Gastroparesis and Diabetes

Gastroparesis is a medical condition affecting the stomach and its emptying function within the digestive tract. Although common in diabetics it can affect any person acutely (mildly) or chronically (severely). Gastroparesis means paralysis (paresis) of the stomach (gastro) muscles, which affects muscle function so that food and fluids build up in the stomach and are not released through normal healthy digestive function.

Gastroparesis and stomach function

Understanding how the stomach functions will help us comprehend the impact of Gastroparesis. During healthy digestive function we consume food and liquids that move down our oesophagus (throat) into our stomach. The vagus nerve stimulates and controls stomach muscle contraction to break down the food, mix it with digestive juices and release the contents into the small intestine for further digestive functions. Paralysis of the stomach muscles means the food can no longer be properly broken down, mixed with digestive juices or moved through the digestive tract, and may be due to nerve or muscle dysfunction.

What causes Gastroparesis?

A number of reasons can result in either neural or muscle dysfunction within the stomach and intestines, causing paralysis, food blockage and impeded digestion. A specific cause of Gastroparesis may not be identified. Gastroparesis is a recognised complication of diabetes and surgery, such as Gastrectomy where part of the stomach is removed. Identified triggers may include:

• Eating disorders and abnormal diet patterns, such as anorexia nervosa or bulimia.
• Cancer treatments and medications.
• Neurological diseases, such as Motor-Neuron or Parkinson’s, and disease such as systemic sclerosis.
• High blood glucose damaging the vagus nerve.
• Autonomic neuropathy due to Diabetes Type I and II Diabetes.
• Connective tissue diseases, such as Ehlers-Danlos Syndrome and Scleroderma.
• Damage to the vagus nerve due to injury or surgery.
• Anticholinergic Medications that block nerve signals.
• Viral infection.
• Hormonal imbalance.

What are the symptoms of Gastroparesis?

Common symptoms of Gastroparesis include nausea and vomiting of undigested food accompanied by swelling, bloating and pain in the stomach and abdomen. However, if mild in proportion, sufferers may not experience vomiting. Other symptoms may include a lack of appetite, feeling full without eating much, stomach spasms, weight loss, heartburn and palpitations.

How is Gastroparesis diagnosed?

To diagnose Gastroparesis a medical examination with discussion of medical history and symptoms will initially be necessary. The medical practitioner may then recommend further diagnostic tests, such as:

• Gastric emptying scans using isotope label.
• Esophagogastroduodenoscopy (EGD).
• X-rays.
• Manometry.

How is Gastroparesis treated?

Depending on the cause and severity of symptoms, a number of treatments are available for Gastroparesis and include:

• Dietary recommendations: low fibre and residue, and reduced fats and solids.
• Jejunostomy tubes: placed in the Jejunum of the small intestine through an artificial opening to move further blockage and assist feeding and digestive movement.
• Parenteral nutrition: intravenous feeding of glucose, amino acids, lipids, minerals and vitamins.
• Medications containing metoclopramide, erythromycin or domperidone or botulinum toxin to stimulate stomach emptying.

• Anti-emetic and appetite stimulant Mirtazapine.
• Acetylcholine nerve stimulating cholinergic medications.

• Circulatory stimulation using Viagra.
• Monitoring diabetic insulin dosages.
• Gastric neurostimulator implants.

Health implications of Gastroparesis

Being medically examined and getting treatment for Gastroparesis is essential for healthy digestion, nutrition and to protect the body against infection. Food blocked in the stomach or intestine can cause excess bacterial growth and infection. The obstruction can cause tissue-damage and build-up into tumours that can become cancerous. Malnutrition may then occur, affecting the body's circulatory and nervous systems. Blood glucose levels can become worse, causing chronic fatigue and, in severe cases, coma or death. Leaving Gastroparesis untreated can result in life-threatening complications and death.

How can Gastroparesis be prevented?

Because the causes of Gastroparesis may not be clear treatments may be aimed at addressing symptoms. Preventative measures can help to reduce symptoms or prevent Gastroparesis for better health:

• Early medical intervention when symptoms are experienced.
• Adhering to a healthy balanced diet.
• Getting treatment when eating disorders start.
• Monitoring blood glucose levels.
• Avoiding obesity that causes diabetes.
• Protecting the body against injury.
• Not having invasive treatments through inexperienced practitioners or poor-equipped practices.
• Practising infection control: good hygiene to prevent infection.