Diabetic Gastroparesis

What is Diabetic Gastroparesis?

This is a condition which affects subjects with Type-1 diabetes as well as Type-2 diabetes. This disorder causes the stomach longer than normal to empty into the small intestine. The stomach normally contracts in order to progress food down into the small intestine. The vagus nerve manages the food movement thru the digestive process. In gastroparesis the vagus nerve stops working or is damaged causing the muscles in the intestines and stomach to not work correctly and the food movement either stops or slows.

This is a form of neuropathy caused by the damage of the vagus nerve when the levels of blood glucose remain high for extended time. This blood glucose level which is high causes changes in chemicals in the nerve and can also damage blood vessels which are needed in order to supply oxygen and nutrition for the nerves.

Diabetic Gastroparesis causes

• Viral infections
• Surgery on vagus nerve or stomach
• Bulimia or anorexia nervosa
• Medications – narcotics and anticholinergics that cause contractions to slow in the intestine.
• Disorders of the smooth muscle disorders such as amyloidosis and scleroderma.
• Gastroesophageal reflux disease
• Metabolic disorders including hypothyroidism
• Nervous system diseases such as Parkinson’s disease or abdominal migraine.

In some people the cause is unknown even after extensive medical testing.

Delayed digestion can make the management of diabetes much more difficult. Depending on the subject, the symptoms can be mild to severe.

Diabetic Gastroparesis Signs and Symptoms

• Undigested food vomiting
• Heartburn
• Nausea
• When eating early development of fullness feeling
• Abdominal bloating
• Weight loss
• Erratic levels of blood glucose
• Gastroesophageal reflux
• No appetite
• Spasms in stomach walls

This condition makes diabetes worse because of difficulties in managing the level of blood glucose. When the food is delayed in the stomach and eventually does enter the small intestine and is absorbed, the levels of blood glucose rise. Because the absorbing of food is erratic so is the blood glucose level which becomes difficult to control.

When the food remains in the stomach too long, problems such as bacterial overgrowth can develop because of food which is fermented. The food also hardens into masses of solids known as bezoars which cause vomiting, nausea, and stomach obstruction. Bezoars are very dangerous because of possible blockage of food trying to pass into the small intestine.

Gastroparesis Diagnosis

To diagnose diabetic gastroparesis tests are done such as x-rays, manometry and scanning. Specific tests that are usually done are:

• Barium x-ray
• Radioisotope gastric-emptying scan
• Barium beefsteak meal
• Gastric manometry
• Upper endoscopy
• Blood tests
• Ultrasound

Barium x-ray

First subject fasts 12 hour and then will drink thick drink of barium which will coat the stomach and shows it up on the x-ray. The stomach should be empty after a 12 hour fast. But if the x-ray shows any food still in the stomach, diabetic gastroparesis is probable. But if the doctor still thinks that the subject has delayed emptying, the doctor may need to repeat the test.

Radioisotope gastric-emptying scan

Subject will eat some food that contains radioisotope which is a slightly radioactive substance, which shows in the scan. After eating, the subject lies under a scan machine which identifies the radioisotope and will show stomach image and the food and how fast it leaves the stomach. The diagnosis of diabetic gastroparesis is made when half of the food remains after two hours.

Barium beefsteak meal

With this test, the subject eats a meal which contains barium which allows the radiologist to watch the stomach as it digests the meal. The total time it takes for the barium meal to be digested and leaves the stomach gives the doctor an idea of how well the stomach is working.

Gastric manometry

The test measures muscular and electrical activities of the stomach. Your doctor will pass a tube which is thin down the esophagus to the stomach. This tube has a wire which measures the stomach’s muscular and electrical activity while the liquids and solid food are digested. This will show if digestion is delay.

Upper endoscopy

This upper endoscopy is done for ruling out causes of gastroparesis besides diabetes. The subject is given a sedative so the doctor can pass a long, thin tube which is an endoscope thru the mouth and guides it down the esophagus into the stomach. The doctor can then look at the lining of the stomach to see if there are any abnormalities.

Blood tests

The doctor will also order lab tests to check blood counts and to measure electrolyte and chemical levels.

Ultrasound

An ultrasound is done to rule out diseases of gallbladder or pancreatitis as a source of the problem. This uses sound waves to outline and define the pancreas and the gallbladder.

Treating gastroparesis will begin with identifying and treating the condition causing the problem. If diabetes is the cause the doctor will work to help better control the diabetes. Other gastroparesis treatments may include:

Changes to diet

Doctor may refer the subject to a dietitian to find foods that are easier to digest. A dietitian will suggest the you try to:

• Eat frequent smaller meals
• Eat low-fiber forms of high-fiber foods, such as well cooked fruits and vegetables rather than raw fruits and vegetables.
• Low-fat food, and if you can tolerate them, add small servings of fatty foods
• Avoid fibrous fruits and vegetables, such as oranges and broccoli which can lead to causing bezoars.
• If liquids are easier for subject, try soups and pureed foods.
• Drink water thru out each meal.
• Gentle exercise after eating, such as a brisk walk.

There are some subjects with gastroparesis who are unable to tolerate any food or liquids. In these situations, doctors may recommend a feeding tube be placed in the small intestine. Tubes for feeding can be passed thru the nose or mouth directly into your small intestine thru the skin. This should only be a temporary treatment and should be used only if gastroparesis is severe or when the levels of blood sugar can’t be controlled by other methods.

Gastroparesis Medications

Medications to treat gastroparesis may include:

• Medications to help stop vomiting and nausea. Anti-emetic medications include prochlorperazine, Zofran and Benadryl.
• Medications to stimulate the muscles in the stomach. These include Reglan and erythromycin. Side effects of these medications are significant. The doctor should discuss the benefits and risks.

Surgery

If treatment does not help, your doctor may suggest gastroparesis surgery. During this surgery, the lower part of the stomach may be stapled or bypassed to help improve stomach emptying.

Doctors are currently working on experimental treatments that could offer new treatment or therapy for this complication of diabetes.