Gastric Emptying

Rapid and delayed gastric emptying are functional gastrointestinal disorders (FGIDs) that occur when undigested foods, primarily sugars and carbohydrates, move too quickly from the stomach to the small intestine.
Some people suffer from both rapid and delayed gastric emptying disorders. Symptoms for both types disorders range from mild to severe and treatment depends on the underlying symptoms.

Diagnosis for Gastric Emptying Disorders

Diagnosis may involve a barium x-ray, a radioisotope gastric-emptying scan and blood tests. A gastric manometry test may also be performed to measure muscle activity in the stomach.

Rapid Gastric Emptying (Dumping Syndrome)

Rapid or early gastric emptying (dumping syndrome) occurs when undigested food or fluid passes too quickly from the stomach into the lower section of the small intestine (jejunum), the part of the gastrointestinal tract involved with digestion.
Rapid gastric dumping usually occurs immediately after eating. But as its name suggests, rapid gastric emptying may happen even during a meal.
Symptoms of Dumping Syndrome: Symptoms of rapid gastric emptying include:
  • diarrhea
  • cramping
  • palpitations
  • nausea
  • vomiting
  • bloating
  • dizziness
  • tiredness.
Causes of Rapid Gastric Emptying: The most common cause of dumping syndrome is any type of gastric surgery that may also affect the rate at which food passes from the stomach to the small intestine. Gastric bypass surgery is a prime example of stomach surgery associated with rapid gastric emptying.
Surgery for Zollinger-Ellison syndromea disease where gastrin-secreting tumors of the pancreas cause severe peptic ulcerationis also associated with rapid gastric emptying.
Treating Dumping Syndrome: Treatments for rapid gastric emptying include:
  • diet: A low-carbohydrate diet based on eating "little and often" is the main treatment for managing rapid gastric emptying.
  • medication: Medicines that slow digestion, in combination with dietary changes, are sometimes recommended for the treatment of severe cases.
  • liquid intake: Patients with dumping syndrome are advised to drink between rather than during meals.
  • surgery: Severe cases of rapid gastric emptying may require corrective surgery.

Delayed Gastric Emptying (Gastroparesis)

Gastroparesis, also called delayed, late or disordered gastric emptying, is a gastrointestinal disorder caused by delayed digestion and movement of food from the stomach to the small bowel.
Gastroparesis occurs when the vagus nervethe nerve in the stomach that controls the production of stomach acid and the movement of food through the digestive tractbecomes damaged.
Delayed gastric emptying disorder is generally associated with low blood sugar levels. Gastroparesis usually occurs between one and three hours after eating a large a meal.
Symptoms of Gastroparesis: Symptoms of delayed gastric emptying may range from mild to severe and include:
  • slow digestion
  • heartburn
  • vomiting
  • poor appetite
  • stomach spasms
  • bloating
  • weakness
  • weight loss
  • sweating
  • dizziness
  • nausea
  • sleepiness
  • extreme fatigue.
Causes of Gastroparesis: Gastroparesis is often triggered by associated gastrointestinal disorders that affect the normal digestive functions of the stomach, pancreas and liver. Causes include:
  • stomach surgery involving the vagus nerve, such as gastric bypass surgery
  • diabetes, both types 1 and 2, where high blood glucose levels damage the vagus nerve
  • hypoglycemia
  • post-viral infections
  • anorexia nervosa
  • drugs that decrease intestinal contractions
  • smooth muscle diseases such as scleroderma and amyloidosis
  • nervous system disorders such as Parkinson's disease
  • metabolic disorders such as hypothyroidism.
Complications arising from gastroparesis may occur when food retained in the stomach solidifies, causing bacterial infections and/or blockages in the intestinal tract.
Treating Delayed Gastric Emptying: Treatment for gastroparesis depends on the presenting symptoms. However, routine treatment for gastroparesis involves a change in dietary habits to control blood sugar levels. A dietary regimen of up to six small meals a day instead of three large meals is generally recommended.
Other treatments for delayed gastric emptying include insulin to control blood glucose levels, medications such as Reglan® (metoclopramide) and erythromycin to help stimulate stomach muscle contractions and botulinum toxin injections to relax the stomach's sphincter (pylorus).
Surgery to insert a feeding tube is necessary only when all other treatments for delayed gastric emptying have failed.

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