Understanding GP

Milder Forms of Gastroparesis

Intro / Digestion / Who gets GP / What happens / Symptoms / Dx / Mild forms / Tx

Gastroparesis spectrum:

Some gastroenterologists reserve the name “gastroparesis” to refer to stomach "atony" or complete paralysis of the stomach. There is no consensus drawing a line where milder forms of functional GI disorders end and severe forms of dysmotilities begin. The bottom line is that these diseases rob all motility sufferers of their quality of life.

"Disordered gastric motility, particularly delayed gastric emptying (gastroparesis), is thought to be a component of many upper gastrointestinal disorders. Not only is gastroparesis an important entity of its own, it also contributes to symptoms in patients with gastroesophageal reflux, non-ulcer dyspepsia, and intestinal pseudo-obstruction."

Diagnoses such as:

• functional dyspepsia,

• functional abdominal pain,

• non-ulcer dyspepsia, and

• gastroesophageal reflux disease (GERD)

all can have a component of delayed gastric emptying. Some sources have found delayed gastric emptying in a third to half of these dyspeptic patients. Symptoms of dyspepsia are heartburn, belching, indigestion, bloating, feeling full after a few bites of food (early satiety), and nausea.

Some individuals can have normal gastric emptying studies, yet they can be completely debilitated with nausea. This subset of patients is liable to run into difficulty in gaining compassionate guidance from the medical community. Nausea of motility origin will periodically interfere with sleep. A pattern may be seen one or more hours after eating. Nausea develops, building to retching, or the nausea can remain constant. The intensity of the nausea usually increases after physical activity, hot environments, or stressful events.

So puzzling is this nausea, that on occasion patients have been told, "It's all in your head." There is a test to show that this is not the case. This test is called ELECTROGASTROGRAPHY (EGG).

Electrogastrography (EGG) may help to further define what is happening in patients who have normal gastric emptying studies, but are symptomatic. Just as an electrocardiogram (ECG) measures the electrical rhythms of the heart, so too can an electrogastrography (EGG) measure the electrical rhythms (gastric slow waves) of the stomach.

Cardiac dysrhythms are well understood and correlate very well with different diseases of the heart. Stomach dysrhythms are just beginning to be understood, and evidence is piling up that implicate them with symptoms of nausea and a feeling of fullness.

One research paper describes it thus: "Koch et al reported that 9 of 13 subjects with functional dyspepsia and normal gastric emptying studies had gastric dysrhythmias. Furthermore, Cucchiara et al reported Cisapride improved dyspepsia symptoms in children and converted gastric dysrhythmias to normal 3 cycles per minute EGG patterns". (Note: the FDA and Health Canada no longer approve Cisapride).

(See "Diagnostic” section for more information about EGGs).

Functional dyspepsia in children has also shown a relationship with abnormal rhythms of gastric slow waves. One research paper describes: "Functional dyspepsia is a heterogeneous and loosely defined clinical syndrome. It encompasses patients with episodic or persistent abdominal symptoms often related to feeding, for which there is no apparent cause. In functional dyspepsia, no relevant abnormalities are detected by a standard clinical investigation, including laboratory tests and conventional imaging studies. Abnormalities in gastric myoelectrical (gastric slow waves) activity have been found in a number of gastrointestinal motor disorders, such as gastroparesis and unexplained nausea and vomiting."  Dyspeptic symptoms can sometimes be related to poor accommodation in the stomach fundus (see “Digestion”). Satiety tests can help determine if there is a problem in this area of the stomach.

Medical science is still uncovering the physiology of the stomach. As research advances in this area, we are confident that it will provide treatment directions. Most of all, our hope is that it will validate patients’ symptoms and allow doctors and patients to get down to the business of working together on better symptom control and finding solutions.

1) Champion M: Gastroparesis. Medicine North America: 1991;April(18)

2) Koch K: Electrogastrography: Methodology from Provocative Meals to Artifact Removal to Analysis. Paper presented at American Motility Society Course on Motility in Clinical Practice: January 18-20, 2002.

3) Cucchiara S, Minella R, Riezzo G, Vallone G, Vallone P, Castellone F, Auricchio S. Reversal of Gastric Electrical Dysrhythmias by Cisapride in Children with Functional Dyspepsia. Dig Dis Sci; 1992;37:1136-1140.

4) Chen JDZ, Lin X, Zhang M, Torres-Pinedo RB: Gastric Myoelectrical Activity in Healthy Children and Children with Functional Dyspepsia. Dig Dis Sci; 1998;43(11):2384-90.