What causes gastroparesis?

Gastroparesis is the delayed emptying of food from the stomach into the small intestines. Contractions of the stomach to empty food into the small bowel are controlled by tiny nerves.  When these nerves are affected, the necessary stomach contractions do not occur. Symptoms consist of nausea, vomiting of undigested food a few hours after eating, getting full quickly, and occasionally left upper quadrant abdominal discomfort. Most people with gastroparesis have no known trigger for this malfunction of stomach emptying. Many medications may also slow a stomach’s ability to empty, particularly pain medications (narcotics) and anti-depressants (anticholinergics). However, the most common medical cause of gastroparesis is actually diabetes, as prolonged hyperglycemia (elevated, uncontrolled blood glucose from diabetes) can ruin the nerve endings which stimulate the stomach, just as the nerve endings in the fingers and toes are often damaged by diabetes. Other causes of gastroparesis are much more rare – various infections, auto-immune diseases, amyloidosis, and neurological conditions.

The primary treatment is reversible of any causative agent – discontinuation of the offending medication or better control of blood glucose. Modification of diet is extremely important, too. One should have five to six small meals, as opposed to three large meals.  Also, a low-fat, low-fiber diet is easier for the stomach to transfer to the small bowel. There are a few medications which stimulate stomach emptying – metoclopramide / Reglan, a prokinetic medicine, and erythromycin, an antibiotic. However, these medications are used sparingly, as they do have side effects and their efficacy wears off.         

Risk factors for GERD include obesity, hiatal hernia, smoking, pregnancy, and diabetes. Eating large meals, lying down right after eating, some foods, such as spicy foods, alcohol, chocolate, caffeine, tomato sauce, onions, and carbonated beverages may worsen GERD.

Nonulcer dyspepsia (NUD) and GERD are caused by factors that increase intra-abdominal pressure, thereby causing the gastric contents to flow upward. Factors that increase intra-abdominal pressure include obesity and overeating. The other causes of NUD and GERD included factors that decrease the tone of the esophageal sphincter, such as smoking, hiatal hernia, and consumption of chocolate, fried foods, carbonated beverages (soft drinks), tomatoes, mints, alcohol, and coffee.