoscopic myotomy.
If further intervention is needed, we can surgically implant electrodes in the stomach for gastro-electrical stimulation, which uses electrical pulses to control your stomach muscles.
Nasojejunal feeding can also be trialled to see if the small bowel can cope with improved gastric emptying. If the patient responds, we can then focus on stomach motility.
“In my 27 years of practice, I’ve seen many of the successes and challenges of gastroenteric care – and I’ve seen the frontiers of our understanding of gastroparesis being pushed back with huge new discoveries. We’re now in a very strong place to offer more precise diagnoses than ever.”
Are there different stages of gastroparesis?
There are no defined stages of gastroparesis and it doesn’t usually occur in isolation, but is instead associated with motility issues throughout the gut.
With functional and motility disorders, a single snapshot of gut health like what you get from an endoscopy doesn’t give you the full story. Often a patient with gastroparesis can look the same someone without the condition, it’s only when you see the picture over time that you can identify the symptoms, and point to a functional and motility-related illness.
Furthermore, motility disorders are currently labelled under umbrella terms and it’s hard to distinguish between different subgroups. With further research we will have finer diagnostic tools for more targeted treatment.
Can gastroparesis go away?
Gastroparesis can go away on its own, but this depends on what’s caused it. If it’s caused by a medication like opioid painkillers or weight-loss injections, stopping the medication should mean that the gastroparesis goes away. If it’s caused by a viral infection, it should also go away on its own, but this could potentially take a few months to even a year of recovery.
However, some causes of gastroparesis are chronic and won’t go away. The nerve damage caused by diabetic gastroparesis is generally irreversible, so it won’t go away on its own. The same is also true for idiopathic gastroparesis, where there is no known cause. While there’s no cure for these forms of the condition, managing the symptoms can help improve overall quality of life.
When is gastroparesis surgery recommended?
Surgery for gastroparesis is only recommended for very severe cases where all other non-surgical treatments, including dietary changes and medications, have failed. This is rare, but some patients continue to have chronic nausea, vomiting and bloating despite all treatments.
Surgical treatments include gastro-electrical stimulation, where electrodes are put in the abdomen to control the stomach muscles, or surgery to relax the sphincter that connects the stomach to the small intestines so that food can pass through.
Learn more about digestive health at HCA Healthcare UK
Our skilled team of private consultant gastroenterologists, surgeons, radiologists and pathologists has been helping patients with their digestive health for over 20 years. We offer the rapid diagnosis, specialist treatment and ongoing care you need, calling on medical specialties across our extensive network to offer you personalised care pathways, no matter how complex your condition may be. Our private hospitals in London, Birmingham and Manchester have dedicated gastroenterology (GI) units, and our facility at The Wellington Hospital is one of the largest in the country.