Is It GERD or Gastroparesis?

Is It GERD or Gastroparesis?

Gastroparesis and GERD (gastroesophageal reflux disease) are two gastrointestinal problems with overlapping symptoms but different treatments. In the case of gastroparesis or delayed gastric emptying, stomach contractions that propel food down into intestines are lost. Undigested food and stomach secretions accumulate in stomach for days and weeks. This results in nausea, bloating, vomiting, and in many cases, heartburn. Heartburn, a burning sensation behind the breastbone, is indeed very common in gastroparesis cases. Food stasis and increased gastric pressure favor gastric content reflux into esophagus resulting in heartburn.

Heartburn, however, is a classic GERD symptom. In GERD patients a weak anti-reflux barrier allows frequent gastric content reflux into esophagus. In addition to heartburn, GERD patients suffer from food regurgitation, bloating, excessive burping, sore throat, cough, and globus. Nausea, vomiting, and early satiety are not common GERD symptoms.

Careful history taking and symptom analysis along with comprehensive testing by expert acid reflux specialists allows for accurate diagnosis. Upper endoscopy shows hiatal hernia formation in GERD patients and stomach solid food residue in gastroparesis patients. Ambulatory pH testing shows multiple acid reflux events in GERD cases and less numerous but long reflux events in gastroparesis cases. Furthermore, stomach is typically dilated and elongated in gastroparesis. This finding is best appreciated on radiography studies.  Ultimately, the diagnostic test for gastroparesis is a gastric emptying study that shows delayed gastric emptying.

The gold standard treatment for GERD is a properly performed Nissen fundoplication and hiatal hernia repair. Procedure effectively re-establishes the anti-reflux barrier resulting in complete cessation of gastric content reflux into esophagus including vomiting. Nissen fundoplication prevents stomach from venting upward in case of gastroparesis. For this reason, it is contraindicated in the setting of gastroparesis. Gastroparesis patients who mistakenly undergo Nissen fundoplication surgery are likely to experience worsening bloating, nausea, and dry heaving.

Nissen fundoplication takedown is indicated in this case to allow gastroparesis patient to vomit and decompress stomach upwards into esophagus. At Houston Heartburn and Reflux Center, we offer a concomitant antrum preserving longitudinal gastrectomy to promote gastric emptying. We have had great success with this approach. About 50 patients with medically refractory gastroparesis have undergone antrum preserving longitudinal gastrectomy. 70% of the stomach is resected through tiny incisions. Surgery is outpatient and it is associated with fast recovery and very low complication rate. Patients report immediate resolution of nausea, vomiting, bloating and abdominal pain. Repeat gastric emptying study after surgery shows normalization of gastric emptying rate.

To summarize, it is important to differentiate GERD from gastroparesis because treatment is different. Nissen fundoplication is contraindicated in gastroparesis cases. Antrum preserving longitudinal gastrectomy seems like an excellent solution for medically refractory gastroparesis patients.