What causes gastroparesis?

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Matthew L. Brengman, MD
Surgery
Normally, three types of gastroparesis exist: idiopathic, diabetic and postsurgical, and sufferers are usually female. Idiopathic gastroparesis is that of unknown origin and is the most common. Sometimes it can follow gastric illness or respiratory diseases, but most often is characterized by symptoms alone. Diabetic gastroparesis affects both type 1 and type 2 diabetics, with obesity being a major predictor of the disease in type 2 diabetes. Diabetic gastroparesis has multiple root causes, all involving the impairment of gastrointestinal motility and nerve functions. Postsurgical gastroparesis is considered a complication of routine procedures such as those to correct reflux, peptic ulcer disease and common weight loss surgeries.

Other defined causes of gastroparesis include radiation therapy, neurologic disorders (Parkinson’s disease, stroke, multiple sclerosis and spinal injuries), eating disorders, smoking, pregnancy, hormonal disruption diseases, Crohn’s disease and other gastrointestinal afflictions. Children are rarely affected by gastroparesis, but may develop it as a result of viral infections.
Although a number of conditions may cause gastroparesis, by far the most common is diabetes, in which continued high blood sugar levels damage the vagus nerve, which controls the movement of food through the digestive tract. Gastroparesis can develop as a consequence of either type 1 or type 2 diabetes that is poorly controlled.

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.         

For most people, food empties from the stomach within two to four hours after eating. But for those with a condition known as gastroparesis, the stomach doesn’t empty properly, which may cause severe nausea, vomiting and other problems.
Says UCLA gastroenterologist Mark Ovsiowitz, MD, "Although the causes of gastroparesis are numerous, nearly 30% of people with gastroparesis have diabetes as the underlying reason. In some cases, the symptoms of gastroparesis can be alleviated by controlling the person’s diabetes. High blood-sugar levels can lead to problems with the nervous system, which may impair the ability of the stomach to empty.
Gastroparesis may also be caused by medications that slow motility (movement) in the intestine, including narcotics taken for chronic pain, as well as by some connective-tissue disorders, such as scleroderma. It’s therefore very important to conduct a diagnostic evaluation in order to rule out possible causes of a person's symptoms."
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.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.