Gastroparesis

The Invisible Pain

Complications of Gastroparesis

     When a person suffers from Gastroparesis there are complications that can come along either due to the disease process itself or dietary changes that the sufferer must make in order to manage their disease.  While not everyone that has Gastroparesis may experience these issues, it is a good thing to remember that they are a possiblity and they should be aware of what to look out for.

Pseudo-Obstruction

     Pseudo-obstruction symptoms may include cramps, abdominal pain, nausea, vomiting, bloating, constipation and occasionally diarrhea. Over time, the condition can cause bacterial infections, malnutrition, weight loss, and muscle problems in other parts of the body.

     Pseudo-obstruction is a rare condition in normal individuals with symptoms like those caused by a bowel obstruction, or blockage. But when the intestines are examined, no blockage is found because the symptoms are due to nerve or muscle problems that affect the movement of food, fluid, and air through the intestines.

     To diagnose pseudo-obstruction, the doctor will take a complete medical history, do a physical exam, and take x rays. The doctor will make sure that symptoms are not due to an intestinal blockage and will look for the cause of the condition, such as Gastroparesis.

     .Treatment may include medications, such as antibiotics to treat bacterial infections, pain medication, and medication to treat intestinal muscle problems.

Weight issues

     While many sites only list weight loss as a complication of Gastroparesis very few list weight gain as an issue with Gastroparesis.

     Weight loss happens due to the loss of appetite caused by this condition and the inability of the digestive tract to properly break down food to be absorbed.  Because the stomach empties slowly the sufferer feels full early when they do eat and does not get hungry again as soon as the normal individual because the sensation of hunger is triggered by an empty stomach.  With the stomach not emptying the feeling of hunger simply does not happen. 

     To try to slow or stop weight loss a person with Gastroparesis will need to modify their diet by removing foods that are hard to digest (such as fresh fruits and vegitables, fats and fiber) and instead eat many small meals through the day (5-6) that consist of easily digestable foods and liquid suppliments.

     It is the weight loss that often leads to a diagnosis when combined with the other symptoms.

     If weight loss drops the sufferers weight to dangerous levels or happens at a rate that cannot be controlled by medication they will often be treated with a J-Tube (a gastric tube placed through the abdominal wall into the small intestine which means that the stomach and throat are bypassed and liquid nutrition and medications are placed straight into the small intestine for digestion and absorbtion) or IV nutrition through a PICC line (a central access port is inserted into the upper arm, chest or neck for IV nutrition).

     Weight gain is not as common as weight loss when it comes to Gastroparesis but it does happen and can be just as devistating to the sufferer and may even delay the diagnosis of Gastroparesis because the doctors that know a little about Gastroparesis often do not know about this aspect and do not believe that a person who is gaining weight is not hungry or eating very little.  Quite often, people with Gastroparesis and weight gain are not even tested until the weight gain stops and weight loss begins.  Since no studies have been done on this aspect of Gastroparesis there is no scientific theory explaining why some people gain weight.  It is theorized by the people with Gastroparesis that started their disease process with weight gain for no reason instead of weight loss that their bodies might have gone into 'starvation mode', meaning that their bodies reacted to the decline of caloric intake by slowing their metabolism and storing any fats and sugars as fat.

     Weight gain can be startling, gaining weight on as few as 500 calories a day for a long period of time while feeling all of the other symptoms of Gastroparesis.  When seeking medical advice the people that gain weight on very limited caloric intake are often ignored by doctors who think that the patient is either lying and trying to seek attention or has an emotional problem such as anxiety or depression.  It is often not until the weight gain stops and weight starts to fall off just as quickly that the doctors will start to look for a reason.

     Weight gain is always followed by weight loss in Gastroparesis, but when weight loss begins in the disease process it is extremely rare for it to switch over to unexplained weight gain. 

     The psychological aspect of weight gain with Gastroparesis can be very devistating because the sufferer is told by their doctor to lose weight to feel better, yet they are already on what could be considered a starvation diet.  The added weight puts a strain on the sufferers joints and can cause blood pressure issues and all the other complications of obesity.  The person that is gaining weight will often feel isolated and depressed because there is nothing they can do to lose weight no matter how hard they try and are often suffering all the complications of malnutrition as those losing weight uncontrollably such as loss of energy, aches and pains, hair loss and other issues.

     Family and friends will often think that the person is simply lazy and along with doctors will tell the sufferer that 'they could lose weight and get in shape if they want to", making the sufferer believe that it is their fault.

