What is Gastroparesis?
Gastroparesis is a condition in which the stomach of certain type 1 as well as type 2 diabetics has to take too long a time to remove the contents. The movement of food along the intestines is controlled by the vagus nerve. The stomach muscles as well as the intestinal muscles cannot work normally and food movement is slower or comes to a complete halt if there is damage to the vagus nerve.
Just like other kinds of neuropathy, diabetes may cause damage to the vagus nerve if levels of blood sugar remain too high for for a long time. High levels of blood sugar lead to chemical changes occurring in the nerves and causes the blood vessels, which send the nerves nutrients and oxygen, to be damaged.
What are the symptoms?
Gastroparesis signs and symptoms are:
- Loss of weight
- Loss of appetite
- Abdominal bloating
- Gastroesophageal reflux
- Erratic levels of blood sugar
- The stomach wall’s sudden tightening of muscles
- Vomiting of food which is found to be undigested
- Feeling already full even when just starting to eat
The above symptoms can be mild or serious, differing from one individual to another.
What are the complications?
By causing difficulty in the management of blood sugar, gastroparesis worsen diabetes. Blood sugar increases when the food eventually goes into the small intestine and is taken into the bloodstream after a period of delay in the stomach.
If food remains too long inside the stomach, problems such as excessive bacteria due to the fermentation of food. Obstruction inside the stomach, vomiting and nausea can result from the hardening of food into solid lumps known as bezoars. These solid lumps are dangerous if they prevent the movement of food from the stomach to the small intestine.
How is it diagnosed?
Confirmation of gastroparesis diagnosis is done with at least one of the tests given below:
To strike out pancreatitis or gallbladder disease as the cause of gastroparesis, the medical practitioner may use the ultrasound which is a test that makes use of sound waves to get the outline and clearly show the pancreas’ and the gallbladder’s shape.
A sedative is given before the medical practitioner sends a tube known as an endoscope from the mouth to the stomach. This endoscope helps the medical practitioner to see the stomach’s lining to watch out for anything abnormal.
Laboratory tests for blood counts as well as to measure levels of electrolyte and chemical may be used.
The doctor may decide to do an ultrasound or an upper endoscopy to make sure there are no other causes but diabetes for the gastroparesis.
The stomach’s muscular and electrical activity is measured in this test. A thin tube is sent from the mouth to the stomach by the doctor. The tube has a wire which measures the muscular and electrical activity of the stomach while it works on the solid food and liquids. From the measurements, the medical practitioner knows how efficient the stomach is and if delayed digestion is a problem.
Radioisotope Gastric-Emptying Scan
Food containing radioisotope, which is a substance with slight radioactivity, is given to you. The radioisotope will help to show the food when scanned. The small amount of radiation from the radioisotope presents no danger. After consuming the food, you lie beneath a machine which allows the medical practitioner to observe the food and see when it goes out of the stomach. If, after two hours, there is still more than 50 percent of the food in the stomach, gastroparesis is diagnosed.
Barium Beefsteak Meal
You will be given a meal that has barium in it. This permits your medical practitioner to observe your stomach during its digestion of the meal. By noting the time taken for the digestion as well as when it moves out of the stomach the doctor knows whether your stomach is in good working condition or not. The test can assist to discover stomach emptying problems which are not seen on the liquid barium X-ray. For diabetics who can usually digest fluid without any problem, this test is better.
After a 12-hour fast, you take a thick drink which contains barium. With barium taken into the stomach, covering it, the X-ray is able to show what is inside. After a 12- hour fast, the stomach should no longer contain any food. So, gastroparesis is suspected if the X-ray gives evidence of food. Even if you see no food in the X-ray, although the doctor thinks there is gastroparesis, you may be required to go through the process again on a different day. This has to be done due to the fact that it is possible for a patient with gastroparesis to empty the stomach normally on one of the days, giving false results on that particular day. Instructions on fasting by diabetics will be given by the doctor.
Diabetic Gastroparesis-Mayo Clinic – Video Guide
How is it treated?
For diabetes-linked gastroparesis, treatment targets good management of the levels of your blood sugar. Changes in your diet as well as the time of your meals and snacks, oral medications and insulin are included in the treatments. In more serious cases, intravenous feeding and feeding tubes are necessary.
Insulin for blood glucose control
With gastroparesis, food is absorbed at a slower pace with the time take not predictable. To manage your blood sugar well, the following suggestions may be tried:
- Inject insulin more frequently
- Inject insulin after each meal and not before
- Test your levels of blood sugar more often after a meal and inject insulin whenever blood sugar levels are still high.
Depending upon the individual needs, particular instructions will be given by your medical practitioner.
There are a number of drugs for the treatment of gastroparesis. Various types of drugs or a mixture of drugs may be used to get the best possible treatment.
Meal and Food Changes
Changes in habits of eating may assist in the control of gastroparesis. Particular instructions will come from your dietitian or medical practitioner. You may have to change from consuming three big meals to six smaller ones. Your stomach may not be too full every time you consume some food if the quantity is small. The dietitian or medical practitioner can also recommend that you take some liquid meals each day until the gastroparesis improves or the levels of blood sugar are under control. All the nutrients are available in liquid meals and when compared with solid foods, they can move through your stomach faster and easier.
Avoiding high-fiber and high-fat foods can be the suggestion of the doctor. Since fiber can hardly be digested and digestion of fat is slow, you should not take them when you are suffering from gastroparesis. Fibers which are indigestible can be found in such high-fiber foods such as broccoli and oranges. Such indigestible parts of the foods can stay too long inside the stomach and can become bezoars.
If all other ways cannot overcome the problem, surgery may be required to put in a feeding tube. This feeding tube, also known as jejunostomy tube, is sent in through an opening in the skin of the abdomen to the small intestine so that nutrients can be sent to the intestine directly, without having to enter the stomach. When using the feeding tube, specially prepared liquid food has to be used. When medications for regulating levels of blood sugar and nutrients are prevented from going to the bloodstream by gastroparesis, the jejunostomy comes in useful.
By not using the stomach which is the cause of the problem and sending medications and nutrients straight to the small intestine, you make sure of the digestion and delivery of both to the bloodstream. However, this feeding tube is only to be used temporarily and only when required because of severity of gastroparesis.
In many cases of gastroparesis, it becomes chronic and treatment cannot cure it.Treatment can only assist you to manage the condition, to have you as comfortable and healthy as can be.