Diagnosing Gastroparesis and the Role of PillCam™

Pomona Valley Hospital Medical Center (PVHMC) aims to raise awareness about digestive tract paralysis, also known as gastroparesis.

Nischita Merla, MD, a gastroenterologist at PVHMC, highlights the importance of the PillCam™ (capsule endoscopy) in diagnosing gastrointestinal diseases like gastroparesis. The PillCam™ helps by monitoring the time the capsule spends in the stomach before moving to the small intestine, providing critical insights into the delayed gastric emptying characteristic of this disorder.

Understanding Gastroparesis

Gastroparesis is a condition where the muscles in the stomach and intestines do not work properly, causing food and liquid to move slowly or stop altogether. This leads to symptoms such as nausea, vomiting, bloating, and severe abdominal pain.

Prevalence and Risk Factors

In the United States, gastroparesis is relatively uncommon. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) states, "out of 100,000 people, about 10 men and about 40 women have gastroparesis.” Those most at risk of contracting gastroparesis include individuals with diabetes, those who have had surgery on their esophagus, stomach, or small intestines, or those who have undergone certain cancer treatments (like radiation) on their chest or stomach area.

Learn More About the PillCam™ and How it can Help Diagnose Gastroparesis:

How does the PillCam™ work?

The PillCam™ is a small camera inside a pill that you swallow. Over a period of 8 – 12 hours, it takes a video as it travels through your small intestine. This video is sent to a recorder you wear. We use it to look for problems like Crohn's disease (a long-lasting inflammation of the intestines), small bowel tumors, low iron levels, visible and hidden bleeding and celiac disease (a reaction to eating gluten). For gastroparesis, the PillCam™ provides valuable information on the time it spends in the stomach, indicating how well the stomach muscles are functioning.

What specific conditions or areas of the gastrointestinal tract is the PillCam™ most useful for?

Currently, the PillCam™ is solely used for diseases in the small intestine, from the duodenum (the first part of the small intestine) to the terminal ileum (the last part of the small intestine). It is not very useful for evaluating the colon or the stomach since they are too large. It can be used to evaluate esophageal varices but has not gained widespread use, and it can help diagnose gastroparesis by tracking the movement of the capsule through the stomach and small intestine.

What are the alternative procedures to the PillCam™? What advantages does the PillCam™ offer?

Other options include CT (computed tomography) or MR (magnetic resonance) enterography. These tests also take pictures of the intestines, but the PillCam™ gives a better view of the inner lining and is better at finding sources of bleeding. For diagnosing gastroparesis, the PillCam™ offers a non-invasive way to observe gastric emptying times.

How are PillCam™ images reviewed to identify potential issues?

Once the patient returns the recorder, usually within 24 hours after initiation of the study, the video images are downloaded for interpretation. Using the patented software, we scroll through the images, capture necessary ones for documentation and location within the small bowel, and plan the final course of care, usually endoscopic or surgical intervention as indicated.

Can you share a successful case with the PillCam™?

The PillCam™ found a small carcinoid tumor (a type of slow-growing cancer) in the proximal ileum (the start of the last part of the small intestine). This tumor was causing a patient's abdominal disease and fluid buildup. Other tests and surgeries, including surgery to open the abdomen, did not find this tumor.

How can patients ensure they are doing all they can to maintain good digestive health?

Increasing dietary fiber with vegetables and fruit, using whole grains, and adding fermented foods and prebiotics to one's diet are the best ways to take care of your gut health. Daily sleep, exercise, and activities to limit stress and depression also help immensely in reducing most gut symptoms in otherwise healthy patients.

What symptoms should someone look out for if they think they may have gastroparesis?

According to the Centers for Disease Control and Prevention (CDC), symptoms of gastroparesis include:

• Feeling “stuffed,” bloated, discomfort or pain after eating, even if it’s a small amount of food.
• Heartburn
• Nausea
• Vomiting
• Poor appetite

Visit our Gastrointestinal Medicine webpage to learn more about the PillCam™ and other advanced gastrointestinal procedures. Talk to your doctor to determine if the PillCam™ is the right option for your diagnosis and treatment.