Gastroparesis Turns Meals into Misery

Food is at the center of life’s most enjoyable moments; it brings us together, evokes memories, and shapes our culture. It’s also important because without food we tend to not live very long. For some people, however, problems with the stomach make food less enjoyable. Gastroparesis, which comes from the Greek “gastro-” meaning “stomach” and “-paresis” meaning “partial paralysis,”  is when the movement of food through the stomach slows.^[1] Slow stomach emptying increases the chances that someone will feel full early and can cause nausea, vomiting, and pain when eating.^[1,2] Long-term complications include poor nutrition, poor quality of life, severe anxiety, and depression.^[2,3]

We don’t usually think about how eating works. This is because, much like my behavior around cookies, it’s an entirely automatic process. Getting food through the stomach and digestive tract is actually a complex process requiring a lot of coordination, storage of things like excess gas, and pumping action. Gastroparesis is when this process slows down without some type of blockage.^[2,4] Diabetes, surgery, and some medications can cause gastroparesis. The most common type, when the cause is unknown, is termed idiopathic gastroparesis.^[3] Idiopathic gastroparesis affects predominantly women and can be accompanied by nerve problems, issues with the stomach itself, and inflammation, though each case is unique.^[2,3,4]

Treatments for idiopathic gastroparesis are like cake designs, they range from the simple to the complex. Simple treatments target the effects of gastroparesis and include diet and exercise.^[1] Dietary treatments may include extra electrolytes, extra water, and blood sugar control, which may have a more significant effect if diabetes plays a role.^[1] Patients with idiopathic gastroparesis may be prescribed antiemetic medications - ones that target nausea and vomiting.^[1] Beyond symptomatic treatment, prokinetic medications try to convince the stomach to move food faster.^[1,3] Metoclopramide is a prokinetic medication that causes muscle movements and can help convince the stomach to move faster.^[5] Unfortunately, its effects aren’t limited to the stomach; it can cross the barrier into the brain causing side effects including involuntary muscle movement, drowsiness, fatigue, and can worsen depression.^[5] Because of these side effects, clinical research is looking at medications that work similarly but can’t cross into the brain.^[1,6] An ideal medication would solve all problems at the same time, reducing nausea and vomiting while inducing stomach movement and avoiding side effects in the brain. I would love a solution like this almost as much as I love food in general.

Creative Director Benton Lowey-Ball, BS, BFA

References:

[1] Parkman, H. P., Jacobs, M. R., Mishra, A., Hurdle, J. A., Sachdeva, P., Gaughan, J. P., & Krynetskiy, E. (2011). Domperidone treatment for gastroparesis: demographic and pharmacogenetic characterization of clinical efficacy and side-effects. Digestive diseases and sciences, 56, 115-124. https://link.springer.com/article/10.1007/s10620-010-1472-2

[2] Hasler, W. L. (2011). Gastroparesis: pathogenesis, diagnosis and management. Nature Reviews Gastroenterology & Hepatology, 8(8), 438-453. https://www.nature.com/articles/nrgastro.2011.116

[3] Bielefeldt, K. (2012). Gastroparesis: concepts, controversies, and challenges. Scientifica, 2012(1), 424802. https://onlinelibrary.wiley.com/doi/full/10.6064/2012/424802

[4] Syed, A. R., Wolfe, M. M., & Calles-Escandon, J. (2020). Epidemiology and diagnosis of gastroparesis in the United States: a population-based study. Journal of clinical gastroenterology, 54(1), 50-54. https://journals.lww.com/jcge/fulltext/2020/01000/advances_in_helicobacter_pylori_therapy.9.aspx

[5] Lee, A., & Kuo, B. (2010). Metoclopramide in the treatment of diabetic gastroparesis. Expert review of endocrinology & metabolism, 5(5), 653-662. https://www.tandfonline.com/doi/abs/10.1586/eem.10.41