August is Gastroparesis Awareness Month!

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Patients with gastroparesis may experience symptoms for 5 years before they finally get correctly diagnosed... FIVE YEARS!

Gastroparesis literally means “paralysis” of the stomach. GI motility is complex. It involves  coordination of both the sympathetic and parasympathetic nervous systems, neurons, and “pacemaker cells” as well as the smooth muscle cells of the gut. You can imagine a lot can go wrong here and lead to disordered and delayed gastric emptying. Gastroparesis is a condition that is not really well understood or known among both doctors and patients. Let's get the facts straight!

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What is gastroparesis? A syndrome of delayed gastric emptying which means that food and liquid does not leave the stomach as quickly as it should and therefore sits in the stomach causing symptoms like nausea, vomiting, early satiety, bloating, upper abdominal pain.

Is it common? More than we think! It happens in about 10/100,000 men and almost 40/10,000 women. (sorry ladies!)

Why does it happen?? Most of the time, we don’t know! The top 3 reasons it happens are: 1. No reason found 2. Diabetes 3. After surgery. Also important contributors are medications, and especially opiates so avoid at ALL costs! Interestingly in smokers, it could be a clue of an underlying lung cancer, so get checked out if you're at risk!

What are the symptoms? Nausea (93% of people affected), vomiting (up to 84%), abdominal pain (up to 90%), early satiety (up to 86%), fullness after eating, bloating, and even weight loss.

What's the workup?

1. Endoscopy to make sure there are no obstructions and sometime you see food remaining in the stomach after a long fast that is abnormal.

2. Gastric emptying study. This involves eating a low fat meal with imaging (no radiation) immediately after eating a meal and then again at 1, 2, and 4 hours.  A positive study is when >10% remains after 4 hours or >60% after 2 hours.

3. Consider wireless motility capsule and breath test such as the 13-C-Spirulina Gastric Emptying Breath Test,.

Treatment

The cornerstones of treatment are diet, diabetes control, and hydration and if those don’t work… medications. 

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1. Diet

- EAT THIS: LOW-FAT (Fat slows gastric emptying even more!)

- DON'T EAT THIS: Acidic, spicy, non-soluble fiber foods (check out the fiber page here) & roughage-based foods, carbonated beverages (aggravate gastric distension)

- Small, frequent meals 4-5x/day

- If still a lot of trouble tolerating food, blend/puree food as gastric emptying of liquids is often preserved

2. NO alcohol or smoking! They decrease contractility and delay gastric emptying even more!

3. Hydration & nutrition

- With a lot of vomiting, one may be at risk for low potassium and dehydration

- Make sure to drink a lot of liquids and take oral vitamins as directed by a doctor

3. Control your blood sugar!

- High blood sugar slows gastric emptying so make sure you talk to your doctor about the right meds for you. Sitagliptin (Januvia) for example, does not have an effect on gastric emptying.

If you tried all of the above suggestions and are still having trouble then talk to your doctor about meds. Some of the prokinetic/promotility options you may hear about:

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- Don't forget about acupuncture! In a study, acupuncture improved symptoms of postprandial fullness, early satiety, and bloating as compared with sham treatment control

 

Treatment may not be a quick fix and need time. Less than a third of gastroparesis patients had significant symptom relief after treatment. Importantly one study showed that factors associated with NO symptom relief included being overweight/obese with BMI>25, smoking history, and use of pain medications. 

Don't suffer for 5 years! Get tested, diagnosed and treated today!