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Gastroparesis

Gastroparesis

Gastroparesis, also called gastric stasis, occurs when there is delayed gastric emptying. Delayed gastric emptying means your stomach takes too long to empty its contents. If the food hardens into a solid mass, this could cause nausea, vomiting and obstruction in the stomach, which blocks food from passing into the small intestine.

Gastroparesis Symptoms

Gastroparesis often causes a number of nonspecific symptoms. It is important for a gastroenterologist to make a diagnosis. Symptoms of gastroparesis include:

  • An early feeling of fullness

  • Bloating

  • Nausea

  • Anorexia

  • Vomiting

  • Abdominal pain

  • Weight loss

Gastroparesis Diagnosis at Johns Hopkins

At Johns Hopkins, we believe that working as a team provides the best possible outcome for patients. The doctor working with you during your diagnosis and treatment regularly meets with doctors in other fields to discuss your case and make sure you are receiving the best care possible. Our diagnostic technology and high volume of cases makes us uniquely qualified to treat even the most complex case of gastroparesis.

Gastroparesis Diagnostic Procedures

A diagnosis of gastroparesis begins with a comprehensive physical exam during which you describe your symptoms and medical history. Your doctor may find abdominal distention (swelling) or tenderness. Your doctor will also look for signs of underlying diseases or disorders that may be causing the gastroparesis. Treating the underlying cause will treat the gastroparesis as well.

During the physical exam, your doctor may listen for a "succession splash." The doctor will gently shake you and listen for the sound of fluid in your body. It can help confirm that there is an obstruction in your abdomen.

Your doctor may order laboratory tests as well. Although there is no definitive lab test for diagnosing gastroparesis, it may help rule out other underlying conditions.

Other tests your doctor may perform include:

Upper Endoscopy

Your doctor will most likely perform an upper endoscopy to rule out a mechanical obstruction. This is the residue of retained food that was unable to pass through the digestive system. An endoscope is a thin, flexible tube that your doctor passes through your mouth and into your esophagus in order to see the esophagus and stomach.

During an upper endoscopy:

  1. You receive an anesthetic to help relax your gag reflex. You may also receive pain medication and a sedative.

  2. You lie on your left side, referred to as the left lateral position, and the endoscope is inserted through your mouth and pharynx, into the esophagus.

  3. The endoscope transmits an image of the esophagus, stomach and duodenum to a monitor that your physician is watching.

Barium Contrast Radiography

Barium contrast radiography is an X-ray study. It is a commonly used procedure to diagnose gastroparesis.

During barium contrast radiography:

  1. You swallow a contrast solution called barium.

  2. The barium coats your esophagus and gastrointestinal tract, making it easier for the doctor to detect abnormalities.

  3. An X-ray is taken.

  4. Your doctor can determine if there are delays in the liquid emptying from your stomach.

Gastric Emptying Scintigraphy

Gastric emptying scintigraphy is the most commonly used procedure to confirm gastroparesis.
Unlike diagnostic procedures that require you to fast beforehand, gastric emptying scintigraphy actually requires you to eat right before the test.

During a gastric emptying scintigraphy:

  • Eat a meal of solid food that has an adequate caloric content. Eggs and toast is a common pre-test meal. The goal of the food is to produce powerful gastric contractions.

  • Prior to eating, your doctor will attach a radiotracer to the food.

  • A scan is taken immediately, then at two hours and four hours after the meal.
    Your medical team will evaluate how the food you ingested moves through your stomach and gastrointestinal tract.
    If the test results indicate a gastric delay and doctors do not find an obstruction, it may indicate a diagnosis of gastroparesis.

Antroduodenal Manometry

Antroduodenal manometry test the muscles used in digestion. During this procedure:

  1. Your doctor inserts a catheter through your mouth and into your stomach.

  2. The catheter stays in place for a period of six hours, in order to measure electrical and muscular activity in your stomach.

  3. You fast for the first few hours, so the doctor can record the measurements in a fasting state.

  4. Later, you eat a solid meal and your doctor records the measurements during digestion

This procedure can help diagnose the exact cause of the gastroparesis. Doctors often use it for patients after standard treatments have failed, for surgery candidates and for patients with unexplained nausea.

Wireless Motility Study

A wireless motility study evaluates the time it takes for your stomach to empty. This is generally well-tolerated and less invasive than other diagnostic studies.

During a wireless motility study:

  1. You ingest a small pill, which travels through your gastrointestinal system.

  2. As it travels, it collects data and sends it to a data receiver that you wear, usually around your waist.

  3. The doctor sees the data, and you return to your doctor after a few days to review the results.

  4. The capsule is excreted naturally from your body.

The advantage of this method is that you can continue with your normal activities while the capsule gathers the necessary information.

Gastroparesis Treatment at Johns Hopkins

The goal in treating gastroparesis is to reverse or correct the underlying cause of the problem. If that is not possible, doctors will aim to promote gastric emptying and relieve symptoms. Treatment options range from dietary changes to medication or surgery. Learn more about gastroparesis treatment at Johns Hopkins.

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