What is Gastroparesis?
Gastroparesis is a condition in which the stomach takes too long to empty its contents. Food and liquid stay in the stomach for a long time. This leads to symptoms such as nausea, vomiting and abdominal pain. Children with gastroparesis often feel full or bloated.
Gastroparesis is sometimes called delayed gastric emptying. There is no cure yet. But specialists can help your child control the symptoms. Gastroparesis symptoms often improve over time or disappear with treatment. It can be a lifelong condition for some people.
What Causes Gastroparesis?
Experts are not sure what causes gastroparesis. The condition may be caused by:
- Nerves located in the wall of the stomach that don’t work properly
- “Pacemaker cells” in the wall of the stomach that don’t work properly
- Some kind of dysfunction of the wall of the stomach itself
- Dysfunction with the sphincter at the exit of the stomach connecting it to the small bowel
Doctors do not yet understand why some children develop this condition and others do not. Risk factors include:
- Conditions such as an infection, diabetes, hypothyroidism, neurologic disorders, metabolic disorders and joint hypermobility syndrome.
- Certain types of gastrointestinal surgeries. This includes surgery that helps control reflux in patients with gastroesophageal reflux disease (GERD).
- Certain medications and chemotherapy drugs
- Birth defects that affect the stomach or abdomen
Gastroparesis is common in adults, but not very common in children. In children, it most frequently happens following a viral infection, but oftentimes we do not know the cause, which is called idiopathic. Gastroparesis in the presence of diabetes or neurologic conditions is seen less often in children. Additionally, some children can have hypermobility of their joints, a condition that can affect multiple parts of their bodies including the gastrointestinal tract, and can develop gastroparesis.
What are the Signs and Symptoms of Gastroparesis?
Gastroparesis in infants and toddlers can be hard to identify because they cannot tell us what hurts. They will often be diagnosed with a feeding disorder because they will just stop eating and are vomiting or fussy.
The most common symptoms of gastroparesis include:
- Vomiting
- Nausea
- Upper abdominal discomfort or pain
- Bloating
- Feeling full after only a few bites of food
- Excessive burping or belching
Some children with gastroparesis avoid eating because this can make them feel worse. This can lead to weight loss, malnutrition and dehydration. Some children with gastroparesis find that eating small amounts of food throughout the day lessens their symptoms. They can also have associated dizziness, fatigue, sleep problems, anxiety and headaches.
How is Gastroparesis Diagnosed?
A pediatric gastroenterologist can diagnose and treat children who have symptoms of gastroparesis.
The pediatric gastroenterologist will take a careful medical history and examine your child during your child’s first appointment. Many conditions cause symptoms similar to those of gastroparesis. The doctor may order other tests to determine what is causing your child’s symptoms.
The “conventional standard” test for diagnosing gastroparesis is a nuclear medicine test called gastric emptying scintigraphy. Your child eats food mixed with a small and safe amount of a radioactive substance. Then a technician uses a scanner to track how the substance moves through the digestive system. This test takes about four hours. The results show how quickly food is leaving your child’s stomach.
Other tests can help the care team understand the cause of your child’s gastroparesis. These may include:
- Endoscopy. A small, flexible tube (catheter) is placed through the mouth into the stomach to see whether anything is blocking the opening from the stomach to the small intestine (pylorus). A blockage in this area can cause gastroparesis. This test is done in a special procedure room using anesthesia. Your child will be asleep for the test.
- An X-ray study. This test is another way to see if anything is blocking the pylorus.
- Antroduodenal manometry. A catheter is placed through the nose into your child's stomach and small intestine to measure pressure. This can help the care team understand if the cause of your child’s condition is related to a problem with nerve signals.
The stomach has five main parts: cardiac, fundus, body, antrum and pylorus. When working well, these parts work together to take in food , store food, compact food, digest it and push it out into the small intestine. When a child has gastroparesis, however, any combination of these five sections can be problematic and cause symptoms. And the symptoms can be related to liquids or solids.
While we can conduct a four-hour gastric emptying scan to determine if the stomach is slow to empty and can distinguish between liquid and solid emptying, we don’t currently have a good test that tells us which one or more of the five parts are not working properly.
Some children may have normal gastric emptying but may still have symptoms of gastroparesis. These children could have functional dyspepsia where they have sensory problems rather than motor.
What are the Treatment Options for Gastroparesis?
Treatment is going to be different for every child, but options include medications, diet modifications, and medical and surgical procedures.
The care team will develop a treatment plan for your child. Many children need a few different therapies. Your doctor will work with you to find the best treatment for your child.
For children with severe forms of gastroparesis, multiple specialists are required to address all of their needs. We recommend that patients have a team that includes a neurogastroenterologist, nutritionist, psychologist and social services to help children with school.
Treatment options include:
- Treating any condition that is causing the gastroparesis
- A special diet that includes:
- Avoiding high-fat foods and high-fiber foods
- Eating several, small meals a day
- Adding more liquids to your child’s diet. Liquids leave the stomach faster than solids.
- Medicines to control nausea, improve stomach emptying and relieve pain. Medications can work on different parts of the stomach. Some patients may need to use a combination of medications to address their symptoms.
- Pain and nausea coping skills: there are techniques that a GI-focused psychologist can teach children to decrease the symptoms of abdominal pain and nausea and improve appetite. These pain and nausea coping skills can improve attendance at school, daily functioning, nutrition and weight gain.
- Other non-pharmacologic treatments: aromatherapy, acupressure point, acupuncture and ginger chews may help symptoms of nausea and abdominal pain.
- Procedures such as Botox injections and balloon dilation. These can help if the area from the stomach to the small intestine is too narrow or not functioning properly.
- A feeding tube that delivers food directly into the small intestine. This is used when gastroparesis is so severe that the child cannot keep any food or liquids down.
- Percutaneous electrical nerve field stimulation: This neurostimulation treatment to the outer ear for four weeks can improve symptoms. It works by resetting the pain pathways that connect the gut to the brain.
- Gastric electrical stimulation: This treatment involves surgically implanting a device that stimulates the stomach with mild electrical pulses. This allows food to move through the stomach more normally. It can relieve the symptoms of gastroparesis. Learn more about gastric stimulation.
What is the Long Term Outlook for Children with Gastroparesis?
Most children with gastroparesis get relief from their symptoms with careful treatment. The symptoms eventually go away in many cases. Gastroparesis in patients with hypermobility usually improves after adolescence. But gastroparesis can be a chronic, long-term condition for some children. Your child’s care team will help you and your child manage the symptoms of gastroparesis and experience the best health possible.
