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Gastroparesis - Medical Malpractice
Gastroparesis is also known as "delayed gastric emptying" and happens when the stomach doesn't empty its contents very rapidly. In normal cases, the stomach contents move through the stomach due to contractions of the stomach. When the stomach fails to contract, gastroparesis can occur. It is all controlled by the vagus nerve that controls movement of food through the stomach and the intestinal tract. If the vagus nerve is damaged somehow, the muscular aspect of the stomach and digestive tract does not work and food stops moving well through the GI tract.
The most common reason people get gastroparesis is having diabetes. High blood sugar damages nerves, including the vagus nerve, and this results in poor innervation of the GI tract by the vagus nerve. Other causes of gastroparesis include surgery to the stomach, surgery that damages the vagus nerve, viral infections, certain medications (narcotics and anticholinergics), anorexia or bulimia, GE reflux disease, certain smooth muscle diseases like scleroderma and amyloidosis, Parkinson's disease, unusual migraines, metabolic disorders and things like hypothyroidism. A lot of people develop idiopathic gastroparesis with no known cause to the disease.
If you have gastroparesis, you often have the symptoms of heartburn, pain in the upper abdomen, nausea and vomiting, feeling full shortly after eating, weight loss due to poor intake and poor absorption of nutrients, fluctuations of blood sugars, abdominal bloating, GE reflux and stomach spasms. Foods that make the condition worse include foods that are solid, have high fibre or are raw fruits and vegetables. Fatty foods or foods high in carbonation often make the situation much worse. The symptoms can be severe or mild and it all depends on the person with the disease. You can have frequent or infrequent symptoms and a wide range of symptoms can occur.
Food can ferment if it sits in the stomach too long and it can harden into what's known as a bezoar or ball of food that doesn't leave the stomach, except by surgery. Bezoars can block the passage of food into the small intestine and can be dangerous. It can make diabetes worse by making the blood glucose more complicated to control. Blood sugar levels rise when the food stays in the stomach too long and the blood sugar levels can be difficult to control.
Doctors diagnose gastroparesis through a complete history and physical examination. The doctor does dye studies to make sure there are no blockages in the intestines or stomach via an upper GI series. Endoscopy can look for bezoars and can look to see how the stomach is moving. Upper GI endoscopy involves using a camera study to actually see the stomach lining. An ultrasound can look for pancreatitis and gallbladder disease. The dye study uses barium swallowed that looks at the outline of the stomach and small intestines as the barium passes through the stomach and intestines.
More confirmatory tests include a gastric emptying scintigraphy test. The patient eats a bland meal that contains a radioactive material within it. The examination looks at how fast the stomach empties the radioactive substance. If more than ten percent of the radioactive meal is present in the stomach after four hours, the person has gastroparesis. There is also a breath test that detects the amount of isotope in carbon dioxide expelled from the body after eating a radioactive meal. A capsule device can be swallowed and you can measure how long it takes the capsule to leave the stomach. The contractions of the stomach can be seen by the camera capsule, which contains a small camera attached.
The treatment of gastroparesis depends on how severe the symptoms happen to be. There is no real cure for gastroparesis but there are things that can be done to manage the problem. These include medications. Some medications that work for gastroparesis are Reglan or metoclopramide. This drug stimulates muscle contractions and is taken a half hour or so before meals and at bedtime. Erythromycin is an antibiotic that also improves the emptying of the stomach. Domperidone is a medication like Reglan used to promote stomach emptying. Medications can be given to control nausea and vomiting and antibiotics can be used to clear up any bacterial infection that may be contributing to the disease.
You can also change your diet so that you avoid high fat foods and high fibre foods. Food may need to be more liquid or more pureed. In severe cases, a feeding tube or parenteral nutrition may need to be instituted to adequately feed the person.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here