Friday, January 19, 2018

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Tummy Trouble? Persistent, Unexplained Stomach Issues Could Be GASTROPARESIS.

Written by  Christy Rippel

If you’ve bounced around like a pinball from urgent care to physicians’ offices for stomach issues, but are still undiagnosed, consider whether gastroparesis could be the cause of your symptoms.

Often, patients suffer for an extended period of time before they receive a diagnosis—and treatment options that may drastically improve quality of life. As much as five percent of the population has gastroparesis, though the degree that the condition disrupts a person’s life is variable.


What is gastroparesis?

“The term ‘gastroparesis’ is a catch-all, descriptive term meaning the stomach is functioning abnormally and emptying slowly, which can cause many symptoms,” says Matthew Brengman, MD, FACS, a gastrointestinal surgeon who treats patients with gastroparesis at Advanced Surgical Partners of Virginia in Richmond. Patients may experience symptoms differently, but they can include nausea, vomiting, bloating, heartburn, abdominal pain, weight loss and what physicians call early satiety—meaning, you feel full after only eating a small amount of food.

The reason why patients run into dead ends before being diagnosed is because symptoms can mimic those of other conditions. Often, other causes are ruled out first, like gallbladder disease, pancreatitis, irritable bowel syndrome (IBS) or tumors.

The path to diagnosis

Imaging studies, along with a patient’s account of symptoms and their duration, can lead a physician to the diagnosis. A patient may undergo a gastric emptying study, which is a common procedure that measures the rate that food empties from the stomach and enters the small intestine. In the study, a patient eats a meal that is mixed with a small amount of radioactive material. A scanner is placed over the patient’s stomach to monitor the amount of radioactivity in the stomach for several hours, which reveals the rate that the stomach empties. Other physicians might use a wireless motility capsule—a small, non-invasive pill-like device that is swallowed, and gathers information about your digestive system as you go about daily activities.

Dr. Brengman says the cause of gastroparesis varies by patient. One population that is vulnerable to developing gastroparesis is diabetics. In diabetics, elevated blood sugar over a period of years affects the nerve endings in the body (including the stomach) and makes them dysfunctional. The damage to the stomach nerves creates a ripple effect, and the stomach no longer functions and empties property. In diabetics, good blood sugar control does not guarantee that a patient won’t get gastroparesis—but could help prevent or delay its onset.

While diabetics are prone to it, the most common form of gastroparesis is idiopathic—meaning, the cause is unknown. “The prototype patient is a middle aged woman, who was previously well and now has unexplained nausea and vomiting,” says Dr. Brengman. “Sometimes it follows a viral stomach illness or food poisoning.”
A third, more rare cause of gastroparesis is previous gastrointestinal surgery—ulcer, reflux, stomach or esophageal surgery.

Treatment options for gastroparesis

There are treatments that can help, and they often depend on severity of symptoms. “The majority of people with gastroparesis can be managed with diet alone,” says Dr. Brengman.

A common diet for gastroparesis is low fat, not very spicy, with limited caffeine and no raw fruits or vegetables, as the raw, fibrous material is difficult for the stomach to break down. Softer foods are easier on the stomach, such as pasta, cooked vegetables, oatmeal and low-fat yogurt. [End pull quote] A dietician is helpful in managing the condition and following diagnosis most patients are referred to one for guidance.

A small percentage of patients are very symptomatic, and come to Dr. Brengman for surgical intervention. Two options exist for these patients—one is a gastric stimulator, that has been FDA approved since 2000, and works much like a cardiac pacemaker, but for the stomach. It is wired to the stomach through a laparoscopic procedure, meaning incisions are tiny. It has proven helpful for diabetic gastroparesis, says Dr. Brengman.

The other, newer surgical intervention is called pyloroplasty, which Dr. Brengman says is helpful in about 75 percent of gastroparesis cases of unknown cause. This surgery is also done with less-invasive techniques, meaning incisions are tiny. Pyloroplasty involves permanently opening the valve at the end of stomach—leaving it open helps food move to the small intestine more efficiently.

“These surgical strategies aren’t perfect but we find that quality of life can, in most cases, be drastically improved,” notes Dr. Brengman.