What is Gastroparesis?
Gastroparesis is a disease of the stomach where it does not empty properly and food sits in the stomach longer than it is supposed to. There are a few known causes, such as diabetes and narcotic dependence. Other instances are idiopathic, meaning the cause is unknown. Gastroparesis cannot be cured; however, the therapies mentioned are to help manage the symptoms and hopefully improve on the overall quality of life. Symptoms of gastroparesis include nausea, vomiting, reflux, weight loss and abdominal pain. The vomiting can be severe enough to cause dehydration and need for hospitalization. Gastroparesis is a chronic condition and there is no cure.
Diagnosis of Gastroparesis
Gastroparesis diagnosis is made by a study called a solid gastric emptying study (SGE). Some radiology departments do a 2 hour study and calculate a 4 hour estimate. When we are considering surgical options to manage gastroparesis, we require a 4 hour study.
An upper endoscopy is also done to make sure there is not a process that is blocking the exit of the stomach.
Gastroparesis Treatment Options
There are a few medications that can help the stomach empty. These include Reglan (metoclopramide) and domperidone. There are some precautions that need to be taken with taking these medications, but they can help manage symptoms (which is the goal of any therapy for this disease). Because there is not a cure for gastroparesis, the medications need to be taken for life. Reglan is available in the United States. Domperidone is not FDA approved, but can be compounded or purchased from a pharmacy online. An EKG (electrocardiogram) needs to be done before starting the medication as it should not be given to patients that have a prolonged QT interval.
The Enterra device was FDA approved for use in 1999. It is a neurostimulator that is placed surgically. Although this does not make the stomach empty normally, it interferes with the message of nausea to the brain, which helps improve the overall quality of life.
This is a surgically placed tube that is placed in the small intestine. This is done to maintain nutrition without relying on the stomach. This gastroparesis treatment option can be temporary, or permanent, depending on the disease process.
This is a laparoscopic surgery where the valve that empties the stomach is cut and then sewed together in a more open fashion. This can help the stomach empty better and improve symptoms. There are some risks to the surgery, so it isn’t a good choice for everyone. Potential problems include reflux (including bile reflux which is difficult to treat with medications), persistence of gastroparesis symptoms, leaking from the surgery site, and infection.
Removal of Stomach
If other interventions are not successful in improving severe symptoms, Dr. Bell may discuss removing most of your stomach. This is called a partial gastrectomy.
Living with Gastroparesis
Since there is not a cure for gastroparesis, and there is currently not a way to make your stomach work again, we have a few suggestions that may help with improving your overall quality of life.
If your gastroparesis is related to diabetes, the damage has been done and cannot be reversed. The better you can control your blood sugar, the slower the disease will progress. Gastroparesis is only one complication of diabetes. The better control of your A1C, the lower your risk of complications.
Narcotics can be life altering for those with chronic pain. The downside to narcotics is they slow the digestive tract significantly – in some more than others. If the gastroparesis is related to narcotics, the best way to treat gastroparesis is to try to find an alternative to the narcotics for the chronic pain. If this is not possible, the above treatments may be helpful.
Before and After Surgery for Gastroparesis
If surgery is an option and you should decide to proceed, we will want you to be on a clear liquid diet for 48 hours prior to surgery. We are unable to do the surgery if there is food in the stomach. For Enterra and pyloroplasty treatments, surgery is done laparoscopically for the most part. Surgery takes and hour to an hour and a half. Some patients go home the same day and some stay overnight.
For gastrectomy patients, this is done either laparoscopically or openly, depending on the individual circumstances. If it is performed laparoscopically, the hospital stay is generally a few days shorter than the open procedure. There are diet restrictions and vitamin supplements that will need to be followed for life.