Tags: Medical Cannabis
Gastroparesis is also often referred to as delayed gastric emptying. The term “gastric” refers to the stomach. Usually, the stomach voids its contents in a disciplined fashion into the small intestine. In gastroparesis, the muscle contractions that allow the food to move along the digestive tract do not function normally and the stomach does not empty quickly enough. Gastroparesis is defined by long-term symptoms combined with postponed stomach emptying in the absence of any observable obstruction or blockage. The delayed stomach emptying is confirmed by a test.
The cause of gastroparesis is often unclear. However, it has been observed that in many cases, gastroparesis is caused by damage to the vagus nerve (an important link from the gut to the brain.)
The vagus nerve is responsible for managing the intricate mechanisms in your digestive tract, including communicating to the muscles in your stomach when to contract and move food into the small intestine. An impaired vagus nerve cannot signal normally to your stomach muscles. This causes food to remain in your stomach for a longer period of time, rather than pushing into your small intestine to continue the digestion process.
Factors that cause vagus nerve damage can be attributed to diseases, such as diabetes, or by surgery to the stomach or small intestine.
It is important to understand that many people with gastroparesis don't show any observable signs or symptoms. However, if you are showing signs of the following symptoms, consult your physician:
Physical exams will be performed by a doctor if gastroparesis is suspected. Inform your doctor about any medications you are taking. A test that measures how fast the stomach empties is done to confirm the diagnosis. The following tests are performed by doctors to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include:
This test involves eating a light meal that has a small amount of radioactive material. The radioactive material is monitored by a scanner that identifies its movement. This enables the doctor to monitor the rate/speed of gastric emptying.
You'll need to stop taking any medications that could slow gastric emptying. Ask your doctor if any of your medications might slow your digestion.
This process is done to examine your upper digestive system — your esophagus, stomach and beginning of the small intestine (duodenum). A microscopic camera is placed on the tip of a long, malleable tube. This procedure can also diagnose other digestive conditions, such as peptic ulcer disease or pyloric stenosis, which all have similar symptoms to gastroparesis.
This procedure uses sound waves to develop images of masses within your body. Ultrasounds assist in diagnosing whether problems with your gallbladder or your kidneys could be the root of your symptoms.
This is a series of X-rays in which you drink a white, chalky liquid (barium) that coats the digestive system to help abnormalities show up.
The first step in treating gastroparesis is treating the root cause or underlying condition. If it is diabetes your doctor will work with you to control it. A dietitian might suggest that you try to:
Medications to treat gastroparesis may include:
Unfortunately, in severe cases, some patients may be unable to handle any food or liquids. In these instances doctors may recommend a feeding tube (jejunostomy tube) be inserted in the small intestine.
Doctors may also recommend a gastric venting tube to help alleviate pressure from gastric build-up. Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. This procedure is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can't be managed any other way. Some individuals may require an IV (parenteral) feeding tube that goes directly into a vein in the chest.
If you're a smoker, stop. Your gastroparesis symptoms are less likely to improve over time if you keep smoking. People with gastroparesis who are overweight are also less likely to get better over time.
According to Minnesota Gastroenterology Clinic, the diet plan below consists of three phases and is designed for people with gastroparesis to help improve the way food passes through the stomach. Talk to your healthcare provider before making any dietary changes.
Phase 1 is a strict liquid only diet. It consists of nutrient rich fluids that assist in providing caloric intake while putting very little strain on the digestive system.
Phase 2 builds on Phase 1 by allowing the patient a small amount of fat and fibe. Foods high in fat prevent the stomach from emptying, so fat intake should be limited to 40 grams per day.
Phase 3 is meant to be a long-term diet for gastroparesis. This phase includes all the foods allowed in Phase 2 and incorporates additional fat and fibrous foods into the diet. Fibrous foods should be cooked well so they are tender and easy to digest and fat intake should be limited to 50 grams per day.
Each patient is different, and the phasing of the diet should be prescribed and monitored by your physician. Due to the low nutrition content of Phase 1, if a patient needs to remain on this phase for more that 3 days, they may need to also be put on an IV. If your symptoms are still active, check in with your healthcare provider for direction. Phases 2 & 3 can be prescribed for 4-6 weeks at a time as long as the patient is checking in with a Dietitian or healthcare provider every 2-4 weeks.
