Understanding GP

Who gets Gastroparesis?

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

Who develops GP:

How many people suffer with gastroparesis? Depending upon how it is defined medically, it actually is fairly common. The National Institutes of Health in the United States has declared that 5 million Americans are afflicted.

The two largest groups to make up gastroparetic sufferers are the diabetic and idiopathic groups. About 1/3 of the people with gastroparesis are idiopathic, meaning that there is no clearly identifiable cause for the illness. Another 1/3 develops gastroparesis as a complication of diabetes. Patients who are post-surgical or those with Parkinson's disease make up the next largest groups.

Gastroparesis is more common in women.

Autonomic nerve dysfunctions have also been associated in some of the patients with idiopathic gastroparesis.

Regardless of how one develops gastroparesis, the symptoms are similar for all.
 

WHAT CAUSES GASTROPARESIS?

Primary Causes:
No causes have been identified, but enteric (gut) viruses are suspected in some situations. Idiopathic is a term meaning that there is no clearly identifiable cause for the illness.

As stated above, while over 30% of all people with gastroparesis are idiopathic, a subset of idiopathic patients can describe an event that made them ill. Often they report stomach flu, food poisoning, drinking bad water, or some other gut infection as triggering their symptoms. Some patients have described the onset of their illness after a course of antibiotics.

Medical papers have documented associations of idiopathic gastroparesis with:

• Norwalk virus (stomach flu),

• Epstein-Barr virus (mononucleosis),

• herpes simplex virus,

• Cytomegalovirus and

• parasitic infections—Chagas’ disease and schistosomiasis infection, for instance.

The common thread running through all of these infectious agents is inflammation. Inflammation can be damaging to nerve tissues. Some medical papers have found an association between myenteric ganglionitis (inflammation of the bundles of nervous tissue in the gut) and delayed gastric emptying.

Furthermore, researchers from the University of Mississippi, GI division, find high levels of inflammatory cytokines in the majority of their idiopathic GP patient population. In addition, the same group of researchers found very high rates of hypercoagulation problems—both acquired and hereditary forms—in the gastroparesis patients they have studied. The findings of hypercoagulation underline a theme of immune activation.

Secondary causes:
Identifiable diseases that affect other body systems (like the nerves or muscles throughout the body) can result in the derangement of the stomach's motor power (gastroparesis). In other words, illnesses that afflict many parts of the body, including the stomach, can be secondary causes of gastroparesis. Examples of such diseases include systemic lupus, Parkinson's disease and diabetes, to name a few (a more comprehensive list is shown below). Surgery to the stomach can also be a secondary cause of gastroparesis.

Some medications delay gastric emptying, but this effect is reversible by altering the dosage or by switching medications. Medications that can cause transient problems with delayed gastric emptying include:

• morphine

• anticholinergics

• levodopa

• B-agonist, and

• tricyclic antidepressants.

We repeat that regardless of how one gets gastroparesis, the symptom complex is the same, and treatment approaches are very similar.

One common question gastroparesis sufferers ask is:
"WILL I GET BETTER?"

The answer to this question can only be determined on a case-by-case basis. Your doctor bases your prognosis on how you came to get gastroparesis. In other words, was it a secondary cause or idiopathic? Is the underlying problem of the gastroparesis primarily myogenic or neurogenic?
 (i) Myogenic (myopathy): the underlying motility disorder is primarily one of the muscle tissue not functioning properly; or
 (ii) Neurogenic (neuropathy): the underlying motility disorder is primarily one of the nervous tissue not functioning properly. (See "Diagnostic" section.)

Is there a secondary cause that can be corrected It is known that some people with idiopathic gastroparesis do have complete resolution of symptoms. Others with gastroparesis have a good response to medication, and manage their illness very well. Others can remain very ill, and it is for this reason that solutions need to be found.