Gastroparesis
Gastroparesis is a disorder in which the stomach takes too long to empty. Its exact cause isn’t known, but it may be related to disrupted nerve signals in the stomach.
In some cases, gastroparesis begins after a surgery that involves the stomach or other digestive organs. Children who have diabetes are at higher risk for gastroparesis, since diabetes that isn’t well controlled can damage nerves over time. Gastroparesis can also start after a viral illness. In most cases, however, the trigger can’t be identified.
Symptoms
The symptoms of gastroparesis can be mild or severe. For some children, symptoms interfere with daily activities and keep them home from school. Children with gastroparesis may experience:
Upper abdominal pain
Nausea
Vomiting
Loss of appetite
Bloating
Feeling full after eating a small amount
Feeling full long after a meal
Weight loss
Vomiting and decreased appetite can lead to complications such as dehydration and malnutrition. Eventually, these can cause muscle weakness, poor wound healing, a weakened immune system and other problems.
Diagnosis
Your pediatric gastroenterologist at Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition will ask about your child’s symptoms and do a physical exam. They will also ask about other health problems, such as diabetes, and whether your child has had any digestive tract surgeries.
Gastroparesis symptoms are similar to those of other conditions, such as irritable bowel syndrome and cyclic vomiting syndrome, and your child’s doctor will do tests to rule out them out. These tests may include:
Blood tests. These tests can show signs of inflammation, infection and also blood glucose levels.
Upper endoscopy. During this test, while your child is sedated, doctors pass a thin, flexible tube with a camera through their mouth and into their stomach. It can show blockages in the stomach and other conditions.
Barium study. For this test, your child swallows a chalky liquid called barium, which is then tracked through the upper part of their digestive system with X-rays. This test is also called an upper GI.
Abdominal ultrasound. This test uses sound waves to create detailed images of your child’s internal organs to spot any problem areas.
Once your child’s doctor has ruled out other disorders, they will do tests to determine how well your child’s stomach empties. Your child may have one or more of the following tests:
Gastric emptying scintigraphy test. For this test, your child eats a small meal that has a small amount of a harmless radioactive substance added to it. For babies, the meal can be milk or formula. A camera outside their body tracks the movement of the substance, showing how fast their stomach empties after a meal.
Antral-duodenal motility test. This test measures the coordination and strength of contractions at the bottom of your child’s stomach where it empties into the small intestine. The doctor passes a flexible tube through your child’s nose, down their throat and into their small intestine. The tube has pressure sensors that measure how well the muscles are working to move food out of the stomach.
Treatments
If your child’s doctor finds an underlying condition that is causing the gastroparesis, they will treat that condition first. For example, if your child has diabetes, the doctor will help you and your child control it better.
Diet is an important part of gastroparesis treatment. Your child should eat four to six small meals each day, consisting mostly of low-fat foods. Avoid high-fiber foods, and cook vegetables well to lower their fiber content. Limit carbonated drinks and dairy foods. Your child’s doctor may recommend a daily multivitamin.
The gastroparesis diet is a good way to get started. It can reduce symptoms while giving your child adequate nutrition and fluids. It consists of the following steps:
Step one. Give your child mainly liquids, which usually drain into the small intestine by gravity alone. Your child’s doctor will tailor these liquids to your child’s individual nutritional needs. This step doesn’t supply adequate nutrients to your child long term, so it lasts no longer than three days.
Step two. This step adds some milk products, breads, pastas, fruits and vegetables, but no meats. These foods add small amounts of fat for calories. Your child’s doctor will tell you how long this step should last.
Step three. This step is designed for long-term maintenance. It includes a wider variety of foods while limiting foods with fiber and fat to 50 mg per day.
Your child’s doctor also may recommend the following treatments:
Medications. These may help control nausea and vomiting caused by gastroparesis. Other medications stimulate the stomach muscles and help with digestion.
Surgery. If medications haven’t helped, your doctor may recommend surgery to help your child’s stomach empty more efficiently.
Next Steps
Gastroparesis is unusual in children and requires a highly individualized treatment plan. Your team at Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition will design a care plan tailored specifically for your child. The plan will include consultations with one of our registered pediatric dietitians for ongoing help with the gastroparesis diet and to solve any other food-related issues your child may be experiencing. We’re here for your child and your family to ensure the best possible quality of life with gastroparesis.
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