Below is a list of recommended foods and foods to avoid, developed by the Minnesota Gastroenterology Clinic for people with gastroparesis. Always consult your health care professional before making any changes to your diet if you have gastroparesis.
Food Group | Recommended | Avoid |
---|---|---|
Milk & Dairy products | • Skim milk • Fat-free non-dairy milk substitutes • Fat-free yogurt without fruit/seeds (plain, lemon, vanilla, etc.) | • All others |
Vegetables | • Vegetable juice: V-8, tomato | • All raw and cooked vegetables |
Breads, Cereals & Grains | • Cooked, refined cereals: Cream of rice, cream of wheat, grits, farina • Plain saltine, oyster, graham and animal crackers | • All others |
Meat & Meat Substitutes | • None | • All |
Fats & Oils | • None | • All |
Sweets & Desserts | • Gelatin (Jell-O) • Popsicles, fruit ice • Sugar, honey, sugar substitutes • Fat-free custard and pudding • Milkshakes made with skim milk or fat-free nondairy substitutes • Fat free ice cream and sherbet | • All others |
Fruits & Juices | • Juices without pulp: apple, cranberry, grape | • Citrus juices, juice with pulp, prune juice • All fresh, frozen, canned and dried fruits |
© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145
Breakfast | Lunch | Dinner |
---|---|---|
4 oz juice 1 cup cooked cereal 4 oz skim milk 8 oz coffee or tea | 4 oz juice 1 cup fat-free broth 4 plain saltine crackers ½ fat-free pudding | 4 oz juice 1 cup strained cream soup made with skim milk 4 plain saltine crackers ½ cup gelatin |
Morning Snack | Afternoon Snack | Evening Snack |
6 oz fat-free yogurt | 8 oz nutritional supplement such as Boost or Ensure | ½ cup fruit ice |
© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145
Food Group | Recommended | Avoid |
---|---|---|
Milk & Dairy products | • Skim and 1% milk • Fat-free and low-fat non-dairy milk substitutes • Fat-free and low-fat yogurt without fruit/seeds • Low-fat cheeses & cottage cheese | • Whole and 2% milk and milk products • Full fat non-dairy substitutes |
Vegetables | • Vegetable juice: V-8, tomato • Well-cooked vegetables without skins/seeds/hulls (potatoes without skin, carrots, beets, green beans, squash, asparagus, etc.) | • Raw vegetables • Cooked vegetables with skins/seeds/hulls (corn, peas, broccoli, cauliflower, etc.) |
Fruits & Juices | • Juices without pulp: apple, cranberry, grape • Canned fruits without skin • Fresh ripe banana and seedless melon | • Juice with pulp and prune juice • Canned fruits with skins • All other fresh and dried fruits |
Breads, Cereals & Grains | • White bread, English muffins, bagels, biscuits, and other refined bread products • Pancakes, waffles, refined dry cereals (Rice Krispies, Corn Flakes, Special K, etc.) • Cooked, refined cereals: Cream of rice, cream of wheat, grits, farina • White rice, white pasta & egg noodles • Saltine, oyster, graham and animal crackers • Pretzels | • Whole grain breads and bread products made with bran, rye with seeds, or whole wheat • Oatmeal, bran cereals, granola, shredded wheat • Brown rice, wild rice, oats, barley, and quinoa, whole wheat pasta • Popcorn • Breads or rolls with nuts, seeds, or fruit |
Meat & Meat Substitutes | • Eggs • Creamy peanut butter - limit to 2 tbsp/day • Tofu | • Beef, poultry, pork, lamb, fish • Dried beans, peas & lentils • Nuts, seeds & crunchy peanut butter |
Fats & Oils | • Any tolerated - limit to 2 tbsp/day | • None |
Sweets & Desserts | • Gelatin (Jell-O), Popsicles, fruit ice • Sugar, honey, sugar substitutes, jelly and seedless jams, hard candy • Fat-free and low-fat custard, pudding, ice cream, sherbet, and frozen yogurt • Milkshakes made with skim milk or low-fat milk products/non-dairy substitutes | • Full-fat desserts (cakes, cookies, pies, ice cream) • Desserts, jams and candies containing nuts, seeds, coconut, dried fruits, or fruits with skins |
Beverages | • All | • None |
Soups | • Fat-free or low-fat broth & bouillon • Broth soups with rice/noodles and allowed vegetables • Cream soups made with skim or 1% milk | • Broths containing fat • Soups made with cream, whole or 2% milk |
© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145
Breakfast | Lunch | Dinner |
---|---|---|
