Diagnostic Assessment Of Diabetic Gastroparesis
Gastroparesis is characterized by a constellation of upper gastrointestinal (GI) symptoms in association with delayed gastric emptying (GE) in the absence of mechanical outlet obstruction from the stomach. Cardinal symptoms are nausea, vomiting, early satiety or postprandial fullness, bloating, and abdominal or epigastric pain (1). Gastric retention may be asymptomatic in some, possibly due to afferent dysfunction in the setting of vagal denervation (2,3), and delayed GE may be associated with recurrent hypoglycemia in patients without upper GI symptoms (4,5). In these individuals, the term “delayed GE” is preferred to gastroparesis (1), although others have used terms such as “gastric hypoglycemia” (6). Thus, clinical manifestations of impaired GE may include anorexia, weight loss, malnutrition, phytobezoar formation, poorer quality-of-life, or impaired glycemic control due to erratic delivery of nutrients to the small bowel for absorption, and these may occur independent of factors such as age, gender, alcohol consumption, tobacco use, and diabetes type (7–9). Upper GI symptoms in diabetic patients may result from accelerated GE, often in association with vagal neuropathy and impaired proximal gastric accommodation (10). In addition, upper GI symptoms in diabetic patients were not significantly different in those with delayed compared with rapid GE, except possibly for postprandial distress (P = 0.076 on univariate analysis) (11). Hence, it is essential to measure GE in patients with upper GI symptoms if the right treatment is to be selected, such as choice of a prokinetic agent in those with delayed GE. Similarly, one cannot assume that patients with known vagal neuropathy and upper GI symptoms have gastroparesis, because the measured GE may be normal, fast Continue reading >>
What To Eat, Diabetics
Food Suggestions and Tips for People who have Idiopathic Gastroparesis or Delayed Emptying of the Stomach Information: adapted and reviewed by: Carol Rees Parrish, RD, MS Nutrition Support Specialist University of Virginia Health System Digestive Health Center of Excellence Gastroparesis and Dysmotilities Association (GPDA) www.digestivedistress.com __________________________________________________________ Introduction: What to eat when your stomach is not working right can be challenging for anyone, but is particularly so for individuals with Type I 1 diabetes mellitus, who are also faced with a slow-emptying stomach (gastroparesis). Wide swings in blood glucose levels can be an early sign of gastroparesis in someone with diabetes mellitus. Others may experience digestive symptoms that punctuate life's routines, rob one's appetite, or develop into patterns of nausea and vomiting. Dietary manipulation can greatly assist you in regaining blood glucose control. Proper use of your insulin or diabetic medication is also of utmost importance. Your diabetologist, or primary care physician, dietitian, diabetes nurse specialist, and diabetes educator are your best resources. For those who are experiencing moderate to more severe digestive symptoms, eating may become inconsistent from meal to meal, day to day, or week to week, depending upon the frequency and intensity of digestive distress. Getting a handle on good blood glucose control - while still attempting to eat enough calories in order to maintain your weight - may seem daunting. Our aim is to provide you with knowledge and suggestions to aid your efforts as you work towards optimal management with your medical team. In general: Little research is available in the area of diet and gastroparesis. What works for one perso Continue reading >>
Gastrointestinal Complications Of Diabetes
