Gastroparesis: improving digestive motility through root cause resolution

Gastroparesis symptoms

Symptoms can vary from person to person, with some people unable to eat or drink anything when symptoms are severe, and others only taking small amounts of food. Specific symptoms and severity may change over time and may include:

• Nausea
• Vomiting undigested food
• Abdominal pain
• Bloating
• Feeling full, quickly/ after eating very little
• Poor appetite
• Reflux, or heartburn
• Diarrhoea, usually at night
• Weight loss‍

Because these symptoms can overlap with other digestive conditions, such as functional dyspepsia, it’s important to work with a practitioner experienced in digestive health to identify and address the underlying causes.

Left untreated or poorly managed, gastroparesis symptoms may result in dehydration and malnutrition. Food remaining in the stomach can contribute to bacterial overgrowth such as SIBO (small intestinal bacterial overgrowth), LIBO (large intestinal bacterial overgrowth), and dysbiosis of the gut microbiome which can contribute to worsening symptoms. Dehydration can cause:

• Muscle weakness
• Reduced urine output
• Weakened immune health/inhibited wound healing
• Electrolyte imbalances
• Reduced blood pressure
• Increase in heartbeat
• Shallow/rapid breathing

Constipation can be a complication of gastroparesis, which can lead to the formation of bezoars, which are hardened food masses which obstruct the digestive tract requiring surgical intervention. Bezoars can cause nausea, vomiting and pain and left untreated, can be life-threatening.

Managing blood glucose levels for diabetic patients can become harder with gastroparesis.

Alternative treatment for gastroparesis from a functional medicine-trained naturopath will include holistic care that can treat, manage and/or prevent these complications.

Gastroparesis causes

Gastroparesis is still being researched, however the cause is understood to be related to disrupted nerve signals to the stomach. The vagus nerve is responsible for stimulation of muscles in the stomach wall which contract to push food into the small intestines. It also stimulates gastric secretions required for digestion and absorption of nutrients. When this signal is disrupted, food moves too slowly out from the stomach, resulting in symptoms like nausea, bloating and vomiting. Other problems such as being too sensitive to these signals, are also thought to play a part in this condition.

The main causes of gastroparesis are:

• Idiopathic – (unknown origin), around 30% of cases fall into this category
• Post-viral infection
• Chronic disease-related – most commonly Type 1 and Type 2 diabetes, or autoimmune diseases, scleroderma, multiple sclerosis and Parkinson’s disease, lupus, hypothyroidism, or cerebral palsy
• Post-surgical – such as a vagotomy for peptic ulcers, gallbladder surgery, bariatric surgery or gastric sleeve gastrectomy
• Drug-induced – medications that alter smooth muscle function can contribute to gastroparesis, e.g. diabetes medications, proton pump inhibitors (common medications used to treat reflux) and organ transplant anti-rejection drugs, narcotics and pain medications

Medications, stress and nutrient deficiencies contribute to other aspects of poor digestive function, including poor nutrient absorption, microbiome disruption, constipation and diarrhoea, compounding symptoms.

Fluctuating hormones in both men and women affect gastric emptying. In particular, women during the luteal phase of the menstrual cycle generally experience slower gastric emptying. Hormones that affect gastric emptying are:

• Progesterone and oestrogen in women
• Ghrelin – which stimulates appetite
• Motilin – which stimulates contractions of the digestive system

Testing for gastroparesis

Testing for gastroparesis is usually assessed via:

• Blood tests and/or urine tests to check for malnutrition, dehydration, inflammation or infection
• Clinical examination by your doctor with consideration given to your medical history
• Other investigations such as an endoscopy, ultrasound to explore/rule out structural issues that may be causing symptoms

Newer technologies such as the Smart Pill, an electronic device that is swallowed, can assess how fast food travels through the digestive tract. A breath test may also be used to assess gastric emptying rate.

Treatment of gastroparesis – the conventional approach

Your GP will monitor symptoms regularly and refer you to a dietician to avoid nutrient deficiencies. Depending on the severity of symptoms, your GP or dietician may recommend dietary changes such as:

• Eating smaller, more regular meals and drinks
• Ensure you are eating sufficient protein and calories
• Cook foods until soft and easy to chew, and chew food well
• Avoid high-fibre foods that may make you feel full, and slow gastric emptying
• Avoid high-fat foods that slow gastric emptying, except full-cream dairy and yoghurt
• Avoid fluids within 30 minutes before or after meals
• Avoid lying down for at least 1 hour after eating
• Avoid carbonated drinks
• Meal preparation changes e.g. puree/blending meals or liquid foods
• Prepared protein or energy supplements such as Sustagen

Medications in intravenous, pill, liquid or nasal spray forms may be prescribed to:

• Stimulate muscle contraction (prokinetics) such as metoclopramide (Reglan), domperidone (Motilin) and erythromycin (EES)
• Antiemetics to help reduce nausea and vomiting such as ondansetron (Zofran), promethazine (Phenergan) and prochlorperazine (Compazine)
• People who experience sensory abnormalities may be prescribed tricyclic antidepressants
• Pain medications – can be more challenging as they can make gastroparesis symptoms worse on their own, and when interacting with other medications. Opiate pain medications slow digestive function, and tend to not be suitable for gastrointestinal pain, or may lead to addiction or dependency and inadvertent overdose

All of these medications can cause side effects, and your GP will determine if the benefits outweigh the risks of taking them, particularly in the long term.

Where symptoms are severe, and patients are unable to maintain adequate nutrition, a feeding tube may be required:

• Jejunostomy tube – inserted through the abdomen into the upper part of the small intestine or jejunum
• Gastric drainage tube –  inserted into the stomach via the abdomen to drain stomach contents
• Parental support may be required where nutrients are intravenously injected into a vein, however this very expensive treatment may have short and long term complications

Other treatments may include:

• Botox injections into pyloric muscles (around the sphincter below the stomach) for relaxation, with varying results
• Surgery to widen the pyloric valve
• Gastric electrical stimulation – similar to a pacemaker for the gastric muscles, inserted beneath the skin of the abdomen and is programmable. It is expensive and does not work for all patients
• In some cases, referral to a psychologist may be made to help manage pain symptoms

However, these measures all manage symptoms without addressing the underlying cause of vagus nerve dysfunction, and complications can develop from long-term medication use. This is why many people in Australia with gastroparesis would like to ensure optimal health with natural support and treatments.

A functional medicine practitioner can help you find relief from symptoms and improve overall digestive function to help you achieve optimal health.

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