Gastroparesis in Elderly People - Causes, Symptoms, Diagnosis, and Management

Introduction:

Gastroparesis, or gastric stasis, is a stomach disorder in which the emptying of gastric contents from the stomach to the small intestine is prevented or delayed. Therefore, it is also known as delayed gastric emptying. In gastroparesis, the muscles in the gastrointestinal tract that produce strong contractions are affected. This leads to a delay in digestion which in turn causes many symptoms like nausea and vomiting and severe complications. Women are more likely to get affected than men. Older people are more prone to gastroparesis than younger people.

What Are the Causes of Gastroparesis in Elderly People?

The exact underlying cause of gastroparesis is still unknown. Disturbance in nerve signals in the stomach is thought to be one of the causes. Studies found that 36 percent of the cases of gastroparesis are idiopathic or of unknown origin. The major causes of gastroparesis are classified into three:

• Idiopathic Gastroparesis: When delayed gastric emptying occurs without any obvious cause, it is known as idiopathic gastric emptying.

• Diabetic Gastroparesis: Uncontrolled diabetes over time can cause damage to the nerves, including the vagus nerve, which has a role in stimulating the movements of muscles.

• Post-surgical Gastroparesis: Surgery in the abdomen or small intestine may sometimes injure the vagus nerve, resulting in gastroparesis.

Other causes include:

• Parkinson’s Disease: It is an age related neurodegenerative condition which causes problems in motor functions.

• Scleroderma: It is a rare autoimmune condition that causes changes in the skin, muscles, blood vessels, and internal organs.

• Paraneoplastic: It is a group of rare diseases that occurs due to the presence of tumors in the body.

• Mesenteric Ischemia: It is a condition where the blood flow to the small intestine is obstructed due to narrow or blocked blood vessels.

• Amyloidosis: It is a rare disorder which occurs due to the build up of abnormal proteins called amyloid fibrils in the tissue.

• Cystic Fibrosis: It is a rare inherited condition which commonly affects pancreas, kidney, liver, and intestine.

• Hypothyroidism: It is a disorder that occurs due to the inadequate production of thyroid hormones by the thyroid gland.

• Chronic Renal Failure: It is the damage or loss of function of kidneys that occurs gradually over many months or years.

• Gastric Cancer: The cancer that starts in the mucus producing cells lining the stomach is called gastric cancer.

• Viral Infections: Viral infections can sometimes cause gastroparesis in elders.

• Cancer: Certain cancers and cancer therapies.

• Medications: Use of certain medications like antidepressants and narcotics.

What Are the Symptoms of Gastroparesis?

Some of the common symptoms of gastroparesis are:

• Nausea and vomiting.

• Stomach fullness.

• Stomach pain.

• Bloating.

• Early feeling of fullness while eating.

• Anorexia or inability to eat food.

• Loss of appetite.

• Weight loss.

• Larger belly or stomach.

How Is Gastroparesis Diagnosed?

After taking detailed medical history, including eating habits, signs, and symptoms, a doctor will check for abdominal distension or swelling in the stomach and tenderness. Followed by this, the doctor will ask to take a blood test to know the blood sugar levels. If the patient has a high blood sugar level, then the most probable cause for gastroparesis would be diabetes. Ultrasound of the abdomen will be taken to check for pancreatitis, liver disease, and gallbladder disease, as these diseases have symptoms similar to gastroparesis. The diagnostic methods for gastroparesis include:

• Upper endoscopy.

• Gastric emptying scintigraphy test.

• Smart pill.

• Carbon breath test.

How Is Gastroparesis Managed in Older Adults?

The first step in the treatment of gastroparesis is treating the underlying cause, if there is any. The treatment plan for gastroparesis in older adults includes dietary modification, medications, and surgical procedures.

Medications: Patients are supposed to inform doctors about the medications they are already taking, as some medications can worsen gastroparesis. The medications which are used to relieve the symptoms of gastroparesis are:

Medications that stimulate stomach muscles:

• Metoclopramide.

