Rare Stomach Condition Often Misdiagnosed as Acid Reflux

It’s Gastroparesis Awareness Month! If you just said, “What?” You’re not alone. Currently about 1.5 million Americans suffer from gastroparesis (gas-tro-par-EE-sus) which slows or stops the movement of food from the stomach to the small intestine.
Gastroenterologist Michael Cline, DO, at the Cleveland Clinic says that primary care physicians, and even gastroenterologists, frequently overlook this underdiagnosed condition and that it is sometimes initially diagnosed as an ulcer, heartburn or an allergic reaction.
“In current data, up to 40 percent of people with acid reflux have some sort of delay in gastric emptying. So that’s a fairly large number when you look at the millions of Americans who have acid reflux,” Dr. Cline says.
So, what is it? “Normally the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract,” explains the National Institute of Diabetes and Digestive and Kidney Diseases. “The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.
“The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally.”
Temple University Hospital in Philadelphia’s website says that the symptoms of this disease are severe, chronic nausea and vomiting. The patient may feel full after eating just a small amount and suffer abdominal pain that cannot be controlled by typically prescribed medications.
“Often, patients require some form of feeding tube to ensure adequate nutrition,” TUH says. Gastroparesis can be managed, but the disease cannot be cured. Type 1 diabetes is a major cause of the disorder, but sometimes, there is no known cause.”
Statistics vary from website to website, but the claims are that 60 to 80 percent of gastroparesis cases are idiopathic (cause unknown), with 10 to 20 percent attributed to diabetes patients and much smaller numbers for those with vagal nerve injury, a virus, complications of surgery, an autoimmune disorder such as lupus or scleroderma or those having a side-effect from medication.
Gastroparesis is confirmed by a couple of tests. With a radioisotope gastric emptying scan the patient eats food containing a slight radioactive substance that shows up on a machine that detects the image of the food in and leaving the stomach. If after two hours there’s still food in the stomach, gastroparesis is diagnosed.
“To rule out causes of gastroparesis other than diabetes, a physician may do an upper endoscopy or an ultrasound. An upper endoscopy guides a long, thin flexible tube called an endoscope down the esophagus and into the stomach to look at the lining of the stomach to check for any abnormalities. An ultrasound uses soundwaves to outline and define the shape of the gallbladder and pancreas to rule out gallbladder disease or pancreatitis,” TUH explains.
Gastroparesis is a relapsing condition in that it comes and goes. However, early diagnosis makes for easier treatment which can be as simple as diet and medications. NIDDK says that eating habits can help control the severity of symptoms.
“A health care provider may suggest eating six small meals a day instead of three large ones. If less food enters the stomach each time a person eats, the stomach may not become overly full, allowing it to empty more easily,” NIDDK says.
Patients will most likely be told to avoid high-fat, fibrous foods and a person suffering with severe symptoms will most likely be advised to eat a liquid or pureed diet. A dietitian can help with meal planning. If diet and medication doesn’t alleviate the symptoms, then surgery will most likely be advised.
Untreated gastroparesis can lead to severe dehydration due to persistent vomiting, malnutrition due to poor absorption of nutrients, developing gastroesophageal reflux disease, bezoars (solid mass of indigestible material that can cause a blockage), difficulty managing blood glucose levels and, rather obviously, a decreased quality of life.
Kathy Hubbard is a member of Bonner General Health Foundation Advisory Council. She can be reached at 264-4029 or [email protected].