Gastroparesis, also known as “stomach paralysis”, affects the normal working of muscles (motility) of the stomach and delays or stops the movement of food from the stomach to the small intestine. To create global awareness about this chronic gastrointestinal disorder and to improve understanding and management of the disease and encourage preventive strategies, every year, the month of August is observed as “Gastroparesis Awareness Month” in the United States. The awareness campaign, sponsored by the International Foundation for Functional Gastrointestinal Disorders (IFFGD), brings attention to gastroparesis diagnosis, treatment, and quality of life issues. Mild gastroparesis can be easily managed, but if the condition becomes chronic (long-term), then it could lead to life threatening complications. There is no specific cure for this gastro-intestinal disorder, but following a well-balanced nutritional diet along with medications can help to control the disorder symptoms in the long-run. Also, appropriate and timely treatment for Gastroparesis can relieve symptoms. For correct clinical documentation of this gastrointestinal disorder, physicians can consider medical billing outsourcing services.
When your stomach muscles are functioning normally, ingested food is crushed and pushed into the small intestine where further digestion and absorption of nutrients takes place. But in people with Gastroparesis, the stomach’s motility is slowed down or does not work at all, which in turn affects normal digestion and will lead to various symptoms and complications.
Signs & Symptoms of Gastroparesis
The signs and symptoms of gastroparesis – that usually occur during and after eating a meal – may differ among persons with the condition.
The symptoms include:
- Nausea and /or vomiting
- Retching (dry heaves)
- Feeling full early while eating meals
- Acid reflux or heartburn
- Abdominal bloating
- Chronic abdominal pain
- Changes in blood sugar levels
- Loss of appetite
- Weight loss and malnutrition
Apart from this, complications of gastroparesis include dehydration due to continuous vomiting, fluctuations in blood sugar levels, and acute symptoms which make daily living activities challenging.
The severity of gastroparesis symptoms ranges from being painful to devastating and in some cases life-threatening, impairing the patient’s quality of life and well-being.
Cause of Gastroparesis
The underlying cause of gastroparesis is not clear as there are a number of things that may contribute to or cause gastroparesis. The cause is unknown in the majority of people and is termed “idiopathic.” Some people with idiopathic gastroparesis report symptoms following a virus infection (post-infectious or post-viral gastroparesis). Other possible causes include:
- Diabetes: One of the most common underlying causes of Gastroparesis is uncontrolled diabetes, although only a small percentage of people with diabetes develop Gastroparesis. Known as diabetic Gastroparesis, the condition makes it more difficult for a person with diabetes to control their blood sugar. According to gastroenterologist Michael Cline, DO, in diabetic patients, the condition appears as more of a neuropathy-based disease associated with damaged nerves that supply the stomach (www.clevelandclinic.org). If the vagus nerve – which controls the movement of food through the stomach or transmits impulses to the stomach and intestines – is injured then it can impair gastric emptying, which means, the functioning of the muscles in the stomach and other parts of the digestive tract get affected. This will upset and slow down the movement of food through the digestive system.
- Surgeries: Complication from some surgical procedures can also result in Gastroparesis. Most often these include nerve damage following esophageal or upper abdominal surgeries.
- Medications: This is a less frequent case for Gastroparesis, but also seen to occur after the use of certain medications that can impair motility such as the following:
- Narcotic pain relievers
- Anticholinergic/antispasmodic agents
- Calcium channel blockers
- Some antidepressants, and
- Some medications for diabetes.
In addition to uncontrolled diabetes, surgeries and medications, other potential causes of gastroparesis include:
- Connective tissue diseases, such as multiple sclerosis or muscular dystrophy
- Nervous system diseases (such as Parkinson’s disease or multiple sclerosis)
In non-diabetic patients, the condition may have to do with acid reflux, which causes delayed gastric emptying.
According to IFFGD estimates, there are about five million people in the United States living with the debilitating or life-threatening symptoms of Gastroparesis. Among this, women are more likely to develop this disorder than men.
Diagnosis and Tests
As the symptoms of gastroparesis are similar to those that occur in a number of other illnesses, when a particular symptom or symptoms persist over time or keep coming back, patients must visit a doctor to diagnose the root cause of the problem. This is important because an accurate and timely diagnosis is the starting point for an effective treatment.
Diagnosis of gastroparesis begins with a doctor enquiring about symptoms and past medical and health experiences (history). Any medications that are being taken need to be disclosed at this moment. If the doctor suspects Gastroparesis, a slow gastric emptying test to measure how fast the stomach empties is required to confirm the diagnosis. Once confirmed, the doctor will perform a physical exam, followed by certain tests to make a definite diagnosis, which include:
- A blood test.
