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| Gastroparesis
like any disease comes about as a malfunction of
one or more of your bodies systems. Much if not most of the
time this is a result of a slow degenerative process due to the
lack of adequate bodily supplies of the elements necessary for
normal function and rejuvenation of affected organs. Commercial
Farming and natural erosion has depleted global farmlands of most
essential elements therefore it is not wise to assume that your
diet contains enough of these elements for normal body function
and maintenance. See
Senate Document 264.
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What Is Gastroparesis?
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Gastroparesis is
a disorder in which the stomach takes too long to empty its
contents. Gastroparesis is most often a complication of type 1
diabetes. At least 20 percent of people with type 1 diabetes
develop gastroparesis. It also occurs in people with type 2
diabetes, although less often.
Gastroparesis happens when nerves to the stomach
are damaged or stop working. The vagus nerve controls the movement
of food through the digestive tract. If the vagus nerve is
damaged, the muscles of the stomach and intestines do not work
normally, and the movement of food is slowed or stopped.
Diabetes can damage the vagus nerve if blood
glucose (sugar) levels remain high over a long period of time.
High blood glucose causes chemical changes in nerves and damages
the blood vessels that carry oxygen and nutrients to the nerves.
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Symptoms
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Symptoms of
gastroparesis are
- Nausea
- Vomiting
- An early feeling of fullness when eating
- Weight loss
- Abdominal bloating
- Abdominal discomfort.
These symptoms may be mild or severe, depending on
the person.
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Complications of Gastroparesis
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If food lingers too
long in the stomach, it can cause problems like bacterial
overgrowth from the fermentation of food. Also, the food can
harden into solid masses called bezoars that may cause nausea,
vomiting, and obstruction in the stomach. Bezoars can be dangerous
if they block the passage of food into the small intestine.
Gastroparesis can make diabetes worse by adding
to the difficulty of controlling blood glucose. When food that has
been delayed in the stomach finally enters the small intestine and
is absorbed, blood glucose levels rise. Since gastroparesis makes
stomach emptying unpredictable, a person's blood glucose levels
can be erratic and difficult to control.
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Major Causes of Gastroparesis
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- Diabetes.
- Postviral syndromes.
- Anorexia nervosa.
- Surgery on the stomach or vagus nerve.
- Medications, particularly anticholinergics
and narcotics (drugs that slow contractions in the intestine).
- Gastroesophageal reflux disease (rarely).
- Smooth muscle disorders such as amyloidosis
and scleroderma.
- Nervous system diseases, including abdominal
migraine and Parkinson's disease.
- Metabolic disorders, including
hypothyroidism.
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Diagnosis
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The diagnosis of
gastroparesis is confirmed through one or more of the following
tests:
- Barium x-ray: After fasting for 12
hours, you will drink a thick liquid called barium, which
coats the inside of the stomach, making it show up on the
x-ray. Normally, the stomach will be empty of all food after
12 hours of fasting. If the x-ray shows food in the stomach,
gastroparesis is likely. If the x-ray shows an empty stomach
but the doctor still suspects that you have delayed emptying,
you may need to repeat the test another day. On any one day, a
person with gastroparesis may digest a meal normally, giving a
falsely normal test result. If you have diabetes, your doctor
may have special instructions about fasting.
- Barium beefsteak meal: You will eat a
meal that contains barium, thus allowing the radiologist to
watch your stomach as it digests the meal. The amount of time
it takes for the barium meal to be digested and leave the
stomach gives the doctor an idea of how well the stomach is
working. This test can help detect emptying problems that do
not show up on the liquid barium x-ray. In fact, people who
have diabetes-related gastroparesis often digest fluid
normally, so the barium beefsteak meal can be more useful.
- Radioisotope gastric-emptying scan: You
will eat food that contains a radioisotope, a slightly
radioactive substance that will show up on the scan. The dose
of radiation from the radioisotope is small and not dangerous.
After eating, you will lie under a machine that detects the
radioisotope and shows an image of the food in the stomach and
how quickly it leaves the stomach. Gastroparesis is diagnosed
if more than half of the food remains in the stomach after 2
hours.
- Gastric manometry: This test measures
electrical and muscular activity in the stomach. The doctor
passes a thin tube down the throat into the stomach. The tube
contains a wire that takes measurements of the stomach's
electrical and muscular activity as it digests liquids and
solid food. The measurements show how the stomach is working
and whether there is any delay in digestion.
- Blood tests: The doctor may also order
laboratory tests to check blood counts and to measure chemical
and electrolyte levels.
To rule out causes of gastroparesis other than
diabetes, the doctor may do an upper endoscopy or an ultrasound.
- Upper endoscopy. After giving you a
sedative, the doctor passes a long, thin, tube called an
endoscope through the mouth and gently guides it down the
esophagus into the stomach. Through the endoscope, the doctor
can look at the lining of the stomach to check for any
abnormalities.
- Ultrasound. To rule out gallbladder
disease or pancreatitis as a source of the problem, you may
have an ultrasound test, which uses harmless sound waves to
outline and define the shape of the gallbladder and pancreas.