1 cup dry cereal 4 oz skim milk 1 small ripe banana 8 oz coffee or tea | 1 cup tomato soup made with skim milk 4 plain saltine crackers ½ cup gelatin 4 oz juice | 1 cup Campbell’s chicken noodle soup 4 plain saltine crackers ½ cup canned fruit (in juice) 4 oz skim milk |
Morning Snack | Afternoon Snack | Evening Snack |
1 slice white toast 2 tbsp smooth peanut butter | 1 string cheese 1 oz pretzels | ½ cup fat-free sherbet |
© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145
The following foods may be added to the foods allowed in Phase 2:
Food Group | Recommended | Avoid |
---|---|---|
Vegetables | • Raw vegetables without skins/seeds/hulls | • Raw and cooked vegetables with skins/seeds/hulls |
Fruits & Juices | • Juices • Fresh and canned fruits without skins | • Fresh fruit with skins • Dried fruit |
Meat & Meat Substitutes | • Lean, tender cuts of beef, pork, poultry, and lamb • Fish, canned tuna | • Fatty cuts of beef, poultry, pork, lamb |
Fats & Oils | • Any tolerated – limit to 2 tbsp/day | • None |
Soups | • Fat-free or low-fat broth & bouillon • Soups with allowed foods | • Broths containing fat • Soups made with cream or whole milk |
© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145
Breakfast | Lunch | Dinner |
---|---|---|
1 slice white toast with 1 tbsp seedless jelly 2 eggs scrambled 4 oz juice 6 oz fat-free Greek yogurt 8 oz coffee or tea | 3 oz canned tuna (packed in water) 2 tbsp light mayonnaise 2 slices white bread ½ cup canned fruit (in juice) 4 oz skim milk | 3 oz baked chicken breast 1 medium skinless baked potato 1 tbsp fat-free sour cream ½ cup cooked carrots 1 white dinner roll with1 tbsp margarine 4 oz juice |
Morning Snack | Afternoon Snack | Evening Snack |
2 large graham cracker squares 4 oz skim milk | 1 string cheese 1 small ripe banana | ½ cup low-fat vanilla frozen yogurt |
Citations:
Parkman HP. Idiopathic gastroparesis. Gastroenterol Clin North Am. 2015 Mar;44(1):59-68.
Wadhwa V et al. Healthcare utilization and costs associated with gastroparesis. World J Gastroenterol. 2017 Jun 28;23(24):4428-36.
Woodhouse S et al. Psychological controversies in gastroparesis: A systematic review. World J Gastroenterol. 2017 Feb 21;23(7):1298-309.
Yu D et al. The burdens, concerns, and quality of life of patients with gastroparesis. Dig Dis Sci. 2017 Apr;62(4):879-93.
You're likely to first see your primary care doctor if you have signs and symptoms of gastroparesis. If your doctor agree that your symptoms point to gastroparesis, you may be referred to a gastroenterologist ( a specialist in digestive diseases.) You may also be referred to a dietitian who can help you manage your diet plan.
Because appointments can be quick, it's important to be well-prepared. To get ready, try to:
Prepare a list of questions ahead of time to ensure that you optimize your time with your doctor or specialist. Take this list of questions to ask your doctor if you're worried you have gastroparesis with you to your next appointment:
Gastroparesis is a debilitating stomach disease for which there is no cure. However, there are a few medications for gastroparesis that may help mask symptoms and make life more manageable.
Despite the debilitating nature of the disorder, gastroparesis is sorely lacking in available resources for patients in the way of education and awareness. So, we (successfully) petitioned this year to make August the official gastroparesis awareness month. In our efforts to raise both funds for research and awareness this month, we also wanted to develop some resources that we felt would be an asset to someone who is newly diagnosed.
CDHF worked together with gastroparesis patient and advocate; Jennifer Ouellette, to put together a list of medications for gastroparesis. This detailed and comprehensive list will walk you through each medication, its uses, the potential side effects, and risks, along with some insights from Jennifer herself.
If you're newly diagnosed and would like a deeper look into what medications for gastroparesis might make an appearance in your treatment plan, feel free to take a read or share with your doctor.
This list of medications for gastroparesis is meant for general information only and is not intended to replace any advice you may have already received from your healthcare practitioner.