Gastrointestinal complications of diabetes include gastroparesis, intestinal enteropathy (which can cause diarrhea, constipation, and fecal incontinence), and nonalcoholic fatty liver disease. Patients with gastroparesis may present with early satiety, nausea, vomiting, bloating, postprandial fullness, or upper abdominal pain. The diagnosis of diabetic gastroparesis is made when other causes are excluded and postprandial gastric stasis is confirmed by gastric emptying scintigraphy. Whenever possible, patients should discontinue medications that exacerbate gastric dysmotility; control blood glucose levels; increase the liquid content of their diet; eat smaller meals more often; discontinue the use of tobacco products; and reduce the intake of insoluble dietary fiber, foods high in fat, and alcohol. Prokinetic agents (e.g., metoclopramide, erythromycin) may be helpful in controlling symptoms of gastroparesis. Treatment of diabetes-related constipation and diarrhea is aimed at supportive measures and symptom control. Nonalcoholic fatty liver disease is common in persons who are obese and who have diabetes. In persons with diabetes who have elevated hepatic transaminase levels, it is important to search for other causes of liver disease, including hepatitis and hemochromatosis. Gradual weight loss, control of blood glucose levels, and use of medications (e.g., pioglitazone, metformin) may normalize hepatic transaminase levels, but the clinical benefit of aggressively treating nonalcoholic fatty liver disease is unknown. Controlling blood glucose levels is important for managing most gastrointestinal complications. Clinical recommendation Evidence rating References Initial work-up for gastroparesis should include a complete history and physical examination, along with pertin Continue reading >>
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Treating Gastroparesis
Although the term gastroparesis may be new to some, the symptoms of this ailment, in which the stomach’s ability to move food into the small intestine is impaired, can be all too familiar, as up to 50% of people with diabetes will develop gastroparesis. The slow stomach emptying characteristic of this condition can cause nausea, vomiting, a feeling of fullness after eating a small amount of food, bloating, discomfort in the upper abdomen, and a lack of appetite. These symptoms can also be accompanied by erratic blood glucose levels, requiring frequent blood glucose checks and injections of insulin. Symptoms and complications The most common cause of gastroparesis is damage to the nerve fibers that control the movements of the stomach, branches of a major nerve known as the vagus nerve. The exact cause of the nerve damage is not completely understood, but the most widely accepted theory is that insulin deficiency, high blood glucose levels, or both gradually damage the vagus nerve. Symptoms associated with gastroparesis include heartburn, reflux of food and liquids into the esophagus, difficulty swallowing, hypoglycemia (low blood glucose) after a meal followed by high blood glucose, constipation alternating with diarrhea, and weight loss. Other consequences and complications include the erratic absorption of medicines taken by mouth, foul breath, dehydration, electrolyte imbalance (electrolytes include salts such as sodium and potassium), and potentially even coma and death. Gastroparesis can be diagnosed by special studies that evaluate how well the stomach and small intestine are digesting food. At times, the symptoms of gastroparesis may improve or even disappear. However, the actual delay in stomach emptying time does not seem to correlate very well with the sympt Continue reading >>
When Diabetes Leads To A Lazy Stomach: The Goods On Gastroparesis
Gastroparesis doesn’t sound good, and it isn’t. Literally “stomach paralysis,” it is a form of diabetic neuropathy, or nerve damage, that is a common complication of diabetes. The damaged nerve in question is the vagus nerve, named for its vagabond-like wandering nature. The vagus nerve meanders all the way from the brainstem to the colon, controlling heart rate, sweating, gastrointestinal contractions, and various other involuntary, automatic functions on its way. In the case of gastroparesis, it’s the vagus nerve’s control of stomach contractions that’s damaged. The stomach is basically a hollow ball made of muscle that serves as a storage container and mixing bowl for food. It’s about the size of a small melon, but it can stretch to hold nearly a gallon if you really press the issue. In healthy people, wave-like contractions of the stomach, prompted by the vagus nerve, crush and churn your food into small particles and mix it up with enzymes and acids produced by the stomach’s inner lining. Then the stomach contractions, coming along in waves at about three per minute, slowly and evenly propel the pulverized food out through the pyloric valve, which opens just enough to release an eighth of an ounce of food at a time. From there it’s down the small intestine, where the real nutrient absorption occurs. It can take four hours to empty your stomach into your small intestine, especially if you’ve eaten fat, which slows the process down. If the vagus nerve has been damaged by years of high blood sugars, the process hits a snag. The walls of the stomach, paralyzed by the lack of vagus nerve stimulation, don’t make their muscular wave-like contractions. As a result, food just sticks around in the stomach, unpulverized and going nowhere. It may sit an Continue reading >>