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Treatment
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The primary treatment
goal for gastroparesis related to diabetes is to regain control of
blood glucose levels. Treatments include insulin, oral
medications, changes in what and when you eat, and, in severe
cases, feeding tubes and intravenous feeding.
It is important to note that in most cases
treatment does not cure gastroparesis--it is usually a chronic
condition. Treatment helps you manage the condition so that you
can be as healthy and comfortable as possible.
Insulin for blood glucose control in people
with diabetes
If you have gastroparesis, your food is being
absorbed more slowly and at unpredictable times. To control blood
glucose, you may need to
- Take insulin more often.
- Take your insulin after you eat instead of
before.
- Check your blood glucose levels frequently
after you eat, administering insulin whenever necessary.
Some doctors recommend taking two injections of
intermediate insulin every day and as many injections of a
fast-acting insulin as needed according to blood glucose
monitoring. The newest insulin, lispro insulin (Humalog), is a
quick-acting insulin that might be advantageous for people with
gastroparesis. It starts working within 5 to 15 minutes after
injection and peaks after 1 to 2 hours, lowering blood glucose
levels after a meal about twice as fast as the slower-acting
regular insulin. Your doctor will give you specific instructions
based on your particular needs.
Medication
Several drugs are used to treat gastroparesis.
Your doctor may try different drugs or combinations of drugs to
find the most effective treatment.
- Metoclopramide (Reglan). This drug
stimulates stomach muscle contractions to help empty food. It
also helps reduce nausea and vomiting. Metoclopramide is taken
20 to 30 minutes before meals and at bedtime. Side effects of
this drug are fatigue, sleepiness, and sometimes depression,
anxiety, and problems with physical movement.
- Erythromycin. This antibiotic also
improves stomach emptying. It works by increasing the
contractions that move food through the stomach. Side effects
are nausea, vomiting, and abdominal cramps.
- Domperidone. The Food and Drug
Administration is reviewing domperidone, which has been used
elsewhere in the world to treat gastroparesis. It is a
promotility agent like cisapride and metoclopramide.
Domperidone also helps with nausea.
- Other medications. Other medications
may be used to treat symptoms and problems related to
gastroparesis. For example, an antiemetic can help with nausea
and vomiting. Antibiotics will clear up a bacterial infection.
If you have a bezoar, the doctor may use an endoscope to
inject medication that will dissolve it.
Meal and food changes
Changing your eating habits can help control
gastroparesis. Your doctor or dietitian will give you specific
instructions, but you may be asked to eat six small meals a day
instead of three large ones. If less food enters the stomach each
time you eat, it may not become overly full. Or the doctor or
dietitian may suggest that you try several liquid meals a day
until your blood glucose levels are stable and the gastroparesis
is corrected. Liquid meals provide all the nutrients found in
solid foods, but can pass through the stomach more easily and
quickly.
The doctor may also recommend that you avoid
fatty and high-fiber foods. Fat naturally slows digestion--a
problem you do not need if you have gastroparesis--and fiber is
difficult to digest. Some high-fiber foods like oranges and
broccoli contain material that cannot be digested. Avoid these
foods because the indigestible part will remain in the stomach too
long and possibly form bezoars.
Feeding tube
If other approaches do not work, you may need
surgery to insert a feeding tube. The tube, called a jejunostomy
tube, is inserted through the skin on your abdomen into the small
intestine. The feeding tube allows you to put nutrients directly
into the small intestine, bypassing the stomach altogether. You
will receive special liquid food to use with the tube. A
jejunostomy is particularly useful when gastroparesis prevents the
nutrients and medication necessary to regulate blood glucose
levels from reaching the bloodstream. By avoiding the source of
the problem--the stomach--and putting nutrients and medication
directly into the small intestine, you ensure that these products
are digested and delivered to your bloodstream quickly. A
jejunostomy tube can be temporary and is used only if necessary
when gastroparesis is severe.
Parenteral nutrition
Parenteral nutrition refers to delivering
nutrients directly into the bloodstream, bypassing the digestive
system. The doctor places a thin tube called a catheter in a chest
vein, leaving an opening to it outside the skin. For feeding, you
attach a bag containing liquid nutrients or medication to the
catheter. The fluid enters your bloodstream through the vein. Your
doctor will tell you what type of liquid nutrition to use.
This approach is an alternative to the
jejunostomy tube and is usually a temporary method to get you
through a difficult spell of gastroparesis. Parenteral nutrition
is used only when gastroparesis is severe and is not helped by
other methods.
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Points to Remember
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- Gastroparesis is a common complication of
type 1 diabetes.
- Gastroparesis is the result of damage to the
vagus nerve, which controls the movement of food through the
digestive system. Instead of the food moving through the
digestive tract normally, it is retained in the stomach.
- The vagus nerve becomes damaged after years
of poor blood glucose control, resulting in gastroparesis. In
turn, gastroparesis contributes to poor blood glucose control.
- Symptoms of gastroparesis include early
fullness, nausea, vomiting, and weight loss.
- Gastroparesis is diagnosed through tests such
as x-rays, manometry, and scanning.
- Treatments include changes in when and what
you eat, changes in insulin type and timing of injections,
oral medications, a jejunostomy, or parenteral nutrition.
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The
Whole Story