Gastroparesis is a functional digestive disorder, generally chronic, characterized by a slowing of the emptying of the stomach, in the absence of any mechanical obstacle. Often chronic, gastroparesis can cause dangerous side effects, especially in people with diabetes. While dietary hygiene is often sufficient to reduce symptoms, some cases will require long-term medication or even surgery.

Definition of gastroparesis

Gastroparesis is a functional digestive disorder, generally chronic, characterized by a slowing of the emptying of the stomach, in the absence of any mechanical obstacle.

Gastroparesis is a problem in regulating gastric muscle activity. It occurs when the vagus nerves do not perform these functions well. This pair of nerves connects, among other things, the brain to most of the digestive tract and sends the messages necessary for the proper functioning of the stomach muscles. Rather than being dragged after about two hours into the aftermath of the digestive tract, the food then stagnates in the stomach for much longer.

Types of gastroparesis

Gastroparesis can be classified into the following categories:

• Idiopathic gastroparesis, that is to say without an identified cause;
• Gastroparesis by neurological involvement;
• Gastroparesis by myogenic damage (muscle disease);
• Gastroparesis due to another etiology.

Causes of gastroparesis

In more than a third of cases, gastroparesis is idiopathic, that is to say without an identified cause.

For all other cases, it arises from multiple causes, listed here from the most frequent to the least frequent:

• Type 1 or 2 diabetes;
• Digestive surgeries: vagotomy (surgical section of vagus nerves in the abdomen) or partial gastrectomy (partial removal of the stomach);
• Medication intakes: anticholinergics, opioids, antidepressants including tricyclics, phenothiazines, L-Dopa, anticalcics, alumina hydroxide;
• Infections (Epstein-Barr virus, varicella virus, zonatosis, trypanosoma cruzi);
• Neurological diseases: multiple sclerosis, stroke, Parkinson’s disease;
• Systemic diseases: scleroderma, polymyositis, amyloidosis;
• Progressive muscular dystrophies;
• Zollinger-Ellison syndrome (a disease characterized by severe stomach and duodenal ulcers);
• Gastrointestinal lesions caused by radiation therapy;
• Digestive ischemia or decreased arterial blood supply to the stomach;
• Anorexia nervosa ;
• Hypothyroidism or the consequence of low production of hormones by the thyroid gland;
• Chronic renal failure.

Diagnosis of gastroparesis

When gastroparesis is suspected, the scintigraphy makes it possible to measure the speed at which the food is digested: a tiny radioactive substance, whose radiation can be monitored by medical imaging, is then consumed with a light meal and makes it possible to follow the rate at which the meal passes through the digestive system. The octanoic acid breath test labeled with a stable, non-radioactive isotope of carbon (13C) is an alternative to scintigraphy.

Other methods proposed for the study of gastric emptying include:

• Ultrasound which assesses changes in the surface area of ​​the stomach lining as a function of time after a meal and also helps to determine if there are other physical abnormalities that could lead to the symptoms attributed to gastroparesis;
• The scanner or magnetic resonance imaging (MRI) which reconstructs the gastric volume over time.

The indication of an exploration of gastric emptying, available only in specialized centers, is only prescribed in the event of severe symptoms affecting the nutritional state of the patient:

• Gastroscopy is an endoscopy – insertion of a small flexible tube fitted with a camera and a light – allowing to visualize the internal wall of the stomach, the esophagus and the duodenum;
• Peptic manometry involves inserting a long, thin tube that measures muscle pressure and contractions from the digestive tract to the stomach.

A connected capsule, the SmartPill ™ motility is currently being tested to record variations in pressure, pH and temperature in the digestive tract. It could constitute an alternative to the exploration of patients outside specialized centers.

People affected by gastroparesis

Gastroparesis affects about 4% of the population and seems to expose women three to four times more than men.

People with diabetes are more likely to trigger gastroparesis.

Factors favoring gastroparesis

The presence of gastroparesis is more common in diabetics who present:

• Nephropathy (a complication that occurs in the kidneys);
• Retinopathy (damage to the blood vessels in the retina);
• Neuropathy (damage to motor and sensory nerves).

Prolonged digestion

Gastroparesis is often expressed by a feeling of full stomach from the first bites, associated with the feeling of prolonged digestion, early satiety and nausea.

Abdominal pain

Abdominal pain affects more than 90% of patients with gastroparesis. These pains are often daily, sometimes permanent, and occur at night in nearly two thirds of cases.

Weight Loss

In diabetics, vomiting is more intermittent or even absent. Gastroparesis more often results in an unexplained deterioration in the general condition of the patient, such as weight loss and difficulty in balancing the level of glucose in the blood – or blood sugar – despite treatment.

Bézoard

Gastroparesis can sometimes cause a compact conglomerate of undigested or partially digested food, called a bezoar, to form that cannot exit the stomach.

Other symptoms

• Lack of appetite ;
• Bloating;
• Constipation ;
• Muscular weakness ;
• Night sweats ;
• Stomach pains ;
• Vomiting;
• Regurgitation;
• Dehydration;
• Gastroesophageal reflux ;
• Irritable bowel syndrome.

The hygieno-dietetic recommendations are the preferred option in the treatment of gastroparesis:

• Fragmentation of the diet with the consumption of smaller meals but more often;
• Reduction of lipids, fibers;
• Removal of drugs that slow gastric emptying;
• Normalization of blood sugar;
• Treatment of constipation.

Prokinetics, which stimulate gastrointestinal motility, represent the main therapeutic option in gastroparesis.

In the event of persistent treatment failure, other solutions may be considered:

• Gastric electrical stimulation (ESG): this implanted device generates light electrical impulses stimulating the vagus nerves around the digestive tract in order to accelerate gastric emptying;
• Artificial feeding techniques;
• Surgery, in the form of partial or subtotal gastrectomy, remains exceptional.

If it seems difficult to prevent the onset of gastroparesis, a few tips can however limit its symptoms:

• Eat light meals more often;
• Prefer soft or liquid foods;
• Chew well;
• Combine nutritional supplements in the form of drinks with the diet.