Is one of the most commonly prescribed medications for gastroparesis, and usually the first treatment option that is offered. It does pose cardiac risk so it is recommended to have an electrocardiogram before starting and to continue to have cardiac activity monitored while on the medication. It can be used long term but you should be monitored by a doctor while on the medication. It works as an antiemetic and as a gastric prokinetic. It is supposed to help with nausea and vomiting as well as help speed up the gastric emptying time. This is the drug that I was on for 4 times a day for almost 10 years before it stopped working. It kept a lot of my symptoms calm with an occasional flare-up happening every once in a while.
Despite some troublesome side effects, Metoclopramide is also one of the more commonly prescribed medications for Gastroparesis. Like Domperidone, it is supposed to help relief nausea, vomiting and also help with speeding up gastric emptying times and also help with reflux. It poses a risk of developing serious side effects such as Tardive Dyskenesia and Neuroleptic malignant syndrome. I was on the liquid form of this medication and started developing neurological twitches that could have turned into Tardive Dyskensia and been permanent. Thankfully for me, they went away after stopping the medication but that is unfortunately not the case for everyone.
The same antibiotic that we use to treat bacterial infections also has a use in treating Gastroparesis. It is typically used at a lower dosage, not the same dosing used for antibiotic treatment with the drug. I was told it shouldn't be used longer than 4 weeks without a break because of side effect risks. It works by helping to stimulate the receptors that assist in making GI contractions and that helps increase motility in the GI tract. This is one of the medications for gastroparesis that was not effective for me when I tried it but I have heard some people have success with it short term.
This is one of the medications for gastroparesis that has been banned in many countries. It is still available to my knowledge in Canada through Health Canada Special Access program. It is severely restricted because of the risk of rare but serious cardiac events associated with the drug. Cisapride works as a gastric prokinetic agent increasing the motility in the GI tract.
This is one of the medications for gastroparesis that was part of the clinical trials held in Calgary. It is primarily used as a drug to help treat chronic constipation in women. It has been used by a lot of people in our Facebook support group, including myself. Some people have responded very well to Resotran. It worked great for me for about 6-7 months and then it stopped working. It helped speed up emptying times for me but the trade-off was a great deal of diarrhea.
This is probably one of the more common antiemetic medications for gastroparesis that is prescribed. It is a drug that is used most often to treat nausea and vomiting associated with chemo or radiation in cancer patients. Many Gastroparesis patients including myself (until they no longer worked) find that this drug works well to help with nausea.
It is an antihistamine used to treat allergies, nausea, and trouble sleeping. They use this medication a lot to help women with morning sickness during pregnancy. I have used it a few times for nausea and it works decently.
It is a new drug being trialed currently with diabetic Gastroparesis patients here in Canada. As I have idiopathic Gastroparesis I have not had a chance to trial this drug as of yet.
I don't have a list of side effects yet as they are still testing the drug. The studies have been promising. Showing so far that there have been no cardiac or neurological side effects which would mean it could potentially be a safer option than some of the other medications out there currently.
This seems to be hit or miss among patients who have tried it. My specialist said for my personal case my Gastroparesis it is too severe and it wouldn't be worth it. As I am not incredibly familiar with how it all works, so here is the official description of its use in cases of gastroparesis:
"While the patient is sedated, the physician will advance a scope through the esophagus, stomach, and the pyloric sphincter. Botox is injected into the pyloric sphincter in an effort to relax that muscle, enabling food to empty from the stomach more easily. It takes approximately 15-30 minutes.
The effects of the botox may be felt immediately or may take some time to begin working. Complications from the procedure include nausea and vomiting from sedatives. Although rare, some report bleeding, perforation of the esophagus, fever, or severe vomiting.
Botox injections are not a permanent solution and usually last no more than 6 months. Repeat injections do not always produce the same results."
It is used to treat IBS-C and to treat chronic (long-term) constipation. It seems to be commonly prescribed for Gastroparesis patients who experience chronic constipation as well. It is usually my go-to medication when I am having issues with constipation and while it causes a bit more pain and bloating it does help with relieving constipation.
Used to treat severe nausea. I know some people in the group have tried this as they can get their insurance to cover the pill form of synthetic cannabinoids but no coverage for actual cannabis. I cannot speak personally about this one as I use actual Medical Cannabis to treat my symptoms.
