Gastroparesis (cont.)
What is the prognosis (long-term outcome) for patients with gastroparesis?
If gastroparesis is caused by a reversible problem, for example pancreatitis,
the condition will subside when the underlying problem resolves. In some
diabetics, better control of their blood sugar will improve emptying of the
stomach. If there is no reversible cause, gastroparesis rarely resolves. In
fact, it may become worse with time. Gastroparesis is particularly difficult to
treat when there are accompanying motility disorders of the muscles of the small
intestine.
What is new in gastroparesis?
The newest experimental treatment for gastroparesis is
injection of botulinum toxin into the pylorus. The pylorus is
the narrow channel through which food passes from the stomach to the duodenum.
The pylorus, like the stomach, is a muscular organ. The pylorus is closed most
of the time due to continuous contraction of the pyloric muscle. Intermittently
it opens and allows secretions from the stomach to enter the small intestine.
After meals, the pylorus is very important for metering the emptying of the
stomach. In gastroparesis, although the muscles of the stomach are weak all of
the time, the muscle of the pylorus remains strong and contracted and the
pylorus relatively closed. It was hypothesized that if the strength of the
pyloric muscle was reduced, food might empty from the stomach more readily.
Although a surgical procedure, termed pyloroplasty, to enlarge the pylorus has
been used in the past to treat problems with emptying of the stomach, it is
major surgery and has had mixed results with respect to its efficacy. More
recently, relaxation of the pyloric muscles has been produced by injecting
botulinum toxin (Botox) into the pylorus. Although results have been good, the
procedure has not been studied enough to recommend its use unless it is part of
a research protocol.
- Gastroparesis is a disease of the muscles of the
stomach or the nerves controlling the muscles that causes the muscles to stop
working.
- Gastroparesis results in inadequate grinding of food
by the stomach and poor emptying of food from the stomach into the intestine.
- The primary symptoms of gastroparesis are nausea and
vomiting.
- Gastroparesis is best diagnosed by a test called a
gastric emptying study.
- Gastroparesis
usually is treated with nutritional support, drugs for treating nausea and
vomiting, drugs that stimulate the muscle to contract, and, less often,
electrical pacing and surgery.
Last Editorial Review: 4/2/2007
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