Gastroparesis: Causes And Effects
A number of times throughout this book, you’ve come across the terms “delayed stomach-emptying” and “gastroparesis.” As I explained in Chapter 2, elevated blood sugars for prolonged periods can impair the ability of nerves to function properly. It’s very common that the nerves that stimulate the muscular activity, enzyme secretion, and acid production essential to digestion function poorly in long-standing diabetes. These changes affect the stomach, the gut, or both. Dr. Richard McCullum, a noted authority on digestion, has said that if a diabetic has any other form of neuropathy (dry feet, reduced feeling in the toes, diminished reflexes, et cetera), he or she will also experience delayed or erratic digestion. Slowed digestion can be fraught with unpleasant symptoms (rarely), or it may only be detectable when we review blood sugar profiles (commonly) or perform certain diagnostic tests. The picture is different for each of us. For more than twenty-five years, I suffered from many unpleasant symptoms myself. I eventually saw them taper off and vanish after thirteen years of essentially normal blood sugars. Some of the physical complaints possible (usually after meals) include burning along the midline of the chest (“heartburn”), belching, feeling full after a small meal (early satiety), bloating, nausea, vomiting, constipation, constipation alternating with diarrhea, cramps a few inches above the belly button, and an acid taste in the mouth. GASTROPARESIS: CAUSES AND EFFECTS Most of these symptoms, as well as effects upon blood sugar, relate to delayed stomach-emptying. This condition is called gastroparesis diabeticorum, which translates from the Latin as “weak stomach of diabetics.” It is believed that the major cause of this condition is neuropath Continue reading >>
Diabetic Gastroparesis
Learn the connection between diabetes and tummy and bowel troubles. By the dLife Editors If you have diabetes, you may have noticed that your digestion isn’t quite what it used to be. The connection isn’t obvious, but diabetes can damage the nervous system in ways that show up in the form of stomach or bowel problems. It’s sometimes referred to as diabetic gastroparesis. What is gastroparesis? In gastroparesis, also called delayed gastric emptying, the stomach takes too long to empty its contents. Here’s how it works. The autonomic nervous system—the part of the nervous system that “automatically” regulates our internal organs while we go about our lives —controls the movement of food through the digestive tract. Normally, the vagus nerve, which controls the muscles of the stomach, tells the muscles to contract after a meal or snack to break up food and move it along to the small intestine. But if the vagus nerve is damaged, the muscles of the stomach don’t work normally, and the movement of food slows or even grinds to a halt. Diabetes is the most common known cause of gastroparesis. Type 1 and type 2 diabetes can damage the vagus nerve if blood glucose levels stay high for too long. How? High blood glucose causes chemical changes in nerves and damages the blood vessels that bring them much-needed oxygen and nutrients. While there’s no cure for gastroparesis, treatment can help manage the condition. What are the signs of gastroparesis? Signs and symptoms may be mild or severe and can include: heartburn nausea vomiting of undigested food an early feeling of fullness when eating weight loss abdominal bloating erratic blood glucose levels lack of appetite acid reflux spasms of the stomach wall erratic bowel movements Symptoms might be worse after eatin Continue reading >>
How Should I Eat With Gastroparesis?
