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Gastroparesis

As a leading diabetes center in the Pacific Northwest, Virginia Mason treats a high number of patients with gastroparesis, offering state-of-the-art therapies that include gastric stimulators. Virginia Mason has been ranked consistently among the top five medical centers in Washington state for treatment of GI disorders. To schedule an appointment, call (206) 223-2319.

Gastroparesis is a medical term for delayed emptying of stomach contents. It occurs from damage to the vagus nerve that extends from the brain to the stomach, and is usually associated with type 1 and type 2 diabetes. Unregulated high blood sugar (glucose) levels of diabetes damage nerves and blood vessels throughout the body, including the vagus nerve in the gastrointestinal tract. Idiopathic gastroparesis is a similar condition in which the exact cause is unknown. It is treated in the same manner as diabetes-related gastroparesis.

Symptoms of Gastroparesis

Symptoms of gastroparesis can range from mild to severe and include the following:

  • Fullness
  • Gastroesophageal reflux disease (GERD)
  • Nausea
  • Vomiting
  • Stomach pain from undigested food, obstruction
  • Abdominal distension (bloating)
  • Loss of appetite
  • Weight loss
  • Uncontrolled blood glucose levels

Serious Complications

Food that remains in the stomach too long can harden into a ball called a bezoar that can block passage to the small intestine. Additionally, bacteria can grow on undigested food that remains in the stomach.

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Diagnosis of Gastroparesis

Your gastroenterologist will conduct a medical history and physical exam, and will listen to a description of your symptoms. He or she may suspect gastroparesis if you have long-standing diabetes. Your gastroenterologist also will have you undergo one or more diagnostic procedures and will want to rule out cancer of the stomach, or another type of cancer, as the cause of your symptoms.

  • Upper Endoscopy
    An upper GI or esophagogastroduodenoscopy (EGD) is a minimally invasive, endoscopic procedure that allows your physician to view the esophagus, stomach and part of the small intestine. An endoscope is a thin flexible tube that contains miniaturized instruments, including a camera. Once you have been given a mild anesthetic for your throat and a sedative, your gastroenterologist will gently guide the endoscope down the esophagus and into the stomach, and take pictures that are transferred to a video monitor. Your gastroenterologist is also able to take tissue samples (biopsy).
     
  • Gastric Emptying Scintigraphy
    For this procedure, a solid meal is ingested that has been labeled with a low dose of a radioactive substance called technetium. In this way, the passage of the meal can be measured at various time points and the diagnosis of delayed emptying of the stomach or gastroparesis can be made. This is a physiologic test and is mandatory to confirm the diagnosis of gastroparesis. Measuring the emptying of liquids is not diagnostic.

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Treatment of Gastroparesis

Your gastroenterologist, in consultation with an endocrinology specialist at Virginia Mason, will first want to control your blood glucose levels with medications, or increase the diabetes medications you are currently taking. Our gastroenterologists then utilize a number of treatment modalities for patients with gastroparesis.

  • Medical Therapy
    Your gastroenterologist may prescribe one or more "promotility" medications to stimulate stomach muscle contractions. These medications also help to reduce nausea and vomiting associated with gastroparesis.
     
  • Dietary Therapy
    Because gastroparesis is a chronic condition associated with damage to the vagus nerve, a dietitian may recommend dietary changes to aid in successful emptying of food from the stomach. These recommendations include eating certain foods and avoiding others, or eating smaller portions.
     
  • Surgical Therapy
    If your symptoms cannot be controlled with medications, your gastroenterologist may recommend that you have a gastric stimulator implanted. A gastric stimulator stimulates and regulates the electrical activity in the nerves and muscles of the stomach, allowing the muscles to contract and digest food, and reduces nausea, vomiting and sometimes pain. Implantation of the device, about the size of a small pager, is done as a minimally invasive procedure by a Virginia Mason surgeon, and has been successful for most patients.
     
  • Treatment of Bezoars and Bacteria Infections
    If a bezoar — a clump of hardened food — remains in the stomach, it can be treated with medicines inserted through an endoscope that dissolve it. Bacterial infections are treated with antibiotics.

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