Pronunciation- Gas-trow-pah-re-sus
Rarity- not rare
Difficulty in Diagnosis- mixed, while there is a test to diagnose this condition, finding a doctor that will know to test for it can be difficult.
Gastropasresis, also known as delayed gastric emptying, is a medical condition where the stomach does not contract normally, resulting in food remaining in the stomach for a longer period of time than normal. Normally, the stomach contracts to move food down into the small intestine for digestion within a short time of eating The vagus nerve controls the contractions in the stomach and gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. This results in food moving slowly through the digestive tract, causing a myriad of problems.
The term "Gastroparesis" when broken is - 'gastro'-stomach and 'paresis'-paralyzed... so the name actually means "paralyzed stomach".
Gastroparesis is often associated with Diabetes (since neuropathies can be common in diabetes) but it can also be caused by smooth muscle disorders (such as Lupus and Scleroderma), other neuropathies (such as MS and ALS) Myopathies (such as Shy Dagger Syndrome) or may be caused by a viral infection. In many cases the cause of the Gastroparesis is never found and the condition is called Idiopathic Gastroparesis. Other things that can cause Gastroparesis are chemotherapy, radiation therapy and opiate based pain killers such as morphine and codeine.
Some of the more common symptoms are:
- Early satiety (feeling full early in a meal or after just a few bites)
- Heartburn
- Weight loss (unintentional)
- Weight gain (unintentional)
- Abdominal bloating
- Abdominal pain
- Diarrhea
- Constipation
- Erratic blood glucose levels (mainly in Diabetes)
- Lack of appetite
- Gastroesophageal reflux
- Spasms of the stomach wall
- Chronic nausea
- Vomiting (especially of undigested food)
- Inability to tolerate dietary fats
This is a pretty straight forward test-
You are asked to fast for 12 to 18 hours before the test then will be taken to the testing room and given a small meal (often scrambled eggs, oatmeal or a sandwich) that has had a small amount of a radioactive tracer dye added to it. This dye is not harmful and will pass through your body within 24 hours in most cases.
You will then either be asked to lay on a table for 90 minutes as a 'camera' is placed over your abdomen which takes a reading every 10 seconds to see how long it takes the tracer to leave your stomach or will have a reading done over a period of 2 to 4 hours where you are allowed to leave the room between image captures. Unfortunately, there is no one standardized test for the Gastric Emptying Scan (often called the GES) and it seem that every testing facility does it differently, but the results are all read in the same way. They are testing to see how long it takes for the tracer in the food to leave your stomach since in a healthy individual normal ranges for gastric emptying in healthy subjects at 1 hour, 2 hours and 4 hours is 90, 60 and 10 percent meaning that in one hour 10% of the food should have left the stomach, in 2 hours 40%, and so on.
There is no cure for Gastroparesis... only treatments meant to relieve symptoms and help the stomach empty faster.
Treatments include-
- Dietary changes- avoiding fat, fiber (since it is hard to digest), raw fruits and vegetables and most meats. It is also recommended to eat smaller meals through the day instead of three larger meals, though many sufferers have trouble eating even one small meal a day.
- Medications- Reglan (generic name- metoclopramide, this helps increase gastric emptying, but is also known to cause another condition called 'Tardive Dyskinesia'); Erythromycin (an antibiotic that is shown to improve gastric emptying in some patients); Domperidone (a medication that cannot be gotten in the US due to issues with heart conditions and off label use by nursing women who wanted to increase lactation but is probably one of the best medications to help with symptom control and for this reason many patients get this medication from pharmacies outside of the US, such as Canada. The FDA is cracking down on this, much to the detriment of patients who desperately need the medication); Zofran (a medication used for nausea that has a high incidence of migraine headaches as a side effect); Phenergan (an antihistamine that helps control nausea); Botox (when Gastroparesis is caused by nerve damage of the pyloric muscle at the base of the stomach it can cause it to spasm closed, causing delayed emptying and injecting botox into this muscle can give relief for a period of time to some sufferers)
- Medical Intervention- Nasogastric Tube (often referred to as an NG tube, this is a long flexible tube that is inserted through the nose and down the throat to the stomach or more often to the first section of the small intestine so that medication and nutrients can be fed directly into the small intestine, bypassing the stomach completely. Like all forms of 'tube feeding', this tube is then attached to a pump that continuously trickles a nutrient formula into the digestive tract ); G and J Tubes (inserted through the abdominal wall directly into the small intestine); IV Nutrition (carries the constant risk of sepsis and organ damage as nutrients are given via IV to the bloodstream); Gastric Stimulator (much like a pacemaker for the heart, the Gastric Stimulator uses electric pulses from a small battery back to cause the stomach to contract and empty and is useful for some patients in easing symptoms)
There are many good websites to go to where you can find more information about Gastroparesis and other Digestive Tract Paralysis Conditions as well as places you can go to find other sufferers and support, both for yourself and family members.
- G-PACT - Gastroparesis Patient Association for Cures and Treatment- a legal non-profit in the United States of America who is striving to raise awareness of Gastroparesis and other Digestive Tract Paralysis Conditions. They also have support groups set up in many social online sites (like FaceBook) where hundreds interact daily to share support, tips and frustrations in a safe and understanding environment.
- Gastroparesis- Current Concepts and Considerations - an online article from the Medscape online Journal of Medicine in 2008 giving facts and figures about the number of people affected, costs of the condition and more.
- Gastroparesis- A Common Gastric Disorder - a PDF of the minutes from a meeting at the National Institute of Health in Bethesda, Maryland on April 2, 2004 discussing Gastroparesis.
- Gastroparesis Awareness - a small free website with some helpful information and facts about Gastroparesis including a page for friends and family and helpful kitchen tools.
While Gastroparesis is not a rare condition, it is incurable and people do die as a result of either the condition itself (from malnutrition leading to heart attacks and organ failure) or the available treatments (sepsis, organ failure, etc) and the lack of awareness is a huge problem for those who suffer from it.
Just to give an example of the rarity in comparison to the awareness-
- 1 in every 550 Americans have Crohns Disease
- 1 in every 500 Americans have Cerebral Palsy
- 1 in every 185 Americans have Lupus
- 1 in every 150 Americans have Autism
- 1 in every 25 people have some severity (from mild to severe) of Gastroparesis
People have heard of the other conditions listed, thanks to the awareness of those conditions in the general public and the Medical field.
Many of those estimated to be affected by Gastroparesis are un-diagnosed because their Doctors do not understand that Gastroparesis is not a rare condition or do not know enough about Gastroparesis to diagnose it or even recognize it... many Doctors thinking that it can only be caused by Diabetes.
No comments:
Post a Comment