Gastroparesis Overview and Surgical Treatment

Gastroparesis is a condition that delays the emptying of the contents of the stomach into the small intestine. In the normal course of digestion, food enters the stomach through the esophagus and is partially metabolized. After a period of time, the vagus nerve triggers the release of the food through the pyloric valve and into the small intestine, where it is further processed. Those experencing gastroparesis will accumulate food in the stomach long after it should be passed through to the small intestine. This can lead to a bacterial overgrowth and, in severe cases, the complete blockage of the pyloric valve.

Symptoms & Diagnosis of Gastroparesis

Milder forms of gastroparesis are often mistaken for other conditions and are often ignored until they progress to a later stage. Common symptoms include:

• The symptoms of GERD including heartburn, nausea, chest pain and vomiting
• Feeling full before much food has been consumed
• Vomiting well after having eaten
• Bloating in the abdominal area
• Weight loss due to lack of appetite or poor absorption of nutrients
• Gastric spasms
• Significant fluctuations in blood sugar, usually due to obstruction

No two patients are alike, making a diagnosis more difficult for physicians who are not experienced in the signs of gastroparesis.

A physical and medical history along with routine blood work will go a long way toward ruling out other conditions. Once our team suspects that gastroparesis may be the cause of the problem, we have a number of diagnostic tests to definitively conclude that it is indeed gastroparesis and not an obstruction. These include:

• A barium swallow. After drinking a specially formulated liquid, we will be able to determine the contents of the stomach using an x-ray. This test will be able to tell if food remains in the stomach after fasting.
• Ultrasound testing will be used to rule out other possible issues including those associated with the gallbladder or pancreas.
• An upper endoscopy involves the threading of a camera through the mouth and down the esophagus to check for abnormal tissue or blockage.

Diagnostic testing to positively identify gastroparesis may include:

• A breath test. After swallowing a radioisotope (small amount of radiation) with a pre-defined meal, breath samples are taken to see how quickly the meal passes through the stomach.
• Similarly, gastric emptying scintigraphy uses radiation to follow the meal through the stomach and see how much passes into the small intestine. If, at 4 hours, more than 10% of the meal remains in the stomach, it is a sure sign of gastroparesis.

Causes of Gastroparesis

Gastroparesis is caused by the malfunctioning or damage of the vagus nerve – the control mechanism for the movement of food out of the stomach and into the small intestine. The leading cause of damage to the vagus nerve is diabetes, which causes a degradation of the function of blood vessels to the nerves, including the vagus nerve. There are several other causes of gastroparesis that can be environmental or genetic.

In some cases, we cannot find the true cause of gastroparesis despite all of the testing above. This is known as idiopathic gastroparesis.

Surgical Treatment of Gastroparesis

Surgery for gastroparesis becomes an option when lifestyle change (dietary changes in particular) and medication do not offer the patient significant relief from their symptoms. This is known as refractory gastroparesis. Further, medications do not treat the actual cause of gastroparesis, and some patients may not react well to them. Further, feeding tubes, Botox injections and intravenous introduction of nutrition are only temporary solutions to the problem.

Gastric Electrical Stimulation

Gastric electrical stimulation is used to relieve nausea and vomiting associated with gastroparesis. A small device, similar in function to a pacemaker, is implanted in the abdomen. This device releases electrical impulses into the nerves and muscles around the pyloric valve to alleviate symptoms.

This treatment is not suitable for patients who develop obstructions as a result of gastroparesis.

Pyloroplasty

For those who do not respond to any treatment above, a pyloroplasty – the enlargement of the pyloric valve – may be indicated. By widening the valve that separates the stomach and the small intestine, food is allowed into the small intestine more rapidly. Learn more about  pyloroplasty.

To learn more about gastroparesis and the best treatment for your particular circumstance, we suggest you contact our office and schedule a consultation with one of our highly skilled surgeons.