Gastroparesis is a gastric motility disorder that is characterized by delayed stomach emptying in the absence of a mechanical obstruction. The characteristic symptoms of gastroparesis include nausea, vomiting, bloating and early satiety. Abdominal pain may be a prominent symptom in some patients. The diagnosis of gastroparesis requires ruling out other causes of nausea and vomiting, such as peptic ulcer disease, gastrointestinal infection, pancreatic disease, hormonal disorders and medication side effects. The most common cause of gastroparesis is diabetes. Some patients develop gastroparesis following an episode of viral gastroenteritis.
A gastric emptying study is usually performed to objectively document a delay in gastric emptying. This test involves ingesting a radiolabled meal of scrambled eggs, bread and jam and then lying under a camera that measures the amount of food that is emptied from the stomach into the small intestine at 1, 2 and 4 hours after ingestion.
The treatment of gastroparesis begins with dietary management. Patients should eat smaller, more frequent meals and should avoid fatty foods, fibrous foods, red meat and fresh vegetables. Meals that are rich in protein and starches are preferred because they are more easily mixed and emptied by the stomach. Many patients may require medical therapy with anti-nausea and/or pro-motility drugs. Botox injections into the pyloric sphincter of the stomach may sometimes also alleviate the symptoms of gastroparesis.
The vast majority of patients with gastroparesis can be successfully managed with dietary and medical therapy. Patients with refractory nausea and vomiting who require periodic hospitalizations and/or dietary support via intravenous nutrition or direct small intestinal feeding, may be candidates for a novel therapy known as gastric electrical stimulation. This involves a device, known as Enterra (Medtronics, Inc.), which consists of a neurostimulator that is implanted in the abdominal wall, along with two wires that lead from the stimulator to the stomach. The Enterra device provides a direct electrical stimulation to the stomach and can dramatically improve symptoms of nausea and vomiting in some patients. A newer approach for patients with gastroparesis is the GPOEM procedure (gastric peroral endoscopic myotomy) where the pyloric sphincter that controls stomach emptying is incised using an endoscope inserted directly into the stomach, without requiring any external abdominal incisions or scars.