Some of the common symptoms experienced by about 60 to 90% of individuals suffering from gastroparesis, include chronic nausea accompanied by vomiting, pain in abdomen, and feeling of fullness after first few bites. In addition, individuals would also suffer from malnutrition, bloating, heartburn, gastroesophageal reflux, palpitations, spasms in the stomach muscles and decreased appetite which eventually leads to weight loss [7].

• Malnutrition

  Other symptoms of gastroparesis include gastroesophageal reflux, palpitations, bloating, heartburn, weight loss, reduced appetite, malnutrition and changes in blood glucose levels. [symptoma.com]

• Weight Loss

  Other symptoms of gastroparesis include gastroesophageal reflux, palpitations, bloating, heartburn, weight loss, reduced appetite, malnutrition and changes in blood glucose levels. [symptoma.com]

• Nausea

  Some of the common symptoms experienced by about 60 to 90% of individuals suffering from gastroparesis, include chronic nausea accompanied by vomiting, pain in abdomen, and feeling of fullness after first few bites. [symptoma.com]

• Vomiting

  In addition, majority of the affected individuals also experience vomiting, abdominal pain and feeling of fullness after the first few bites of meal. [symptoma.com]

• Delayed Gastric Emptying

  Definition Gastroparesis is a condition characterized by delayed gastric emptying, due to various underlying conditions. It is a common phenomenon amongst the diabetic population. [symptoma.com]

• Abdominal Pain

  In addition, majority of the affected individuals also experience vomiting, abdominal pain and feeling of fullness after the first few bites of meal. [symptoma.com]

Several tests are done to diagnose the condition of gastroparesis. Various tests that are employed include the following:

• Gastric emptying study: This method is accomplished with the help of isotope labeling. In this, the individual is given small amount of food that contains radioactive elements. The food is consumed, and the scanner detects the amount of time food takes to leave the stomach [8].
• Endoscopy: With the help of this method, abnormalities in the stomach and small intestine can be determined. 
• Ultrasonography: Transabdominal sonography is indicated in patients with gastroparesis which helps in determining the proximal stomach function.

At the preliminary level, attempts are made to treat the underlying condition that is causing delayed gastric emptying. If diabetes is the cause, then medications along with dietary control are advised to control the blood sugar levels. The following methods are employed for treating gastroparesis [9]:

• Changes in dietary pattern: Foods that can be easily digested by the individuals are suggested. Raw and high fibrous food should be avoided in order to prevent the onset of bezoars. In addition, small and frequent meals are advised. Individuals are also suggested to sip in water throughout the meal.
• Medications: Medications to stimulate muscle contractions and facilitate the movement of the food through the digestive tract are given. These include erythromycin and metoclopramide. In addition, other medications such as lorazepam, prochlorperazine and diphenhydramine are administered to relieve the accompanying symptoms of gastroparesis [10].
• Surgery: Surgery is indicated in patients, who do not show signs of recovery with medications and dietary changes. Surgical interventions would include stomach bypass procedure or stomach stapling, which would help in faster gastric emptying.

Gastroparesis cannot be cured; however, the condition can be managed to a certain extent with medications. These provide temporary relief from the symptoms and individuals are also required to adhere to dietary changes to get the desired effect. When left untreated, gastroparesis can give rise to several debilitating complications.

Gastroparesis occurs due to partial paralysis of the vagus nerve that regulates the contractions of the stomach muscles. The exact factor that causes paralysis of the nerve is not known. Gastroparesis often occurs as a secondary complication in individuals with diabetes, both type 1 and type 2 [2]. In addition, certain other risk factors are also known. These include [3]:

• Gastrectomy
• Anticholinergic medications 
• Systemic sclerosis
• Infections
• Conditions such as bulimia and anorexia

The exact incidence of gastroparesis is not available. With the available data, it can be estimated that about 20% of adults in US are diagnosed with functional gastroparesis [4]. The condition is a common occurrence amongst the diabetic population. It was reported that, 30% individuals with type 2 diabetes and 25 to 55% individuals with type 1 diabetes develope gastroparesis as a secondary complication [5].

