Bhatti Heartburn Center is the only institution in the Twin Cities area to offer a comprehensive, multi-disciplinary approach for the treatment of gastroparesis. This is a chronic, debilitating disease in which the stomach cannot empty the solid food well into the small intestine. characterized by delayed gastric emptying of solid food in the absence of a mechanical obstruction. The condition is related to damage to the stomach nerves or muscles, which affects their normal strength and coordination, thus slowing the progression of food through the digestive system. It may be caused by secondary to diabetes, prior stomach or esophagus operations surgical, or related to a viral illness or autoimmune condition, such as amyloidosis or scleroderma. Patients often experience chronic intense nausea, chronic vomiting, bloating, feeling full soon after starting to eat, heartburn or gastroesophageal reflux (backup of stomach contents into the esophagus) or weight loss.
- Upper Endoscopy. Upper Endoscopy is a procedure used to view the esophagus, stomach, and part of the small intestine. It can detect other causes of slow stomach emptying, such as stomach blockage due to a growth or large ulcer. In patients with gastroparesis, the endoscopist is often able to see signs of reflux or food that is still present in the stomach from a prior meal.
- Gastric Emptying Study. The 4-hour solid phase gastric emptying study is the most commonly used test to diagnose gastroparesis. This radiologic study determines the time is takes food to move through the stomach. Patients are given a meal tagged with a radioactive isotope. Serial images of their stomach are taken until up to 4 hours after ingestion, thus calculating the amount of food which does not empty at various time points.
Gastroparesis can cause several problems:
- Prolonged sitting of food into the can lead to fermentation and growth of bacteria.
- Since food takes a long time to leave the stomach, sometimes it can harden into a solid mass called a bezoar. Bezoars may cause blockages in the stomach that keep food from passing into the small intestine.
- Inability to eat or drink due to severe vomiting may lead to dehydration episodes, sometimes requiring hospital admission. These could be particularly worrisome in patients with diabetes, who can develop a condition called diabetic ketoacidosis.
- Weight loss and malnutrition (poor nutrition) may happen in patients who are unable to get necessary amounts of calories for a long time.
Unfortunately, gastroparesis is an uncurable disease. The goals of treatment are to alleviate the symptoms and improve patients’ quality of life.
- Diet and Lifestyle Modifications. Diet modifications are advised in all patients with gastroparesis. Eating small portions and avoiding foods reach in fat content may help improve the symptoms. Liquids and low-residue foods are better tolerated than solids and foods with high fiber content. In patients with diabetes, good blood sugar control is important, as this reduces the severity of symptoms.
- Medication. Various medications are used to control the symptoms of gastroparesis, such as nausea or vomiting (e.g. Zofran) or to help the stomach contract and help move the food out towards the small intestine (e.g. Reglan, Erythromycin). Anti-acid medication also helps in patients with associated gastro-esophageal reflux disease.
Surgical interventions are reserved for patients with severe cases of gastroparesis, who are not responding to medical interventions.
- Gastric Electrical Stimulation. Enterra II therapy or gastric neurostimulator implantation (AKA “gastric pacemaker”), is a gastroparesis procedure in which low-amplitude electrical impulses are transmitted to the stomach by a battery implanted under the skin. Although this treatment does accelerate the stomach emptying, it helps control the symptoms of nausea and vomiting, and overall improves the patients’ quality of life. The procedures can be performed laparoscopically or robotically.
- Pyloroplasty. Pyloroplasty is another treatment option for gastroparesis, which works better in patients with predominant symptoms of bloating and fullness, rather than nausea or vomiting. It involves division of the pylorus sphincter, which separates the stomach from the first portion of the small intestine, and results in faster emptying of the stomach.
- Subtotal Gastrectomy. This operation is reserved for patients who failed all other surgical options for gastroparesis. It is a more involved operation, in which most of the stomach is removed from the body. The top part of the stomach, which is preserved, is then connected with a loop of small intestine. It is efficient in controlling gastroparesis-related symptoms, but irreversible.
- Sleeve Gastrectomy and Gastric Bypass
Some bariatric operations are occasionally effective in selected patients with gastroparesis, particularly if they are also overweight.