Gastroparesis

This is a term which is used to describe conditions which affect the nervous control of gastric emptying and leads to delayed or in severe cases absent emptying of the stomach into the small bowel. As one might expect this condition can lead to symptoms of nausea, vomiting and because of the increase in gastric pressure gastro-oesophageal reflux. When It becomes more severe or persistent then it can lead to weight loss.

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Many different conditions may lead to or exacerbate gastroparesis. The commonest cause is an enteral neuropathy associated with poorly controlled diabetes. Poorly controlled diabetes can lead to long term nerve damage in the nerves that control gastric emptying, this leads to reduced motility within the stomach and reduced relaxation of the pylorus, thence leading to accumulation of food and gastric juices in the stomach. Such dysfunction then often exacerbates the pre-existing poor diabetic control.

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Stress and emotion may lead to reduced accommodation (relaxation in order to hold the ingested meal and act as a reservoir) of the upper stomach in response to a meal and reduced movement in the lower stomach which then leads to a delay in gastric emptying. This is partly why people may lose their appetite when they are nervous or stressed. Many patients with gastroparesis find their symptoms are worse when they are under stress.

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There are of course other reasons why emptying of the stomach may be delayed. Sometimes ulcers or tumours at the outlet of the stomach or within the bowel jus beyond it may obstructed the normal flow of food. This is not gastroparesis, but may have the same effect causing nausea, vomiting and weight loss.