I was recently diagnosed with gastroparesis, but I’m unclear about what I can and can’t eat. Do you have any meal-planning guidelines? Continue reading >>
Gastroparesis
What is gastroparesis? Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine. Normally, the muscles of the stomach, which are controlled by the vagus nerve, contract to break up food and move it through the gastrointestinal (GI) tract. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The movement of muscles in the GI tract, along with the release of hormones and enzymes, allows for the digestion of food. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether. What causes gastroparesis? Most people diagnosed with gastroparesis have idiopathic gastroparesis, which means a health care provider cannot identify the cause, even with medical tests. Diabetes is the most common known cause of gastroparesis. People with diabetes have high levels of blood glucose, also called blood sugar. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery and nervous system diseases such as Parkinson’s disease or multiple sclerosis. For reasons that are still unclear, gastroparesis is more commonly found in women than in men. What are the symptoms of gastroparesis? The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating only a small amount of food, and vomiting undigested food—sometimes several hours after a meal. Other symptoms of gastroparesis include gastroesophageal reflux (GER), also called acid reflux or acid regurgitation—a condition in which stomach contents flow back Continue reading >>
Gastroparesis And Diabetes
Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. It often occurs in people with type 1 diabetes or type 2 diabetes. 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 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. Signs and Symptoms Signs and symptoms of gastroparesis are: heartburn nausea vomiting of undigested food an early feeling of fullness when eating weight loss abdominal bloating erratic blood glucose levels lack of appetite spasms of the stomach wall These symptoms may be mild or severe, depending on the person. Complications of Gastroparesis 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. Major Causes of Gastroparesis Gastroparesis is most of Continue reading >>
Gastroparesis
Gastroparesis is a disease of the muscles of the stomach or the nerves controlling the muscles that causes the muscles to stop working. Gastroparesis results in inadequate grinding of food by the stomach, and poor emptying of food from the stomach into the intestine. The primary symptoms of gastroparesis are nausea, vomiting, and abdominal pain. Gastroparesis is best diagnosed by a test called agastric emptying study. Gastroparesis usually is treated with nutritional support, drugs for treating nausea and vomiting, drugs that stimulate the muscle to contract, and, less often, electrical pacing, and surgery. What is gastroparesis? Gastroparesis means weakness of the muscles of the stomach. Gastroparesis results in poor grinding of food in the stomach into small particles and slow emptying of food from the stomach into the small intestine. The stomach is a hollow organ composed primarily of muscle. Solid food that has been swallowed is stored in the stomach while it is ground into tiny pieces by the constant churning generated by rhythmic contractions of the stomach's muscles. Smaller particles are digested better in the small intestine than larger particles, and only food that has been ground into small particles is emptied from the stomach and well digested. Liquid food does not require grinding. The ground solid and liquid food is emptied from the stomach into the small intestine slowly in a metered fashion. The metering process allows the emptied food to be well-mixed with the digestive juices of the small intestine, pancreas, and liver (bile) and to be absorbed well from the intestine. The metering process by which solid and liquid foods are emptied from the stomach is a result of a combination of relaxation of the muscle in parts of the stomach designed to accommoda Continue reading >>
What You Need To Know About Gastroparesis
Gastroparesis, or paralysis of the stomach, is a digestive condition where there is a delay in the emptying of solids and liquids from the stomach. Gastroparesis is one of the complications from nerve damage, called autonomic neuropathy, that can occur in diabetes. It is the result of damage from long-term high blood glucose levels (BGLs) to the vagus nerve of the stomach. What are the symptoms? early fullness at mealtimes (resulting in low appetite) reflux/heartburn bloating nausea vomiting (can be occasional and sudden or severe and prolonged) severe abdominal pain wide swings in blood glucose levels from hypoglycaemia after meals, later followed by hyperglycaemia weight loss malnutrition diarrhoea at night Note – symptoms can improve with improved blood glucose management. Gastroparesis is common in people with diabetes who: have type 1 diabetes or who have been managing their diabetes with insulin for 10 years or more, or who already have developed other complications or neuropathy (nerve damage). For people living with diabetes, irregular emptying of stomach contents can make management of blood glucose difficult. How do I manage my gastroparesis? The treatment of gastroparesis is centred on symptom management as there is no ‘cure’ for the condition. It is important to check your BGLs frequently and your diabetes medication or insulin may need to be changed. It is very important to get your individualised medical management plan from your diabetes team. Nutrition management is essential for gastroparesis as it helps to maintain or improve your nutrient intake, reduces your symptoms and assists your blood glucose management. See an Accredited Practising Dietitian for an individualised nutrition plan depending on your symptoms. Visit the Accredited Practising D Continue reading >>
