Nausea. Vomiting. Abdominal pain. Feeling full quickly after eating. These are some of the symptoms of gastroparesis, or ‘delayed gastric emptying’ – and there is no known cure. Gastroenterologist Dr Vincent Ho, clinical project director of Western Sydney University’s GI Motility Disorders Unit together with other gastroenterology motility specialists is developing new diagnostics and treatment options that address the root cause of this mysterious condition which commonly affects young women.
“With gastroparesis, the normal stomach contractions that move food through the digestive tract are weakened or impaired,” says Dr Ho.
“If left untreated, for some, drastic measures are required, such as feeding tubes. Symptoms can linger for a lifetime.”
Dr Ho is passionate about making a real difference for the lives of people suffering from this condition. In conducting research investigating the underlying cause, he is hoping that more specific treatments may one day help improve the quality of life of people with gastroparesis.
A patient meeting with a turning point
It was back in 2011 when a consultation with a young patient opened Dr Ho’s eyes to the unusual condition of gastroparesis. Investigations indicated that there was nothing wrong with the structure of the stomach. But there was something seriously wrong with its functioning.
“I was privileged to meet a young lady named Ashley, a law clerk in her twenties, who presented to my Campbelltown Hospital gastroenterology clinic with symptoms of nausea, vomiting and fullness. Multiple tests later, Dr Ho discovered that she had a condition called gastroparesis.
“I tried multiple medications, none of which had worked for her. It was a real eye opener. I thought to myself – how am I going to get her better? A large part of me just could not accept that this condition could strike down a young person and leave them so sick without a possibility of a cure.”
Gastrointestinal motility program well underway
Ashley was instrumental in Dr Ho developing a program focusing on gastrointestinal motility disorders including gastroparesis.
“A motility disorder occurs when muscles and nerves in the digestive tract don’t work properly,” explains Dr Ho. “This causes abnormal movement (or ‘motility’) of food, fluid, or waste through the digestive system. In the case of gastroparesis where the food moves very slowly out of the stomach, this means that it’s stuck in the stomach for a prolonged period. Food which is stuck leads to those symptoms of nausea, vomiting and feeling full.”
Ashley ended up having to be tube fed.
“This was a drastic solution. Imagine the impact on someone who is otherwise healthy, having to have a feeding tube inserted.”
“This all happened to her one day when she was recovering from the flu. Gastroparesis can often start after an infection, or gastro and tends to be a chronic problem,” Dr Ho explains.
“Today — as it was back then — not a lot is known about the condition, other than that it predominantly affects young women, and they continue to experience symptoms.”
Cellular research
As principal investigator with the Gastroparesis and Functional Dyspepsia Biobank project through Western Sydney University’s School of Medicine, Dr Ho together with Professor Nicholas Talley at Newcastle University is conducting cellular-level research into why stomach motility fails, and what treatments could help.
“We know that the stomach — like the heart — has a natural ‘pacemaker’ function. Unlike the heart, where in people it can vary between 60-100 beats per minute, the stomach has contractions of three cycles per minute or so. In the digestive system, slow-wave electrical activity — like pulses — keeps the digestive system working properly. In people with gastroparesis, these specialised cells, in the gastrointestinal tract, are dysfunctional.”
Dr Ho wants to understand why or how these rare and fragile cells, called ICC cells (interstitial cells of Cajal) become dysfunctional in gastroparesis.
Dr Ho and his research team at the School of Medicine, Western Sydney University were the first to conduct genomic sequencing of these ICC cells. From the genomic sequencing came interesting insights into the genetic makeup of these cells in healthy humans.
The cells were extracted from stomach samples donated by people who had completed gastric sleeve surgery. The technique used to identify and extract the cells was quite unique and difficult to undertake, requiring a significant effort from the research team to co-ordinate.
The research identified proteins that could shed more light on how these ICC cells become dysfunctional with gastroparesis.
“We know that people with gastroparesis have fewer ICCs, and they are dysfunctional. We are yet to uncover how the patients have developed the dysfunction. Knowing why ICC cells are lost or don’t work properly will enable the development of diagnostics and treatments based on this dysfunction.”
“This will hopefully give us more insights into drug targets,” Dr Ho explains.
Discovery of dietary fibre suited to people with gastroparesis
Dietary fibre is often touted as good for gut health. For people with gastroparesis, fibre is problematic. “This is because it slows digestion and may worsen symptoms such as bloating, nausea, fullness, and stomach pain,” Dr Ho says.
“We are exploring how different types of fibre affect people with gastroparesis. A pilot study that we conducted suggested that some low-viscosity soluble fibres such as partially hydrolysed guar gum and gum arabic, instead of standard fibre like psyllium husk, may be better tolerated without aggravating symptoms.”
Ways to obtain samples from the stomach, minus surgery
Previously, endoscopy could only sample the superficial layers of the stomach. Collecting deeper layers of stomach tissue, which included muscle, required surgery.
“In the past, getting any deep kind of tissue from deep within the stomach has been challenging … we are researching ways, using new technologies, to access deeper samples from the stomach via endoscopy. This could open up the possibility of getting deep stomach tissue samples from people with gastroparesis.”
A minimally invasive way to sample the deeper layers of the stomach would be a game-changer for gastroparesis research. This would enable many more samples to be collected from both healthy individuals and people with gastroparesis. This minimally invasive approach of collecting stomach samples combined with the cellular research Dr Ho is undertaking would provide a much better understanding of how the ICC cells in healthy people can change and become dysfunctional in gastroparesis.
Gastroparesis awareness and advocacy
Dr Ho, together with the gastroparesis community, are raising awareness of the condition through advocacy via a website and Facebook group.
- The GI Motility website, created by Western Sydney University
This informs patients and referrers about clinical evaluation and care for motility disorders; highlights pioneering research into gut physiology, therapeutic innovation, and device technologies; and engages the broader community and amplifies the voices of patients through support networks and partnerships.
https://www.westernsydney.edu.au/gimotility/home - A Facebook community called The Inside Story is a safe, peer-led space where patients and carers connect and share information. Dr Ho was instrumental in helping establish this Facebook community a decade ago.
- The Gastroparesis Australia website
This website is a source of support, advocacy, and information for people living with gastroparesis.
Western Sydney University’s GI Motility Unit provides the digital infrastructure for the organisation.
https://www.gastroparesisaustralia.com/
Topics that Dr Vincent Ho is available to present on include:
- Gut health
- Gut science
- Any gut diseases such as IBS, IBD, coeliac disease, eosinophilic oesophagitis, gastroparesis, reflux, colon cancer
- Life as a clinician scientist
About Vincent Ho
Dr Vincent Ho is a 2024 New South Wales Young Tall Poppy Science Award recipient.
Dr Vincent Ho is a gastroenterologist at Campbelltown Hospital and an Associate Professor at the School of Medicine, Western Sydney University. Vincent leads a Translational Gastroenterology Research program at the School of Medicine focusing on basic science and clinical research in the gut. He has a strong passion in education of the science of the gut to health discipline audiences as well as the general public. He is more widely known to the public as the GutDr.