Bezoars

     Bezoars are collections of undigested material that collects in the stomach or intestines and can be a complication of Gastroparesis because of motility problems in the stomach or small intestine. 

     -Food Boli imitate true bezoars and are composed of loose aggregates of food items such as seeds, fruit pith, or pits as well as other types of items such as shellac, bubble gum, soil, and concretions of some medications.

     -Pharmacobezoars (or medication bezoars) are mostly tablets or semi-liquid masses of drugs that do not pass and instead collect in the stomach or intestine. 

     -Phytobezoars are composed of nondigestible plant material  and are frequently reported in patients with impaired digestion and decreased gastric motility.

     Bezoars in humans cause the feeling of fullness, pain, nausea , and vomiting.  Stomach bezoars are diagnosed by a doctor during an EGD (upper-endoscope exam) at which time smaller ones can be removed but larger ones usually require surgery to remove.  When in the intestine they are found using x-ray, barium studies, CAT Scan or MRI and are then surgically removed.


 

Anemia (Iron Deficiency)

     People with Gastroparesis are at risk of many deficiencies due to the restrictive nature of our diets as well as the fact that often what we do eat is not properly absorbed and one important mineral that can be lacking is iron.

     Our bone marrow (and other red blood cell manufacturing processes in our bodies) need iron to create healthy normal cells to transport oxygen and nutrients to our cells.  When we are iron deficient due to our diet or the inability of our bodies to absorb foods properly our blood cells can be smaller than normal and less able to function.

     The common symptoms of Anemia are:

     -Fatigue

     -Dizzy

     -Sleep Disturbance

     -Breathlessness with normal activity

     You can find out more by clicking here including a listing of iron rich foods that you can try to add to your diet, but as you will see by the foods listed, many of them are not foods that people with Gastroparesis easily tolerate and because of this your best bet if you think you might be suffering from anemia is to go to your Doctor for a simple blood test that will tell you if you are anemic.

     If you are found to be anemic from an iron deficiency you can go on an iron suppliment (in pill form or the pediatric liquid suspension calculated for your body weight and needs if you cannot take pills) and make other modifications to your diet that will help the iron be absorbed.  Vitamin C helps in iron absorbtion, so simply drinking pulp free orange juice or any juice fortified with vitamin C when taking your iron will help bind the iron and improve absorbtion.

Tooth Damage and Tooth Loss

     Tooth damage and loss can be a very troubling complication of Gastroparesis due to the self esteem and social stigma often associated with missing teeth.

     The damage and loss can come from many different factors assocaited with Gastroparesis such as damage to the enamel from chronic vomiting as well as malnutrition, vitamin and mineral deficiencies from either the inablility to eat properly, the restricted diet or vomiting.

     This can have a major impact on trying to manage your Gastroparesis since it is recommended to chew your food thoroughly to help aid in digestion and if your teeth are loose, weakened or missing it can be very hard to properly chew your meals. 

     It is important to maintain regular check-ups with your Dentist and to educate your Dentist about Gastroparesis so that they can work with you when and if a problem manifests.  The fact that Gastroparesis is an ongoing and incurable condition means that temporary fixes often fail and often the only choice left to you will be extraction of affected teeth.

     When it comes to replacing lost teeth you need to use partial dentures and not dental implants since there is a good chance that the implant will fail due to vomiting and bone loss from continued nutritional difficulties.

     Important things to remember:

          Keep your foods soft... a simple rule to follow- If you can cut it with a spoon you can usually eat it

          Brush your teeth after every meal and after vomiting- the acids from your stomach can be very damaging    to your tooth enamel so it is best to try to clear it out of your mouth as swiftly as possible.  If you cannot brush your teeth then you should rinse your mouth out thoroughly three times, swishing the water the third time for at least 15 seconds.

          Visit your Dentist every 6 months

          If you damage a tooth (split, crack or break) see your dentist immediatly-  that break allows bacteria to enter your tooth and may cause an infection.

          Since your teeth are probably sensitive, use toothpastes and rinses market for sensitive teeth.

          Do not bleach or whiten your teeth!  You may be tempted to try to whiten your teeth to reverse discoloration caused by damage but many tooth whiteners on the market can only speed up the damage or mask what is going on making it harder for you to be able to keep an eye on your true tooth health.

-----Gastroparesis----- The Invisible Pain

Created October 7, 2009

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