Pediatric Gastroparesis

Gastroparesis is a stomach disorder. It happens when your stomach takes too long to empty out food.

If food stays in your stomach for too long, it can cause problems. The food can harden into solid masses. These are called bezoars. These masses may upset your stomach and make you vomit. They can also create a blockage in your stomach. This can be dangerous if it stops food from passing into your small intestine.

In most cases, gastroparesis is a long-term (chronic) condition.

Gastroparesis is caused when the vagus nerve is damaged or stops working. The vagus nerve controls how food moves through your digestive tract. When this nerve doesn’t work well, food moves too slowly or stops moving.

The vagus nerve gets damaged if you have diabetes and your blood sugar or blood glucose levels stay high over a long period of time.

Other causes of gastroparesis include:

• Eating disorders, such as anorexia or bulimia
• Surgery on your stomach or vagus nerve
• Extreme tiredness that does not seem to be caused by a health problem (chronic fatigue syndrome)
• Some medicines that slow movement in your intestine, such as narcotics for chronic pain
• Disorders involving smooth muscle that may affect the stomach, such as amyloidosis and scleroderma
• Nervous system disorders such as abdominal migraine and Parkinson's disease
• Metabolic disorders, which make the body have either too much or too little of essential things it needs to stay healthy, such as having too little of the thyroid hormone ( hypothyroidism)
• A viral illness, such as a viral gastroenteritis

Each person’s symptoms may vary. Symptoms may include:

• Upset stomach or nausea
• Vomiting
• Weight loss
• Feeling full too soon after you start eating
• Belly (abdominal) bloating or pain
• Heartburn or GERD (gastroesophageal reflux disease)

The symptoms of gastroparesis may look like other health problems. Always see your child's pediatrician to be sure.

Your healthcare provider will give you a physical exam and ask about your past health. You may also have other tests, including:

• Blood tests. These tests check your blood counts and measure your chemical and electrolyte (mineral) levels.
• Upper GI (gastrointestinal) series. This is also called a barium swallow. This test checks the organs of the top part of your digestive system. These are your food pipe (esophagus), your stomach, and the first part of your small intestine (duodenum). You will swallow a metallic fluid called barium. Barium coats the organs so that they can be seen on an X-ray. X-rays are then taken to check your digestive organs.
• Radioisotope gastric-emptying scan. During this test, you will eat food containing a mildly radioactive substance, or radioisotope, that will show up on a scan. The amount of radiation is very small. It's not harmful. But it lets the radiologist see the food in your stomach during the scan. They can also see how quickly food leaves your stomach. This test can take as long as 4 hours.
• Gastric manometry (antroduodenal manometry).This test checks the muscle movement in your stomach and small intestine. A thin tube is passed down your throat into your stomach. This tube has a wire that measures the muscle movement of your stomach as it digests foods and liquids. This helps show how your stomach is working. It also shows if your digestion is slower than normal.
• Upper endoscopy. This test looks at the lining or inside of your esophagus, stomach, and duodenum. This test uses a thin, lighted tube, called an endoscope. The tube has a camera at one end. The tube is put into your mouth and throat. Then it goes into your esophagus, stomach, and duodenum. Your healthcare provider can see the inside of these organs. They can also take a small tissue sample (biopsy) if needed.
• Wireless capsule study. This test involves swallowing a wireless capsule that measures stomach emptying and how fast food and fluids move through your intestine. You will pass the capsule out of your body with a bowel movement.
• Gastric emptying breath test (GEBT). This test checks stomach emptying by measuring how much carbon dioxide you breathe out over several hours after eating food.
• Scintigraphic gastric accommodation. This test measures your stomach contents before and after a meal. It also checks how well your stomach relaxes after you eat food.

In most cases gastroparesis is a long-term or chronic health problem. It can’t be cured. But you can manage the disease with a care plan.

If your child has diabetes and gastroparesis, the main goal is to control their blood sugar levels. Any medicines that can cause gastroparesis will likely be stopped.

Treatment will depend on the symptoms, age, and general health. It will also depend on how severe the condition is.

Your child's care plan may include:

• Taking medicines. Your child's pediatrician may prescribe a few medicines to see which works best.
• Changing your child's diet. Changing your child's eating habits can also help control the disease. In some cases eating 6 smaller meals a day is more helpful than eating 3 larger ones. Some experts suggest having a few liquid meals a day. They suggest to do this until  blood glucose levels are stable and the gastroparesis is under control. You may also be told not to let them eat fatty and high-fiber foods. These can slow their digestion and be hard to digest. See your child's pediatrician or a dietitian for the eating plan that is best for your child.
• Surgery. In some cases your child may need a type of surgery called a jejunostomy. A feeding tube is inserted through the skin on their abdomen into their small intestine. This tube lets nutrients go right into their small intestine instead of their stomach. This surgery is used only if their gastroparesis very severe.
• Gastric neurotransmitter. This device may help control any upset stomach and vomiting. It's put into their body by surgery.
• Feeding by IV (intravenously). This is also called parenteral nutrition. This is when nutrients are put right into the veins. This is done instead of eating and having food go through the digestive system. A tube or catheter is put into one of the chest veins. The tube has an opening on the outside of your child's skin. A bag with liquid nutrients or medicine is joined to the tube. The fluids go into their bloodstream through their vein.

Gastroparesis can lead to weight loss and not getting enough nutrients (malnutrition). It's very important to follow your child's pediatrician's diet instructions.

In most cases your child will be given a special diet. This will have foods that are easier to digest and pass through their stomach. They may also be given medicines to take. Follow all instructions carefully.