More Common Side effects:
Is one of the most effective medications for gastroparesis, as far as managing symptoms go. Everyone is going to be different and Cannabis may or may not work for everyone. Finding strains that have proper terpenes to help digestive issues, like Limonene is important when trying to find the best strains to help. This study may be of interest as it is newer research. Hopefully, more research and some clinical trials can happen soon!
With the help of people like YOU, we can raise money and awareness for gastroparesis. Hopefully, in time, new, more effective medications for gastroparesis can be found. Perhaps even a cure!
If you're interested in helping us work towards abolishing this terrible disorder, please head over to cdhf.ca/donation/ today and make a contribution!
She has graciously agreed to share her personal health journey with gastroparesis and medical cannabis in the hopes that you all can learn from her experiences.
We had the opportunity to interview her on our medical cannabis: patient experiences webinar. This is her story:
My journey with gastroparesis has been a long one full of ups and downs. It was 2005 and I was 18 at the time I was diagnosed. I had to fight so very hard to finally reach a diagnosis of Gastroparesis. It started with what I thought was a stomach flu at the time. I couldn’t keep anything down after I would eat. As time went on it kept getting worse, not better and I was becoming quite concerned. I was starting to lose weight very rapidly and I couldn't keep a single bite of food from coming back up after I would try and eat. I went to see my family doctor and I was very scared at that point. He brushed me off and said it was just acid reflux, gave me a prescription and said to come back in a week if it didn’t get better. So, after a week with zero change and still losing weight I was back in his office. He again, did not listen to me and my concerns and gave me a prescription for a different acid reflux pill and said to come back again if it didn't help.
At this point I had lost close to 30 pounds and was in pretty rough shape.
I went back to see him the following week and refused to leave his office until he actually listened to me and did something about what was happening. It was at that point that he tried to tell me it “was all in my head” and accused me of being bulimic and said I needed mental health help. At that point in my life, I was already in therapy, on medication and getting help for mental health issues, bulimia not being one of them. If he had bothered to ever listen to me or read my file, he would have known that. I screamed and just broke down crying and said he HAD to do something, I wasn’t doing this to myself and I just wanted to be heard; I just wanted help. I was terrified and had no idea what was wrong and was slowly wasting away. He finally agreed to send me over to the hospital, but told me they would not find anything wrong with me.
I was admitted to the hospital, where I spent over three weeks with an amazing gastroenterologist who actually listened to me, acknowledged that something was very wrong and ran every test he could until he found out what was behind all of this.
He was very upset that my family doctor had let me get so bad and brushed me off countless times. At the time, gastroparesis was quite unheard of in my city, so they did not think to check for it until every other test came back negative. The gastric emptying scan finally gave me my answer, my stomach emptying process was quite delayed and I had gastroparesis.
I consider myself extremely lucky that over the years my symptoms remained mild to moderate with some flare-ups and my body continued to respond to the domperidone. Now let’s fast-forward a decade, when everything changed again.
It was as if I were 18 again and starting this cycle all over again.
I ended up hospitalized and that is where I met my new gastroenterologist. He has been supportive and helpful and has been fighting for me. One of the first things he did was repeat my gastric emptying test, which revealed how severe my gastroparesis had become over the years, showing that less than 1% of my stomach was actually functioning now.
We cycled through all of the regular medications, which either didn’t help or I developed horrible reactions to. This continued for a few more months as I progressively became worse. I eventually had to be hospitalized with a temporary nasojejunal (NJ) tube. My gastroenterologist decided to try a medication called Resotran (prucalopride). On release from the hospital, I was responding very well to the medication. This continued for several months; however, flare-ups started again and, without being able to keep medications down, my health was declining once again.
This is where my journey with medical cannabis started.
All the medications had failed me and I was out of options. I had first mention the possibility of medical cannabis to my family doctor, which was a big mistake. He is not a doctor who supports use for it even though he knows there are therapeutic benefits. He would not help me so I moved on to my Gastroenterologist. He was actually quite supportive of my decision to want to try it and at that point I had nothing to lose. He filled out a referral for me to go to the Trauma Healing Center Clinic (it is now called Harvest Medical) to explore Medical Cannabis options. After submitting the referral to the clinic I waited almost 4 months before I was able to be seen. When the day of my appointment arrived I met with a great doctor who listened to me and agreed that Medical Cannabis would more than likely be beneficial in helping me treat my symptoms. I got signed up with an LP and then started exploring the different strains and seeing what worked and what didn't during a trial and error process.