• Erythromycin.

Medications to reduce nausea and vomiting:

• Promethazine.

• Benadryl.

• Prochlorperazine.

• Ondansetron.

Dietary and Lifestyle Modification: Patients with gastroparesis are advised to consume a diet rich in nutrients like fruits and vegetables. Doctors also recommend reducing the intake of foods rich in fiber because fiber can delay gastric emptying. For people who cannot eat solid foods, a liquid nutrient diet and foods pureed in a blender are advised. Clear soups, oral rehydration solutions, and low-fiber fruit juices are also highly recommended. Food rich in fat and fiber, carbonated drinks, and alcohol should be avoided. Foods like broccoli, carrot, apple, pear, cauliflower, etc., should also be avoided. In addition, gastroparesis patients are advised to eat small meals five to eight times daily.

Surgical Procedures: If the symptoms of gastroparesis persist even after medications and dietary changes, surgery is advised. Following are the surgical procedures used for the treatment of gastroparesis:

• Gastric Electrical Stimulation (GES): Gastric stimulator is a tiny pacemaker-like device that sends electrical impulses to the stomach muscles through two lead wires. It is a minimally invasive treatment and is performed under general anesthesia. The surgeon will implant a gastric stimulator under the skin of the abdomen and connect it to the two wires attached to the stomach muscles. GES is an FDA (Food and Drug Administration)

Other Approved Treatment for Gastroparesis.

• Pyloroplasty: Laparoscopic pyloroplasty is a safe and effective treatment for gastroparesis. Studies showed that it improved gastric emptying in almost 90 percent of gastroparesis patients. Pylorus is a muscular valve at the end of the stomach that opens up to empty the food from the stomach to the small intestine. In gastroparesis, the function of the pylorus is diminished. In pyloroplasty, the pylorus is altered to open it up during the digestive process. Pyloroplasty is also used to reconstruct the pylorus if it is damaged.

• Vagus Nerve Stimulation: Vagus nerve is the largest cranial nerve with multiple functions, including digestion. Hence, stimulation of the vagus nerve can stimulate the muscles of the stomach to carry out gastric emptying. Recently a handheld device has been developed to stimulate the vagus nerve. So, it's a non-invasive technique and can be used in cases of idiopathic gastroparesis.

• Botulinum Toxin Injections: It is advised in severe cases of gastroparesis. Botulinum toxin is injected into the valve between the stomach and small intestine through an endoscope passed down from the throat to the stomach. This keeps the valve open for a long time, promoting gastric emptying.

What Are the Complications of Gastroparesis?

Gastroparesis itself occurs as a complication of certain diseases and medications. However, if left untreated, gastroparesis can end up in severe complications such as:

• Diabetes: Gastroparesis can result in uncontrollable variations in blood sugar levels in diabetic patients. The level can drop when the food remains in the stomach, while it can spike to high levels when it is emptied into the small intestine. These variations can end up in complications like heart attack and stroke.

• Blockages: In some cases of gastroparesis, masses are formed from the undigested food in the stomach known as bezoars. These can cause serious infections.

• Dehydration and Malnutrition: Frequent vomiting in gastroparesis can result in dehydration. As gastroparesis affects the absorption of nutrients, it can also cause malnutrition. Dehydration and malnutrition can be life-threatening in some cases.

• Acid Reflux: It is a condition where the contents in the stomach pass to the esophagus. Heartburn, regurgitation, and bad breath are the most common symptoms.

Conclusion:

Gastroparesis or delayed gastric emptying occurs when muscle motility in the stomach is affected. There are many risk factors associated with gastroparesis, including diabetes, surgery in the abdomen or small intestine, viral infections, Parkinson's disease, etc. The treatment plan for gastroparesis consists of medications, dietary changes, and surgeries. Older people can prevent gastroparesis by controlling blood sugar levels and eating healthy food.