Greater Richmond G.I. Support

Greater Richmond G.I. Support

Facts About Gastroparesis:

Gastroparesis is essentially partial paralysis of the stomach. It is commonly clumped into a Heading called Digestive Tract Paralysis. Other things in this group are Ileus (intestinal pseudo-obstruction) and Achalasia (affects motility of esophagus).

Gastroparesis reduces the stomach's ability to empty out its contents despite nothing being in there to hinder emptying (also known as mechanical obstruction).

This can be a temporary or chronic condition.

There are many types: that occur for a variety of reasons

Another term used for causes is Etiologies

Idiopathic (no known cause approx. 1/2 of all patients have this type)
Diabetic (can occur in both type 1 and type 2- approx. 40 percent of diabetics have some form a delayed emptying) This typically doesn't happen until after 5+ years with disease.
Scleroderma- this is an autoimmune disorder that really doesn't cause GP but rather induces the esophageal symptoms of heartburn or dysphagia (difficulty swallowing)
Viral (this is a type where it can go away spontaneously from 4 weeks to a year after having the virus) It's associated with a prior virus such as Rotavirus, Norwalk Virus{common occurence on cruise -ships} This can also cause severe dysautonomia.
Iatrogenic - Medication and Surgically Induced

Medications

Narcotics (very common)
Tricyclic Anti-depressants

These are the most common medications known to cause GP, or worsen those with GP. There are also some others, but these are the most familiar to the lay person.

Surgeries

Any prior thoracic or abdominal surgery that can lead to damage of the vagus nerve
Most common procedure that leads to vagal injury is Fundoplication
Roux stasis syndrome- happens after a Roux-En-Y anastomosis.
Variceal Sclerotherapy (for variceal bleeding)
Botox for Achalasia
Subtotal Colectomy for colonic inertia can reveal generalized dysmotility.

Autoimmune Gastrointestinal Dysmotility
Neurologic Disease
Rumination Syndrome-this mimics GP symptoms but it's really a behavioral disorder (so in reality this is not a cause for GP- but another thing to consider in those with a normal Gastric Emptying Study)
These next things are also linked to the above- Psychiatric Disease

(Depression, Anxiety, Eating Disorders, Psychogenic Vomiting, Side effect of Psychotropic Medication)

Symptoms

Classical ones: Nausea, Vomiting, Abdominal Pain, Early Satiety (feeling full after a couple bites), Bloating, and Weight loss/gain.

These symptoms are often worse in the post-prandial (after eating a meal), in the evening or in the morning for some patients. Warning: Gross Fact- The Emesis (vomit) may contain old (undigested) food eaten several hours before. The Abdominal pain is variable in quality but typically in the upper abdomen- this pain can also take on the component of Chronic Functional Abdominal Pain. Gastroparesis is also something to consider in patients with acid reflux that conventional management has not helped in reducing.

At left: John Clarke M.D. , motility specialist at Stanford Medical Center. Formerly at Johns Hopkins Medical Center

Physical Examination: What to expect?

During an examination by a qualified professional they will do a normal workup overgoing some of the following or all of it:

Updated healthy history: a doctor may ask to be updated on new developments including job and relationships, as well as medications or supplements.
Vital sign checks: This includes taking a blood pressure reading, and checking heart rate and respiratory rate. At a minimum, blood pressure should be checked every two years.
Visual exam: the Physician will review a patient’s appearance for signs of any potential conditions.
Physical exams: A thorough physical exam including checking the head and neck, abdominal area, hair, nails, and limbs. The doctor will also listen to the heart and lungs.
Laboratory tests: To complete the physical, the doctor may draw blood in order to run several laboratory tests. These can include a complete blood count (CBC for short) and blood chemistry panel. This helps detect irregularities in the blood that might indicate a larger problem. They may request a lipid panel, or cholesterol test if a patient has an increased risk of heart attack, heart disease, or stroke.

As for the abdominal portion of the exam the patient will often present with epigastric tenderness (also known in layman's terms as upper middle portion of abdomen). Sometimes also a succussion splash will be heard in the left upper quadrant (things a physician will try to hear). In those with diabetes, other signs of autonomic dysfunction may be noted; such as orthostatic hypotension (blood pressure lowers upon rising). Physicians uncovering this disorder really need to be Detectives.