Before I started using Medical Cannabis I was vomiting anywhere between 15-20 times a day and dealt with relentless nausea and pain.
Now, after years of treatment with Medical Cannabis I rarely vomit unless I end up in a bad flare up, the cannabis helps to keep the nausea somewhat manageable and it does help bring my pain levels down a bit. I had been doing research into medical cannabis for a while and continue to do so because I want to learn and have a greater understanding of the plant I am using as medication and the science behind it all. I have come to understand a lot more about different terpenes and cannibinoids and the roles they play in treating our symptoms.
In the past few years since becoming a medical cannabis patient I have been through several different LPs and it is always a trial and error process with each LP to find the strains that work and have the right terpenes for me. That is one of the drawbacks of our current medical cannabis system.
Every LP has different strains, they are all grown differently and can contain varying levels of cannibinoids and terpenes.
There is no one size fits all when it comes to using medical cannabis and it almost always involves a bit of trial and error to find the right strains and dosage to help treat various symptoms. I highly recommend to anyone just starting their journey to use a cannabis journal or an app like Strainprint to keep track of the strains, dosage and effects that you feel and how it helped.
If you are thinking about trying Medical Cannabis go have a chat with your doctor. A lot of doctors are getting on board and becoming more comfortable with recommending cannabis. Other doctors while they may not be supportive they may be able to refer you to a clinic if they aren't comfortable or educated enough on Medical Cannabis. If those avenues don't work and you are under the care of any other doctors try asking them and they may be able to help refer you to a clinic.
If you get to the point where you have seen a doctor and are now approved to order medical cannabis try and do a bit or research before making that first order. Try and find people who are using medical cannabis to treat your illness and ask them what works best for them. Educate yourself about terpenes and how specific ones can help your symptoms. Just remember that everyone is different and not everyone is going to have the same experience even with the same strains. It is a lot of trial and error and that is where I recommend using a Cannabis journal or an app like Strainprint so you can keep track of how each strain affects you and you can figure out from there what is working for you and what isn't. When you are trying it for the first time, no matter how you use it start low and go slow especially if you have zero experience with cannabis.
Recent research in the area of gastroparesis and functional dyspepsia has shed some much needed light on the two disorders, especially in regards to their similarities and differences.
Gastroparesis (GP) and functional dyspepsia (FD) are two of the most common gastric neuromuscular disorders. Disruption of the gastric sensorimotor function is the main factor in the pathogenesis (or development) of upper gastrointestinal symptoms (Tack, 2009). Sensorimotor function encompasses all sensory and motor elements necessary for an individual to interact with their environment (Kalaitzakis, 2007).
These disorders may often be confused, as they have many similarities and differences. Some symptoms include delayed gastric emptying (contents leaving the stomach and moving to the intestine), gastric hypersensitivity, and impaired accommodation of the stomach (leading to feeling full prematurely). The epidemiological and pathophysiological overlap between FD and GP can cause an incorrect diagnosis (Tack, 2009).
Even though considerable progress has been made in the neuromuscular dysfunctions and the gastric sensorimotor dysfunctions of these diseases, more research is required to better understand the etiology and relationship between the dysfunctions and symptoms (Parkman, 2010).
Let’s take a look at the definitions of these two ailments.
The definition of gastroparesis is mainly characterized by delayed gastric emptying in the absence of mechanical obstruction (Parkman, 2014).
The Rome IV diagnostic criteria defines functional dyspepsia as the presence of one or more of the following symptoms:
It is also worth noting that there is no evidence of structural disease to explain the symptoms (Stanghellini et al., 2016).
Etiology is used to describe the cause (or causes) of disease. Let’s take a look at the etiology for gastroparesis and functional dyspepsia.
The etiology of gastroparesis is multifactorial, with the key triggers being diabetes mellitus, post-gastric surgery, and disorders of idiopathic origin (meaning the cause is unknown) (Liu, 2017). The most common causes of gastroparesis are neuropathic disorders, including diabetes mellitus, post-vagotomy (a surgery removing part of the vagus nerve), scleroderma (hardening and tightening of the skin and connective tissues), and myopathic diseases (diseases affecting the muscles that control voluntary movement in the body).
Other causes include connective tissue diseases, Parkinson disease, eating disorders, and medications. That being said, an underlying cause cannot be established in approximately 50% of patients classified as having idiopathic GP.