Diabetes And Gastroparesis
Gastroparesis is a disorder in which the stomach takes too long to empty. It affects people with both type 1 and type 2 diabetes. However, people with type 1 are at a much greater risk. When blood glucose levels fluctuate regularly, diabetes can damage the vagus nerve. This is the nerve that moves food through the digestive tract. Gastroparesis is a sign of autonomic neuropathy which may also affect other involuntary actions in the body. Why is gastroparesis a problem for diabetics? When the vagus nerve stops functioning properly, gastroparesis can cause food to harden into solid masses, causing blockages and potential infection from bacteria. When the stomach does not work properly, the absorption of blood glucose is also affected, and controlling blood sugar may be more difficult. This occurs in around 20% of type 1 diabetics. The following signs could be symptoms of gastroparesis: Inform your doctor if you regularly experience these symptoms. Patients eat or drink barium, or perhaps consume food with a radioactive substance which will show up on a scan. The doctor will then be able to see if gastroparesis is affecting you. Further tests may include a tube-scope to measure electrical and muscular stomach activity. Like most complications of diabetes, the first thing is to get your blood glucose levels under control. Doctors may instantly adjust insulin levels and provide you with medication . Your diet may also need to be changed, including portions and meal frequency. Some doctors recommend parenteral nutrition - direct delivery of nutrition to the blood stream. There are several types of gastroparesis drugs, including: By changing your diet you may also be able to control gastroparesis. This might include eating 6 small meals per day instead of 3, eating liquid mea Continue reading >>
Diagnosis
Print Doctors use several tests to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include: Gastric emptying study. This is the most important test used in making a diagnosis of gastroparesis. It involves eating a light meal, such as eggs and toast, that contains a small amount of radioactive material. A scanner that detects the movement of the radioactive material is placed over your abdomen to monitor the rate at which food leaves your stomach. You'll need to stop taking any medications that could slow gastric emptying. Ask your doctor if any of your medications might slow your digestion. Upper gastrointestinal (GI) endoscopy. This procedure is used to visually examine your upper digestive system — your esophagus, stomach and beginning of the small intestine (duodenum) — with a tiny camera on the end of a long, flexible tube.This test can also diagnose other conditions, such as peptic ulcer disease or pyloric stenosis, which can have symptoms similar to those of gastroparesis. Ultrasound. This test uses high-frequency sound waves to produce images of structures within your body. Ultrasound can help diagnose whether problems with your gallbladder or your kidneys could be causing your symptoms. Upper gastrointestinal series. This is a series of X-rays in which you drink a white, chalky liquid (barium) that coats the digestive system to help abnormalities show up. Treatment Treating gastroparesis begins with identifying and treating the underlying condition. If diabetes is causing your gastroparesis, your doctor can work with you to help you control it. Changes to your diet Maintaining adequate nutrition is the most important goal in the treatment of gastroparesis. Many people can manage gastroparesis with diet changes a Continue reading >>
Type 1 Diabetes Guide
Over time, diabetes can affect many parts of your body. One of those is the vagus nerve, which controls how quickly your stomach empties. When it's damaged, your digestion slows down and food stays in your body longer than it should. This is a condition called gastroparesis. It can make you feel queasy and vomit. It's also bad for your blood sugar levels. Although it's more common in people with type 1 diabetes, people with type 2 can also get it. Most people with gastroparesis have had diabetes for at least 10 years and also have other complications related to the disease. You may have: Heartburn or reflux (backup of stomach contents into the esophagus) Vomiting (in severe cases, this may happen daily) Feeling full quickly when eating Food that stays in your stomach too long can spoil and lead to the growth of bacteria. Undigested food can harden and form a lump called a bezoar. It can block your stomach and keep what you eat from moving into the small intestine. Gastroparesis can make it hard to control diabetes. When food finally does leave your stomach and enters the small intestine, your blood sugar goes up, too. Throwing up can also leave you dehydrated. Your doctor will ask about your symptoms. He’ll also do a physical exam, and he may check your blood sugar. He might also suggest other tests. Barium X-ray: You drink a liquid (barium), which coats your esophagus, stomach, and small intestine and shows up on X-rays. This test is also known as an upper GI (gastrointestinal) series or a barium swallow. Barium beefsteak meal: You eat a meal with barium in it, and the doctor uses an X-ray to watch how long it takes you to digest the food. That tells your doctor how quickly your stomach empties. Radioisotope gastric-emptying scan: You eat food that has a radioactive Continue reading >>
