Gastroparesis is a chronic gastric disorder in which food
moves more slowly than normal through the stomach, in
the absence of mechanical obstruction, resulting in nausea
and vomiting and significantly affecting quality of life. The
effect of gastroparesis on physical well being can be devastating
and lead to malnutrition, dehydration, altered blood
glucose level and significant decrease in work performance
and social activities.
Causes of Gastroparesis
Diabetes, especially in those patients who have had it for
more than ten years, is the most common cause of gastroparesis.
Gastroparesis is present in approximately 30 percent of
patients with Type 2 diabetes. Other causes are vagus nerve
damage after stomach surgery, esophageal surgery, Parkinson’s
disease and vascular disorders. In a significant number
of patients, the cause of gastroparesis cannot be determined
and it is called idiopathic gastroparesis. Patients with idiopathic
gastroparesis are typically young or middle aged and
approximately 90 percent are women.
Symptoms
Nausea and vomiting typically occurring a few hours after
eating are the most common symptoms. This prevents a person
from eating normally and may lead to dehydration, malnutrition
and electrolyte imbalance. Other symptoms may
include bloating, early fullness after eating and heartburn.
Diagnostic Tests
Upper Endoscopy (EGD): This test is necessary to
exclude other conditions such as gastric ulcer and gastric
outlet obstruction. A trained gastroenterologist passes a
thin, flexible tube with a camera on the end through the
patient’s mouth after mild sedation and examines the inside
of the stomach.
Gastric Emptying Test (GET): This X-ray test determines
the speed with which food empties from the stomach
and enters into the small intestine. A patient eats a meal,
commonly a scrambled egg containing a small amount of radioactive
material, and the food is viewed traveling through
the gastrointestinal system. GET is most accurate way to
diagnose gastroparesis.
Treatment
Treatment options are limited, with only a few medicines
available to help. Therapy includes dietary measures, prokinetic
agents, Reglan, Erythromycin and anti-emetics such as
Phenergan and Compazine. Injections of Botox endoscopically
into the pylorus provide some relief of symptoms, at
least transiently. One study showed reduction of symptoms
for five to six months.
Enterra Therapy
Enterra is a gastric stimulation device about the size of a
pocket watch surgically placed in the patient’s abdominal
wall and connected to two electronic leads implanted in
the stomach muscle. Enterra is indicated in patients with
chronic drug refractory symptoms due to gastroparesis of
diabetes or idiopathic origin.
The Enterra device sends mild electrical impulses to
stimulate gastric muscle and nerves to help move food from
the stomach to the small intestine and control symptoms of
nausea and vomiting.
Post-Implant
During an office visit, the gastroenterologist can adjust
the neurotransmitter and customize therapy for the patient’s
needs using a hand-held programmer. Impact in symptoms
can be seen in as soon as a few days, or in some patients it
can take up to three months. Enterra therapy is not a cure,
but with it, patients are offered new hope for relief from this
debilitating and chronic condition. Until now, Memphis and
Mid-South patients had to travel to Vanderbilt University
in Nashville or to Mississippi to have the surgery and again
to have the device adjusted. Now Dr. Siddiq is offering these
patients new hope at a chance to live a normal life.