Similar to gastroparesis, the etiology of functional dyspepsia is diverse among patients. While it can be attributed to genetic predisposition in some patients, a prior viral infection, stress, inflammation, surgery, or trauma can be another cause in other patients. Additionally, although no clear cause-effect relationship has been established, hormonal influences can also affect symptoms in some patients with FD.
Pathophysiology is essentially the functional changes that accompany a particular syndrome or disease. Abnormalities of the gastric sensorimotor function identified in both gastroparesis and functional dyspepsia. In addition to delayed gastric emptying, these shared abnormalities can include hypersensitivity to gastric distension (stomach stretching after eating), abnormal intestinal motility, and central nervous system dysfunction (Tack, 2009).
Although the pathophysiology of gastroparesis has yet to be fully explained, known abnormalities include vagal neuropathy (damage to the vagal nerve) and disorders of intrinsic and extrinsic neuropathy, such as diabetes mellitus and viral infection. Interstitial cells of Cajal, which regulate smooth muscle contractions, are also negatively affected. This is a large reason that intestinal motility loses effectiveness.
Most of the pathophysiology of functional dyspepsia overlaps with gastroparesis, but visceral hypersensitivity is fairly unique to FD. Visceral hypersensitivity is the experience of pain within the inner organs at a level that is more intense than normal.
The pathophysiological results we discussed do not necessarily predict the symptoms of gastroparesis and functional dyspepsia, and conversely, investigators have questioned whether symptoms can be used to predict underlying pathophysiology. Some symptoms common to both diseases, like epigastric fullness, nausea, and vomiting, have been associated with delayed gastric emptying (Sarnelli, 2003). Many reports describe the poor relationship between gastric emptying and symptoms; however, the responsiveness of these symptoms to therapeutic interventions (treatment) more convincingly supports the relationship between pathophysiology and symptoms.
Both gastroparesis and functional dyspepsia overlap with each other in regards to sensory dysfunction, but tests for these abnormalities are very limited. Ultimately, there are no validated algorithms for the diagnosis of GP and FD.
While this is problematic, it is critical to clearly distinguish patients with FD from those with GP. Differential diagnosis consists of two steps. First, mechanical obstruction should be excluded by imaging techniques. Second, motility abnormality should be assed using various tests, including a gastric emptying test and manometry, which tests how well the esophagus is working (Lacy, 2012).
Since the symptoms of gastric sensorimotor disorders do not discriminate functional dyspepsia from gastroparesis, patients should be treated based on their predominant symptoms (Stein, 2014). Some treatment options have a positive outcome for patients with either disease, such as dietary modification (frequent, low-fat, small meals) and pharmacological therapy (prokinetic agents, antiemetic agents, acid suppression therapy).
Dietary modification aims to restore hydration and electrolyte balance. Prokinetic agents are drugs that strengthen coordinated gastrointestinal motility and transit of content in the gastrointestinal tract. Antiemetic agents generally act by central or peripheral blockade of neurotransmitters involved in pathways that promote nausea and vomiting. Acid suppression uses an H2 receptor antagonist or proton pump inhibitor to keep acidity levels to a minimum (Camilleri, 2016).
The most important aspect presented in the current understanding of functional dyspepsia and gastroparesis is that these disorders share a similar pathogenesis in many cases, to the point that separating the two may be artificial. Current treatments for the two diseases are limited, but it is expected that the situation will substantially improve as the understanding of the pathophysiology of the two disorders broadens. Additionally, a combination of approaches such as basic research, clinical investigation, and controlled clinical trials are required to improve patient care in these conditions.
References
Camilleri, M. 2016. Functional Dyspepsia and Gastroparesis. https://pubmed.ncbi.nlm.nih.gov/27332558/
Kalaitzakis, E. 2007. Role of gastric sensorimotor dysfunction in gastrointestinal symptoms and energy intake in liver cirrhosis. https://pubmed.ncbi.nlm.nih.gov/17327944/
Lacy, B. 2012. Functional dyspepsia and gastroparesis: one disease or two? https://pubmed.ncbi.nlm.nih.gov/23160285/
Liu, N. 2017. Gastroparesis Updates on Pathogenesis and Management. https://pubmed.ncbi.nlm.nih.gov/28535580/
Parkman, P. et al. 2010. Gastroparesis and Functional Dyspepsia: Excerpts from the AGA/ANMS Meeting. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892213/
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