EDS and Gastroparesis

About Gastroparesis

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Overview of Gastroparesis

People with Ehlers-Danlos Syndrome quite frequently present with GI issues including Gastroparesis. Gastroparesis is a complex and frequently underdiagnosed disorder marked by delayed emptying of the stomach. This delay prevents the stomach from properly transferring food to the small intestine, leading to a multitude of symptoms.

Around 90% of patients with gastroparesis suffer from persistent nausea, with 84% reporting regular episodes of vomiting. Additional symptoms can include bloating, abdominal pain, early satiety, and a sensation of excessive fullness even after consuming a small meal. These symptoms can be triggered or worsened by various factors, including certain foods, stress, and underlying medical conditions.

Diagnosing gastroparesis can be a challenge due to the commonality of its symptoms with other digestive disorders, as well as the variability in symptom intensity and frequency. Despite these challenges, certain diagnostic procedures, such as a gastric emptying study, endoscopy, or a barium X-ray, can aid in identifying the condition. It's important to note that gastroparesis often presents differently in patients, with some experiencing episodic symptoms and symptom-free periods between flares, while others endure chronic and consistent symptoms. This variance can further complicate diagnosis.

The most effective treatment for gastroparesis typically involves a combination of medications like prokinetics and antiemetics, along with lifestyle adjustments. These may include dietary changes, smaller and more frequent meals, all aimed at reducing symptoms and improving stomach emptying. However, it is not uncommon for some patients to continue experiencing significant symptoms despite these interventions.

The primary causes of gastroparesis can range from diabetes and surgical complications to autonomic neuropathy, connective tissue diseases, and thyroid disorders. However, idiopathic gastroparesis, where no specific cause can be identified, accounts for a around one third of cases.

Given the complexities of this condition and its impact on the quality of life, close collaboration with a healthcare provider experienced in diagnosing and treating gastroparesis is crucial. With proper management and personalized treatment plans, many individuals with gastroparesis can lead healthier, more fulfilling lives, even in the face of this challenging condition.

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Prevalence of Gastroparesis

Gastroparesis affects a significant portion of the population, with the current estimates suggesting a prevalence of up to 4%. This condition, once considered relatively rare, has led to a substantial increase in hospital admissions over recent years, indicating a rising awareness and recognition of the disorder.

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Diagnosis of Gastroparesis

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Identifying Symptoms of Gastroparesis:

Diagnosing gastroparesis involves several steps and different types of tests. It can be a complex process due to the nonspecific nature of the symptoms, which are common to many gastrointestinal disorders. Below are some of the tests commonly used in diagnosing gastroparesis. It's important to note that not all patients will need to undergo all these tests. The choice of tests depends on the individual's specific symptoms, medical history, and the doctor's clinical judgement. After the diagnosis is confirmed, the doctor can develop a personalized treatment plan to help manage symptoms and improve the quality of life.

Patient History and Physical Examination:

The process typically begins with a thorough review of the patient's medical history and a physical examination. The doctor will ask about symptoms, dietary habits, medication use, and any other underlying health conditions.

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Testing for Gastroparesis:

Blood Tests: Blood tests can help rule out other conditions that might cause similar symptoms.

Gastric Emptying Study: This is the most common test for diagnosing gastroparesis. It involves eating a light meal (such as eggs and toast) that contains a small amount of a radioactive substance. A scanner tracks this substance as it moves through the digestive tract, providing information about how quickly food leaves the stomach.

Upper Gastrointestinal (GI) Endoscopy: This procedure allows the doctor to view the inside of the esophagus, stomach, and upper part of the small intestine using a flexible tube with a light and camera at the end (an endoscope). It helps rule out other conditions that may cause similar symptoms, like ulcers or blockages.

Upper GI Series or Barium Swallow X-ray: During this test, the patient drinks a thick liquid (barium), which coats the digestive tract and makes it visible on X-rays. This can help identify any abnormalities in the structure of the digestive tract.

Wireless Capsule Study or SmartPill: This involves swallowing a small, pill-sized device that sends signals to a recorder worn on a belt. The device measures pH levels, temperature, and the speed of transit through the different parts of the digestive tract.

Gastric Manometry: This test measures the electrical and muscular activity in the stomach when you eat. It can help determine if the stomach muscles are working properly.

Ruling out other conditions:

In the context of gastroparesis, it is crucial to rule out other potential causes of symptoms, as many conditions can present with similar gastrointestinal symptoms. During the diagnostic process, other potential diagnoses should be evaluated, with additional investigations as required. These investigations may include endoscopy, colonoscopy, imaging studies, and biopsies.

Several conditions that need to be ruled out in the diagnostic process may include peptic ulcer disease, gallbladder disease, celiac disease, irritable bowel syndrome, and stomach or pancreatic cancers. Importantly, conditions like diabetes need to be evaluated, as it is a common cause of gastroparesis. Other systemic diseases that might affect gastric motility, such as scleroderma or Parkinson's disease, should also be considered.

In each patient, it's essential to conduct a thorough examination and necessary tests to ensure accurate diagnosis and appropriate management of the condition causing their symptoms.

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Seek an Expert Medical Opinion:

It's crucial to collaborate closely with a healthcare provider skilled in diagnosing and managing gastroparesis to complete these diagnostic steps and devise a personalized treatment plan. We can assist you in finding a healthcare provider experienced in identifying and treating gastroparesis. Although the path to a diagnosis may sometimes feel overwhelming and taxing, securing an accurate diagnosis of gastroparesis is essential in paving the way for targeted treatment and effective symptom management.

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Comorbidites of Gastroparesis

Gastroparesis often coexists with other medical conditions, with individuals commonly dealing with at least one additional ailment. The link between gastroparesis and many of these concurrent conditions isn't entirely clear and requires further research.

Frequent concurrent conditions with gastroparesis encompass metabolic disorders like type 2 diabetes, a major known cause of this gastric motility problem. Other conditions often seen in conjunction include connective tissue disorders like Ehlers Danlos Syndrome (EDS), dysautonomia such as Postural Orthostatic Tachycardia Syndrome (POTS), Mast Cell Activation Syndrome (MCAS), and conditions affecting the nervous system.

Beyond these commonly associated conditions, other illnesses often seen with gastroparesis include fibromyalgia, irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME), and migraines. Additionally, autoimmune disorders such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and multiple sclerosis (MS) may also coexist with gastroparesis.

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