See also ESOPHAGEAL VARICES; HEMORRHAGE.gastroparesis Slowed function of the STOMACH
that delays the travel of gastric contents into the
DUODENUM. Gastroparesis results from disturbances
of or damage to the vagus NERVE(the tenth cranial
nerve), which carries the nerve impulses that
accelerate PERISTALSIS(rhythmic contractions of the
gastrointestinal tract). Gastroparesis most com-
monly occurs after a viral infection though also is
a complication of DIABETES, which damages nerve
structures throughout the body. Other causes
include sclerotic conditions such as MULTIPLE SCLE-
ROSISor scleroderma, anticholinergic medications
often prescribed to treat PARKINSON’S DISEASE, inad-
vertent damage to the vagus nerve as a complica-
tion of thoracic or HEARTsurgery, and intentional
interruption of the vagus nerve (vagotomy) to
treat conditions such as PEPTIC ULCER DISEASE. Peo-
ple who are on long-term PARENTERAL NUTRITION
also often have gastroparesis.
The main symptom of gastroparesis is frequent
VOMITINGof undigested food hours after a meal.
Other symptoms may include lack of APPETITEdue
to sense of fullness, NAUSEA, ABDOMINAL DISTENTION,
and unintended weight loss. Gastroparesis can
quickly result in DEHYDRATION, which can create
significant disturbances of blood GLUCOSE and
INSULINlevels in people who have diabetes. The
first approach of treatment is to shift to eating
numerous small meals throughout the day,
attempting to slow the pace of ingestion to accom-
modate the stomach’s slowed functioning.
Medications to stimulate gastrointestinal motil-
ity, such as metoclopramide (Reglan), may
improve gastric emptying. Control of diabetes,
which may require multiple insulin doses
throughout the day, is crucial. If symptoms con-
tinue, the gastroenterologist may suggest a
jejunostomy tube, or feeding tube, that bypasses
the stomach. Most people, however, achieve an
acceptable resolution of their symptoms, even
when gastroparesis persists, through nonsurgical
approaches.
See also CRANIAL NERVES; ENTERAL NUTRITION; NUTRI-
TIONAL NEEDS; PANCREATITIS; RAPID GASTRIC EMPTYING.52 The Gastrointestinal System