What is gastroparesis?
What are the signs and symptoms of gastroparesis?
The typical symptoms of gastroparesis are nausea, vomiting, upper abdominal discomfort or pain and reflux. In particular, patients can experience uncomfortable feelings or early satiety (getting full very quickly after meals), prolonged satiety (continuing to feel full for a long time after) and abdominal bloating.
Signs and symptoms can fluctuate considerably over the years, varying in severity from one day to the next. Patients may have an episode of nausea and vomiting for three months that disappears and comes back a year later with greater severity.
How easy is it diagnose?
Distinguishing gastroparesis from other motility disorders can be challenging but is crucial for successfully managing the condition. There are a number of motility disorders such as rumination syndrome, SMA (Superior Mesenteric Artery) syndrome and MALS (Median Arcuate Ligament Syndrome) that appear to mimic gastroparesis. These first need to be excluded by gastroscopy before diagnosis and treatment.
A common misconception is that gastroparesis only causes weight loss. Many patients lose weight because eating becomes such a challenge, but some patients may paradoxically gain weight. Patients may present with classic symptoms but are mis-diagnosed because they do not fit a particular stereotype.
Gastroparesis patients often suffer unnecessarily with extreme discomfort. After diagnosis, we can introduce a number of measures to significantly improve their quality of life.
What are the causes of gastroparesis?
Gastroparesis is classified into three main groups – and the causes to each one can vary:
- Diabetic gastroparesis patients often have damaged nerves and decreased stomach motility.
- Non-diabetic gastroparesis patients are more likely to have an underlying hypermobility syndrome such as Ehlers-Danlos syndrome. Further research is needed to understand the relationship and causative effects.
- Post-surgical gastroparesis patients can develop gastroparesis following surgery of the hiatus such as fundoplication or repair of a paraesophageal hernia.
Most gastroparesis patients will fall into one of the above three groups, but we need a lot more education and awareness of the symptoms to improve diagnostics. 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 patients who can present with gastroparesis include:
- Idiopathic patients with post-viral infections, such as post-infective gastroparesis or following surgical interventions such as fundoplication, or anti-reflux surgery;
- Patients with rare connective tissue disorders;
- And, rarely, patients with Parkinson’s disease, multiple sclerosis, and the overuse of opioid based analgesics.
How prevalent is gastroparesis?
The latest data on epidemiology and outcomes of gastroparesis suggests that a minority of the population have this condition. The prevalence of diagnosed gastroparesis was 13.8 per 100,000 persons in the UK and the incidence of diabetic gastroparesis was 37.5% in patients with type 1 diabetes.<sup1<></sup1<>
Identifying gastroparesis across the general population is little like trying to spot a hidden iceberg. For every patient diagnosed with gastroparesis there may be many more who go undiagnosed. Consultants and the general public are now becoming increasingly more aware of the disorder, and our knowledge of gastric conditions as a field means we’re now in a much better position to distinguish between conditions such as coeliac disease and gastroparesis. This is a huge benefit for treatment.
What can people with gastroparesis do themselves to help their symptoms before seeing a professional?
Patients can manage less severe symptoms with dietary measures. Eating little and often and switching to a low fat, low fibre diet helps to relieve symptoms. Liquid meals are often better tolerated than solids.
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.
We highly recommend seeing a consultant when symptoms appear for an early diagnosis. This can give the patient access to prescription medications such as prokinetics, as well as professional support for lifestyle modifications and management.
Are there different stages of gastroparesis?
There are no defined stages to gastroparesis and it doesn’t usually occur in isolation but, is often associated with motility issues throughout the gut.
With functional and motility disorders, a single snapshot image such as you gain with a normal endoscopy won’t give the whole story. Often a patient with gastroparesis can look the same as a non-gastroparesis patient, 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.
What are the treatment options for gastroparesis?
The Wellington Hospital offers a combined medical and surgical approach, with all the available tools to treat gastroparesis. The key to success is early diagnosis and improving quality of life with different treatment options and symptom management.
Treatment is always tailored to the individual. However, we also use an algorithm to exclude other complaints such as rumination disorders.
Milder cases can usually be managed by dietary means.
For moderate cases, medical management using anti-sickness medication such as ondansetron or cyclizine greatly helps 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 Botox injections, balloon dilatation of the pylorus or gastric peroral endoscopic myotomy. If further intervention is needed, we can surgically implant electrodes in the stomach for gastric neuromodulation. 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.
Mr Sritharan Kadirkamanathan, General Surgeon
Gastroparesis – your next step
Making an accurate diagnosis is key to ensuring every patient receives the most appropriate treatment for their needs. First, we need to focus on ruling out similarly presenting gastroenteric motility disorders. Once a diagnosis of gastroparesis is confirmed, there are many interventions and treatment options we can offer to help manage the symptoms.
At The Wellington Hospital, we take enormous care in supporting our patients to maximise their quality of life and, where possible, live symptom-free.
To get tailored advice for yourself or a loved one, book a consultation with Mr Sritharan Kadirkamanathan or Dr Ray Shidrawi.