The cause may be a disorder of the stomach muscles.
What do you do when your daughter frequently vomits (and not because she wants to)? When it’s happened too often to blame food poisoning or a flu each time, you may sigh and wish she didn’t have such a “sensitive stomach.”
But there’s a name for the condition she may have, gastroparesis, and an explanation other than nerves. Gastroparesis, when your stomach muscles don’t work well enough to move food along properly, affects an estimated 4 million Americans, often young and middle-aged women. About a quarter of them also have diabetes, yet in nearly half, there’s no clear cause but a clear problem: Food moves too slowly from the stomach to the small intestine or stops moving altogether.
She may also have gastritis, an inflamed stomach; or what’s called “functional dyspepsia,” the grab-bag diagnosis for stomach pain without a clear cause.
In diabetics, high blood glucose levels can damage the vagus nerve, which controls the stomach muscles. Intestinal surgery or diseases of the nervous system such as Parkinson’s or multiple sclerosis can damage the vagus nerve as well. Along with unexplained vomiting sometimes several hours after a meal, symptoms include feeling full quickly, coughing from gastric reflux, stomach pain, bloating, and lack of appetite.
Sometimes gastroparesis shows up after a bout of stomach flu. In those cases, it often resolves within a year or so. But more often, gastroparesis becomes chronic, although symptoms may come and go and vary in severity. In one study of 416 adults with gastroparesis, almost a third had missed work for more than two weeks because of their stomach problems and similar numbers were chronically anxious.
The first step in ruling out other problems is an upper endoscopy, which can be done in the morning after an overnight fast. A gastroenterologist will put a thin flexible telescope into her mouth and look at the stomach and first part of the small intestine, the duodenum, to check for inflammation or a mechanical obstruction. The next step may be a gastric emptying study. Your daughter will eat a meal, typically an egg sandwich, containing a small amount of radioactive material, and lie with a scanner on her stomach monitoring its progress for four hours.
If it turns out that her stomach empties too slowly, her doctor may recommend a diet regime: small meals as often as six times a day, drinking noncarbonated liquids with meals, and avoiding high-fat foods and especially fibrous foods like oranges and broccoli. Nuts and seeds and beans can also be hard to digest. It’s easy to get into a snacking mind-set when you’re eating so often, grabbing one food, but ideally, she’d eat small balanced meals. She can try alternating with liquids, like pureed soups, smoothies with yogurt, pulp-free vegetable juices, or meal replacement products. It’s important to chew solid food thoroughly.
Medications such as metoclopramide (Reglan) can accelerate stomach action, and other agents can prevent vomiting. Some doctors prescribe anti-depressants.
Obviously, you want to be sure your daughter doesn’t lose too much weight and become malnourished or miss many activities or social occasions involving food. Severe cases may require a procedure to implant a battery-operated device that sends mild electrical pulses to the stomach muscles. Once implanted, the settings can be adjusted to see which works best. The device seems to work better with diabetic patients, and complications from the surgery or device occur in about 10 percent of all cases, but it has shown results, according to a survey of the research.
March 26, 2020
Janet O’Dell, RN