Anorexia and Gastroparesis

What is Gastroparesis?

Gastroparesis (literally meaning “stomach paralysis) is a condition that affects the movement and muscles involved in emptying the stomach and moving food onward down the digestive tract. In a normal digestive tract, strong muscular contractions push the food from the stomach to the intestines. Gastroparesis can be a complication of several diseases and conditions, and sometimes the cause is completely unknown. Diabetes, gastric surgery, medications, and eating disorders like anorexia nervosa (AN) can all lead to gastroparesis. (1)

How Does Anorexia Lead to Gastroparesis?

People suffering from gastroparesis anorexia severely limit food intake, resulting in:

• Increasing weight loss 
• Effects on the skin, hair, and nails 
• Muscle weakness 
• Dizziness or fainting
• Malnutrition. 

Just as the visible muscles lose strength and the body weakens, internal muscles are affected the same way. Because of the severely restricted food intake, the muscles in the digestive system are not used as often. 

These internal muscles begin to atrophy, or lose tone and strength. Just as someone’s legs would atrophy if they aren’t used, the stomach muscles do the same. Eventually, gastroparesis develops – the process of emptying the stomach slows or even stops altogether. (2)

How is Gastroparesis Diagnosed?

Gastroparesis is diagnosed via several tests, depending on symptoms, or to rule out other similar conditions. 

There are two types of gastric emptying tests, which determine how fast your stomach empties its contents. 

1. Scintigraphy: This test involves eating a light meal that contains a small amount of radioactive substance. A scanner can detect how the radioactive material moves through the stomach, and at what rate. 
2. Breath test: This test follows the same principle, although the food contains a substance that is detected on your breath as it absorbs. Breath samples are collected every few hours and the level detected is analyzed. This test detects how fast the stomach empties and absorbs nutrients.

Another type of test used for diagnosis is the upper gastrointestinal (GI) endoscopy, commonly called an “upper GI.” In this test, the patient is mildly sedated while a tube with a tiny camera is inserted through the mouth and down the esophagus, stomach, and sometimes small intestine. This test can rule out other conditions such as ulcers or pyloric stenosis (a narrowing of the stomach valve).

Ultrasound of the abdomen can also be used to rule out other conditions, such as gallbladder disease. This involves using a device over the stomach that produces a picture of the internal structures. (3)

Physical Effects of Gastroparesis

Symptoms of decreased digestive movement from gastroparesis may include any of the following:

• Early fullness, soon after beginning a meal
• Feeling full too long after a meal
• Nausea and vomiting
• Bloating and belching
• Upper abdominal pain
• Acid reflux and heartburn
• Poor appetite

These effects are concerning for the treatment of anorexia. As a person suffering from this eating disorder is learning to regulate food intake and listen to body cues about hunger, gastroparesis can alter the normal response. This can cause problems in treatment due to feelings of over-fullness and a lack of desire to eat. 

To complicate the matter even further, certain medications can make gastroparesis symptoms worse:

• Narcotic pain medications such as codeine, hydrocodone, morphine, oxycodone, and tapentadol
• Antidepressants such as amitriptyline, nortriptyline, and venlafaxine
• Some anticholinergics used to treat overactive bladder

It is important that a person dealing with anorexia (even if in recovery) and simultaneously diagnosed with gastroparesis seek professional treatment from someone familiar with both conditions. (4)

What is the Treatment for Gastroparesis?

Treatment for gastroparesis is most effective when it is started early, however this is complicated further by restrictive eating behaviors and distorted body image in people with anorexia nervosa and other eating disorders. Typically the first symptoms of gastroparesis are nausea, vomiting, and early fullness. All of these may be symptoms that people dealing with anorexia may combat on a daily basis. For individuals undergoing treatment for their eating disorder, it is important that symptoms be recorded, and any changes thoroughly examined. 

The best treatment for gastroparesis is prevention and treatment of any underlying conditions or behaviors that may be contributing to it. 

After gastroparesis has progressed, there are a few treatment options that can help:

• Dietary modification: Eating several small meals daily to reduce symptoms of over-fullness and promote nutritional intake. Drinking fluids between meals and not with meals. Eat soft and easily digestible foods, chewing thoroughly. Avoid carbonated beverages. 
• Medications: Metoclopramide is the most used, while some others are used off-label and are currently undergoing FDA evaluation. This drug promotes gastric movement and emptying. Other medications are those commonly used for nausea and vomiting.
• Gastric electrical stimulation: Uses an implanted device to provide nerve stimulation and promote gastric emptying. 
• Nutritional supplementation: Some patients with advanced gastroparesis find that supplementation through a feeding tube in the stomach or small intestine or total parenteral nutrition (TPN) is needed to maintain weight and hydration. This is typically a later-stage treatment after other plans have failed to work. 

Although there is no “cure” for gastroparesis, research is ongoing to develop more treatment options. Individuals with anorexia nervosa, or a history of it, should be aware of the symptoms and seek treatment from a qualified gastroenterologist. Early treatment is always the best.