Under normal conditions, the stomach muscles contract and move the food down the digestive tract. These muscles are controlled by the vagus nerve. During conditions of illness or injury when the nerve get damaged, the contraction of the muscles is inhibited. As a result, the food is not passed on to the intestine for its further digestion and absorption process. Such a phenomenon delays the gastric emptying giving rise to the condition known as gastroparesis [6].

Diabetes has been identified as the most common cause of gastroparesis. Therefore, diabetic individuals are advised to effectively manage their condition to avoid the onset of gastroparesis. Certain medications are also known to delay the gastric emptying. Individuals should also make necessary attempts to avoid such medications.

Gastroparesis occurs without any obstruction. Individuals with diabetes often fall prey to gastroparesis [1]. Improper contractions of the stomach muscles interfere with the passing of food to the small intestine for absorption of nutrients. Gastroparesis cannot be cured; however with medications the symptoms can be controlled to a certain extent. But, in many cases, the medications employed for symptoms relief bring along several debilitating side effects.

Definition

Gastroparesis is a condition characterized by delayed gastric emptying, due to various underlying conditions. It is a common phenomenon amongst the diabetic population. In this condition, the stomach muscles undergo partial paralysis that inhibits the passage of the food to the small intestine, for its future course.

Cause

The exact cause that triggers gastric emptying is unknown. However, certain underlying disease conditions such as diabetes, viral infections, surgery, alcohol abuse, consumption of illegal drugs and medications can all lead to gastroparesis.

Symptoms

Chronic nausea is the classical symptom of gastroparesis. In addition, majority of the affected individuals also experience vomiting, abdominal pain and feeling of fullness after the first few bites of meal. Other symptoms of gastroparesis include gastroesophageal reflux, palpitations, bloating, heartburn, weight loss, reduced appetite, malnutrition and changes in blood glucose levels.

Diagnosis

Gastroparesis is diagnosed using the gastric emptying test. In this test the individual is given food containing small amounts of radioactive material to eat. With the help of scanner, the activity of the food that is ingested is studied, and the time taken for the food to leave the stomach, is also analyzed. In addition, other tests such as CT scan of the abdomen, and small intestine are carried out to look for presence of abnormalities.

Treatment

Medications and dietary changes form the basis of treatment regime for individuals with gastroparesis. Surgery is the last resort, and is used when all other methods to treat gastroparesis fail.

1. Camilleri M. Clinical practice. Diabetic gastroparesis. N Engl J Med 2007; 356:820.
2. Choung RS, Locke GR 3rd, Schleck CD, et al. Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population. Am J Gastroenterol 2012; 107:82.
3. Sigurdsson L, Flores A, Putnam PE, et al. Postviral gastroparesis: presentation, treatment, and outcome. J Pediatr 1997; 131:751.
4. Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis. Gastroenterology 2004; 127: 1589–91.
5. Kong MF, Horowitz M, Jones KL, Wishart JM, Harding PE. Natural history of diabetic gastroparesis. Diabetes Care1999; 22: 503–7
6. Vittal H, Farrugia G, Gomez G, Pasricha PJ. Mechanisms of disease: the pathological basis of gastroparesis--a review of experimental and clinical studies. Nat Clin Pract Gastroenterol Hepatol 2007; 4:336.
7. Janatuinen E, Pikkarainen P, Laakso M, Pyörälä K. Gastrointestinal symptoms in middle-aged diabetic patients. Scand J Gastroenterol 1993; 28:427.
8. Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 2000; 95: 1456–62.
9. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol 2013; 108:18.
10. Keshavarzian A, Isaac RM. Erythromycin accelerates gastric emptying of indigestible solids and transpyloric migration of the tip of an enteral feeding tube in fasting and fed states. Am J Gastroenterol 1993; 88:193.