I feel like I’m stretching a bit to talk about gastroparesis, since I only have a fairly mild case of it, but it’s an important part of the hypermobility syndrome, and I’d feel like I’d missed something out in not writing something about it.
Gastroparesis, broadly speaking, is paralysis or partial paralysis of the stomach – Either the whole stomach, a part of the stomach, all of the time or some of the time, so it can range from quite manageable, via eating small, frequent meals, through to needing surgical intervention in the form of placing a tube either through the nose and into the stomach or through the abdominal wall and into the jejunum, to deliver pre-digested food into the lower parts of the digestive tract in liquid form.
In person, gastroparesis causes all kinds of symptoms – The most common one is a constant, vague nausea, followed by feeling bloated (often with physical distension of the abdomen, to an extent), never really feeling hungry, or always feeling full even if you’re paradoxically still hungry, heartburn, acid reflux, palpitations, all-over aches, fatigue, and just generally a feeling of absolute malaise. And that’s before it gets serious – When it’s serious, the symptoms trend more towards things like bezoars (which cause intestinal blockage) and severe malnutrition. Basically, if food is sitting in the gut and not being digested, it’s going to cause problems. In biological terms, it’s sometimes best to think about the digestive tract as being “outside” the body – a human is basically a complicated torus, after all, with the mouth and the anus being the apertures into the “tube” through the middle, and as such the immune system doesn’t quite function the same inside the hollows of it – There’s no blood in there (In a healthy case) so immune mediation doesn’t work as well as in the rest of the body, so bacterial overgrowth on old food can cause bacterial infections really quite quickly in the whole length of the gut, especially if there’s an under-production of hydrochloric acid in the stomach, which is also a regular consequence of gastroparesis. As such, it’s one of those problems that compounds itself even beyond its original set of issues.
Many of us self-treat for gastroparesis at first – Switching to softer foods, or ones with less complex nutrients in them which need less breaking down, or supplementing with protein shakes or baby food. Gastroparesis itself is usually diagnosed via a gastric emptying test, in which it’s measured how fast a standardised foodstuff exits the stomach after it’s been ingested. Severity of actual paralysis, and severity of symptoms, aren’t actually correlated as directly as one might expect; It’s possible to have quite severe gastroparesis that you’ve barely noticed, and very mild gastroparesis that makes eating a vomity nightmare.
The biggest complication of gastroparesis, other than of course that it’s a problem in itself, is weight loss – Loss of appetite and inefficient digestion means taking on less nutrients, which in turn leads to fatigue, and then on to all the other problems of weight loss (or, indeed, the inability to put weight on in the first place). Ironically, the weight loss might be hard to spot at first, due to the stomach distension from carrying undigested food around in it – Again, thinking of the body as a complicated torus, the contents of the gut isn’t really part of the body’s “weight” in useful terms. So, at least at first, the complaint to the doctor of “I have no appetite and I’m losing weight” might be met with a shrug and a “Well, you look fine to me”.
As ever, perseverance is the answer, along with making sure that you know more about your own condition than any doctor is ever likely to learn in a hundred years.
(Notable runners-up to be “G is for…”; Grief, genetics, gastroenterology)