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Gastroparesis is the blockage of the outlet of the stomach that is functional in nature. This means there is no physical blockage but the stomach has become paralyzed in such a way as to limit the outflow of the gastric contents. Gastroparesis is generally not all that serious and can be managed in many different ways.

The stomach has a way of functioning that propels the food through its lumen. The stomach consists of two parts, the antrum or lower portion and the fundus or upper portion. The upper portion just collects the food and the lower portion grinds the food and breaks it up into small enough portions so that the duodenum, which is much narrower, can accept the food. The stomach has an electrical pacemaker, similar to the heart. It is located about a third of the way down the stomach and helps to send electrical signals to gastric smooth muscle so that the food is propelled down the stomach via smooth muscle contractions. The wave of muscle activity goes down the stomach from the upper part to the lower part. The stomach contracts about three times per minute and is innervated by the vagus nerve.

Gastroparesis happens when the electrical wave of the stomach slows, allowing it to contract less frequently. The food just remains in the stomach and goes nowhere or just dribbles into the duodenum.

There are a number of reasons why you can get gastroparesis. The most common cause of gastroparesis is diabetes, which does damage to the vagus nerve. Abnormalities of the adrenal gland and the thyroid gland can also cause gastroparesis. It is also true that scars and fibrous tissue from tumours and ulcers can block the outlet of the stomach and can look like gastroparesis. There are medications that can weaken stomach muscles, including tricyclic antidepressants like Elavil, medications that are calcium channel blockers, such as Cardizem and Procardia, Bentyl, Levsin, narcotic medications, and hyoscyamine.

Previous stomach surgery can contribute to the formation of gastroparesis as can the diseases anorexia or bulimia. If you have neurologic diseases such as a stroke, Parkinson's disease and brain injury you can have gastroparesis. Lupus and scleroderma, both autoimmune diseases, can cause secondary gastroparesis. Unfortunately, up to 40 percent of cases of gastroparesis have no known cause.

Some of the above disorders affect the stomach's pacemaker while others directly affect the muscle of the stomach. The muscles can become so weak that they do not respond to the normally acting pacemaker.

Symptoms of gastroparesis include feeling full after eating just a few bites of food. You can feel bloating, nausea and excessive belching along with a nagging pain or ache in the upper abdomen. The pain is not sharp or crampy like ulcer pain. You can feel vomiting, regurgitation of stomach contents, heartburn or the feeling of fluid in the mouth. Acid reducers tend not to work very well to control the pain or other symptoms.

The diagnosis of gastroparesis is made with a complete history and physical examination. Blood tests can show malnutrition in rare cases. The examination is normal unless there is active pain. The upper GI barium x-ray can show a lack of normal peristalsis in the stomach but can look normal. The upper GI endoscopy may show a lack of peristalsis and may show normal findings. Ulcers tend not to be found in these cases but may be incidentally found. The best test of stomach emptying is called the stomach emptying test. Food is given with a radio-opaque marker or radioactive marker. The food is measured on a scanner and is seen passing through the stomach into the duodenum. It tracks the length of time it takes until the stomach is emptied completely, usually around 90 minutes. Some doctors can do an electrogastrogram, which measures the electrical activity of the stomach pacemaker and muscle.

The treatment of gastroparesis includes medication that stimulates the function of the heart muscle. It also means that you must keep your blood sugar in good control or treat a low thyroid condition. A low fat diet can be followed as fat decreases the emptying of the stomach. High fiber foods must be restricted and many small feedings are better than larger meals taken two to three times per day.

Medications are taken about a half hour before eating and allow the drug to work on the pacemaker or the stomach muscle. Reglan is used to stimulate muscle contractions as well as the medication Motilin. Urecholine is also used but doesn't seem to work over the long haul.

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