Since 2016, August has marked Gastroparesis Awareness Month to raise an understanding and highlight education about this disorder. Sponsored by the International Foundation for Gastrointestinal Disorders (IFFGD), Gastroparesis Awareness Month can help all nurses identify patients who might be misdiagnosed.
“Gastroparesis is a diagnosis that refers to abnormal stomach movement with slow emptying of the stomach,” says Mackenzie McArthur MPAM, DMSc, PA-C, instructor in the department of Internal Medicine, Director of Neurogenic Bowel Program, Atrium Health Gastroenterology and Hepatology. “This is referred to as delayed gastric emptying and abnormal gastric motility.”
Diagnosis isn’t always straightforward as symptoms can mimic other conditions. Because some patients will have a delay in emptying the stomach as well as in the esophagus, small intestines, and colon, they can experience trouble swallowing and constipation as a range of symptoms. “The most common symptoms of Gastroparesis are abdominal pain, most of the time in the upper part of the abdomen, nausea, and vomiting.” says McArthur. “Other associated symptoms include feeling extremely full, especially after meals, and bloating (feeling like you need to loosen your pants).”
Nurses can be watchful for digestive troubles and, says McArthur, of the some patients who could have conditions that make gastroparesis more common. Surgical procedures including acid reflux surgeries or gastric bypass or medications like opioids or narcotics can slow down digestion. Patients with previous infections of COVID-19, Epstein-Barr Virus, or parvovirus or with diabetes or some autoimmune conditions could have symptoms that point to motility disorders in the gastrointestinal tract, says McArthur.
In these patients, nurses can be particularly alert to any digestive complaints. McArthur says watching for nausea, vomiting, bloating, abdominal pain, fullness, or lack of appetite can signal follow-up testing to help with a proper diagnosis. Those tests could include an upper endoscopy to look for any ulcers, infections, or mechanical obstructions. Patients may also have a gastric emptying study which, McArthur says, uses a specific caloric meal that the patient eats and is followed by nuclear radiology to time the emptying of the meal out of the stomach. If delayed emptying is noted, there is a positive diagnosis of gastroparesis.
Patients will also likely work with a healthcare team that might include a gastrointestinal registered dietician for the gastroparesis type diet which could be very different from the patient’s current diet. McArthur says there are other available therapies including anti-nausea/vomiting medications, prokinetic therapy (medications to speed up the motility of the gastrointestinal system), and likely laxative therapy. “Constipation treatments are often initiated as we know improving the emptying of the colon can help upper gastrointestinal symptoms,” she says. “Other options may include endoscopic therapies, surgical interventions, and/or consideration for gastric electrical stimulation techniques.”
Nurses, whether GI nurses or in another specialty, can play an active role in helping patients navigate through uncomfortable and disruptive symptoms and diagnosis. “Nurses can help patients with gastroparesis and/or motility conditions by showing compassion and empathy,” says McArthur. “Motility patients often need help coordinating testing, medications and other conditions they may be dealing with. Motility disorders are often misdiagnosed/undiagnosed and patients may have seen many different healthcare providers, so having trust in their care team is vital.”