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Imagine having a stomach flu that never goes away: endless bouts of nausea or vomiting of undigested food, abdominal pain and bloating with stomach acid and food washing up into your mouth. Eating seems to make the symptoms all the worse, so food avoidance —or radically altered diets — become your preoccupation, as does an endless search to find doctors who can help.

This is life for many Albertans and other North Americans who suffer from a poorly understood stomach condition known as gastroparesis, or delayed gastric emptying (in other words, a stomach that is slow to empty). Among the many problems of poor stomach function, a continuum of severity exists, with dyspepsia representing the less severe end and gastroparesis at the opposite extreme. Depending upon which experts definition is used, motility disorders appear to be very common.

This family of digestive disorders results from various degrees of neuromuscular dysfunction of the digestive tract. In their most severe form these disorders can actually develop into digestive failure or paralysis of the whole digestive system. Patients are then reliant upon feeding tubes to maintain adequate nutrition.

The orchestration of your food’s transit through the gut is called gastrointestinal motility. When digestive motility falters, food may sit for hours in the upper gut. Nerves needed for coordinating and driving the muscular action for grinding, pumping and moving food through the gut have been damaged or compromised, often for unknown reasons. In other circumstances, such as scleroderma or muscular dystrophy, the gut muscles themselves may not work properly.

In the general Canadian population, the prevalence of upper digestive symptoms of nausea, vomiting, bloating, abdominal pain, reflux and a premature feeling of fullness is substantial. It has been reported that as many as 3.5 million Canadians suffer from these symptoms, while other researchers report that 1 in 4 North Americans experience upper digestive symptoms to a distressing extent.

The degree of disabling digestive symptoms varies from person to person. Gastroparesis, which can lead to repeated hospitalizations or complete disability, often due to intense nausea, represents the most severe form of these symptoms.

Due to a lack of good diagnostic tools and properly equipped centres with specialists trained in the subspecialty of gastrointestinal motility, consensus among doctors as to what these symptoms represent is difficult to find, and many doctors seem reluctant to work towards a proper diagnosis. Thus, many unfortunate gastroparetic sufferers may go for years being misdiagnosed with other diseases such as irritable bowel syndrome, or labelled as having a psychological problem, or in the case of teenage girls, accused of having an eating disorder.

Gastroparesis is primarily a women's health issue. While secondary causes of gastroparesis include diabetes, AIDS, scleroderma, lupus, chronic liver or kidney disease, or some types of stomach surgeries, most often the cause of disordered gut function is unknown, and therefore, all the more easily disregarded by some medical doctors as "all in the patient’s head". Of those in this unknown, or idiopathic, category, who suffer with the more severe forms of faltering digestion, 80% are young females.

 

Historically, research has been compartmentalized into the various regional gut motor problems, and investigative efforts have been furthered restricted to only the milder or functional disorders, as distinct from the more severe forms of motility disorders. However, in some situations, we are seeing an evolving disease process marching along a continuum.

 

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