Gastroparesis Clinic at King’s
King’s is one of the only centres to offer the advanced G-POEM Procedure in Dubai for the treatment of Gastroparesis
Gastroparesis is a chronic condition that causes paralysis of the stomach or a stomach that empties slowly. In normal cases, after swallowing, food is moved through the digestive tract by strong muscular contractions, however, if one has gastroparesis, the motility of his/her stomach is sluggish or non-existent, preventing the stomach from emptying normally.
Symptoms of Gastroparesis
The common symptoms of gastroparesis include:
- Changes in blood sugar levels
- Acid reflux
- Vomiting
- Nausea
- Abdominal pain
- Having a feeling of fullness after having a few nibbles
- Vomiting undigested food after a few hours of eating
- Lack of appetite
- Abdominal bloating
- Weight loss and malnutrition
Causes of Gastroparesis
The actual cause of gastroparesis is generally unknown, however, it can sometimes occur as a result of damage to a nerve that controls the stomach muscles (vagus nerve).
The vagus nerve is vital in the digestive processes like commanding the stomach muscles to contract and push food into the small intestine. However, the vagus nerve can’t convey messages to the stomach properly if it’s damaged. Food may stay in the stomach longer rather than moving into the small intestine to be digested as a result of this.
The vagus nerve and its branches can be damaged by diseases like diabetes, as well as surgery on the stomach or small intestines.
Risk Factors of Gastroparesis
There are factors that can increase an individual’s risk of gastroparesis and these include:
- Nerve system diseases
- Abdominal or esophageal surgery
- Diabetes
- Infection, mostly from a virus
- Underactive thyroid (hypothyroidism)
- Certain medications that slow the rate of stomach emptying, like narcotic pain medications
- Scleroderma (a connective tissue disease)
Diagnosis of Gastroparesis
Various tests may be used to diagnose gastroparesis. This will identify if anything is interfering with the stomach’s ability to empty as intended. These tests will also determine the main cause of the symptoms.
The tests include:
- Imaging tests like CT scans or x-rays
- Blood tests
- Upper endoscopy
- Ultrasound, which uses sound waves that create images to look for disease in the pancreas or gall bladder that may be causing the symptoms
Upper Endoscopy is performed with an endoscope, which is a log flexible tube with a camera and light at one end. This tube is inserted into the mouth, down the esophagus, and into the stomach and duodenum during the endoscopy. The camera and light on the end of the tube allows the specialist to see within the patient’s GI tract and rule out the possibility of an ulcer, cancer, or other abnormalities as the cause of the symptoms.
Stomach Emptying Tests
There are different ways to measure the time it takes for food to empty from the stomach into the small intestine. These include:
- Gastric Emptying Scintigraphy (GES): A stomach emptying scintigraphy entails consuming a meal laced with a small amount of radioactive material. This enables images to be obtained throughout digestion in order to determine the rate at which the stomach empties.
- Wireless Motility Capsule: This is a pill-shaped piece of medical apparatus. The pill is ingested and subsequently passes through the gastrointestinal tract. Temperature, whole gut contractions as the tablet pass down, and GI tract pH values will all be recorded. This data is gathered by wearing a receiver for five days and recording the data. This test also determines how long it takes the GI tract to transport contents through the gut.
- Gastric Emptying Breath Test (GEBT): This test is carried out with the use of breath samples that have been collected. To begin the test, the patient consumes a meal containing a nonradioactive component. This allows one to track and measure the food in the breath over a period of time. The test can be done at home or in a doctor’s office to determine how rapidly the stomach empties.
Treatment of Gastroparesis
Identifying and treating the underlying cause of the condition is the first step in treating gastroparesis. If for instance diabetes is the cause of one’s gastroparesis, the doctor helps him/her manage it. Other treatment options include:
Changes in diet
The most important goal in gastroparesis therapy is to maintain proper nutrition. Dietary adjustments can help individuals with gastroparesis. The doctor may recommend the patient to a dietician who may help choose foods that are easily digestible. This can help the patient in getting enough calories and nutrients from the food.
Medication
The medication to treat gastroparesis may include:
- Medications to control nausea and vomiting
- Medications to stimulate the stomach muscles
Treatment of Gastroparesis with GPOEM
G-POEM procedure is a minimally invasive technique that uses endoscopic technology to treat individuals with gastroparesis. The procedure is used to relax an individual’s pylorus, the valve between the stomach and small vowel, which is not working properly, and as a result make it functional once again.
During the procedure, which is done under general anesthesia, the doctor uses a thin, flexible tube to go down into the throat and stomach. An incision is made, and a tunnel is created between the layers of the stomach in order to reach the tight pyloric muscle. An incision known as myotomy is then performed on the muscle. Myotomy is a permanent cut that creates an opening for food to pass freely into the small intestine.
After the procedure, the patient will not be able to eat or drink at all for the rest of the day. This will help in the healing of the cut made in the lining of the stomach. Afterwards he/she will be put on a liquid diet for a period of time.
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