- AAn upper endoscopy.
- AAn upper gastrointestinal series (UGI) that looks at the stomach on an x-ray, or
- AAn ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.
- AA gastric manometry.
- AAn MRI scan.
Early diagnosis makes treatment easier, which is why awareness about the causes, risk factors, and symptoms of the condition is critical. The monthly campaign is the ideal time to educate the general public about the prominent symptoms of this condition and develop strategies to improve diagnosis, treatment, and prevention of this stomach disorder.
Treatment of Gastroparesis
Depending on the severity of symptoms, the treatment for gastroparesis varies. Aimed at managing symptoms over a long-term, the treatment approaches may involve one or a combination of
- Dietary and lifestyle measures
- Medications, and/or
- Procedures that may include surgery, such as
- Enteral nutrition,
- Parenteral nutrition,
- Gastric electrical stimulation (Enterra), or
- Other surgical procedures
Maintaining adequate nutrition and incorporating dietary changes are the first steps in managing this condition. Patients with the disorder are advised to take small, frequent meals that are low in fat and fiber, and easy to digest. People with mild symptoms of gastroparesis can be managed with dietary and lifestyle measures, however, for patients with comorbid diabetes, irritable bowel syndrome, or renal failure this diet may not work.
Based on the cause, severity of symptoms and complications, and patient variation in treatment response, the treatment for Gastroparesis also varies. Patients with moderate to more severe symptoms may be treated with medications to stimulate motility and/or reduce nausea and vomiting. Whereas people that have severe symptoms which are difficult to treat or do not respond to initial treatment approaches, may require additional procedures to maintain nutrition and/or reduce symptoms. They may be may be unable to consume any food or liquids. In such cases, surgery will be recommended, wherein a feeding tube (jejunostomy tube) is placed in the small intestine to deliver a specially formulated nutrient-rich liquid food directly into the jejunum, where most nutrients are absorbed into the body.
Diabetic patients need to take steps to control their blood glucose levels to reduce risk of gastroparesis complications.
All gastroparesis treatments primarily aim to mitigate symptoms, improve malnutrition, and help the patient resume adequate oral intake of liquids and solids.
If you are experiencing symptoms of gastroparesis, you should consult your physician as an early diagnosis is crucial to prevent or delay complications.
When documenting gastroparesis, gastroenterologists must include the associated causes, symptoms, diagnosis, screening tests, and treatment procedures performed using the correct medical codes. Medical billing and coding services provided by a reputable gastroenterology medical billing company can help physicians use the correct codes for their billing purposes.
The ICD-10 diagnosis code for gastroparesis is K31.84.
ICD-10 combination codes identify both the definitive diagnosis and common symptoms of that diagnosis. So, if the physician has recorded diabetes as an underlying cause for the condition, the medical coder needs to not only code gastroparesis but also code diabetes by type. That is, if the physician has documented a diagnosis of “type 1 diabetes complicated by gastroparesis,” the encounter can be reported using a single code: E10.43 (Type 1 diabetes mellitus with diabetic autonomic [poly]neuropathy. E10.43 includes both the diabetic manifestation as well as the diabetes itself.
As part of the coding, two different conditions must be included. They are:
Bezoars refer to a solid mass of indigestible food material that accumulates in your digestive tract, causing nausea and vomiting. Bezoars have to be coded as foreign bodies using ICD-10-CM code categories such as:
- T18.2: Foreign body in stomach
- T18.3: Foreign body in small intestine
- T18.9: Foreign body in alimentary tract, part unspecified
Ileus is a term for lack of movement in the intestines that results in a build-up and blockage of food material leading to intestinal obstruction. This means no food material, gas, or liquids can get through. The condition can occur as a side effect after surgery. If ileus is confirmed as a post-operative complication without obstruction, the following codes need to be reported:
- K56.7: Ileus, unspecified
- K91.89: Other post-procedural complications and disorders of digestive system
If the post-procedural ileus causes an obstruction with the physician documenting it as a complication, coders are advised to use only code:
- K91.3 – Post-procedural intestinal obstruction
August was officially designated as “Gastroparesis Awareness Month” on July 12, 2016 by the then U.S. Senator Tammy Baldwin (WI) introducing a statement for the record on behalf of the millions of Americans affected by gastroparesis. Throughout the month of August, IFFGD will raise awareness about the symptoms, challenges, and quality of life for those living with gastroparesis – the theme for Gastroparesis Awareness Month 2020. “Patients living with this digestive disorder may suffer from a variety of symptoms which pose a tremendous impact on their daily lives,” says IFFGD president, Ceciel T. Rooker.
During this Gastroparesis Awareness Month, strive to educate people about this gastro-intestinal disorder and the treatments available.