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What is Gastroparesis?

Understanding Gastroparesis
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What Is Gastroparesis?

Gastroparesis is a condition in which your stomach cannot empty itself of food in a normal fashion. It can be caused by damage to the vagus nerve, which regulates the digestive system. A damaged vagus nerve prevents the muscles in the stomach and intestine from functioning, preventing food from moving through the digestive system properly. Often, the cause of gastroparesis is unknown.
However, the causes of gastroparesis can include:
Uncontrolled diabetes
Gastric surgery with injury to the vagus nerve
Medications such as narcotics and some antidepressants
Parkinson’s disease
Multiple sclerosis
Rare conditions such as: amyloidosis (deposits of protein fibers in tissues and organs) and scleroderma (a connective tissue disorder that affects the skin, blood vessels, skeletal muscles, and internal organs)

What Are the Symptoms of Gastroparesis?
There are many symptoms of gastroparesis, including:
Heartburn or GERD
Nausea
Vomiting undigested food
Feeling full quickly when eating
Abdominal bloating
Poor appetite and weight loss
Poor blood sugar control
What Are the Complications of Gastroparesis?
Some of the complications of gastroparesis include:
Food that stays in the stomach too long can ferment, which can lead to the growth of bacteria.
Food in the stomach can harden into a solid collection, called a bezoar. Bezoars can cause obstructions in the stomach that keep food from passing into the small intestine.
People who have both diabetes and gastroparesis may have more difficulty because blood sugar levels rise when food finally leaves the stomach and enters the small intestine, making blood sugar control more of a challenge.

How Is Gastroparesis Diagnosed?
To diagnose gastroparesis, your doctor will review your symptoms and medical history. He or she will also give you a physical exam and may order certain blood tests, including blood sugar levels. Other tests used to diagnose and evaluate gastroparesis may include:
Barium X-ray : You drink a liquid (barium), which coats the esophagus, stomach, and small intestine and shows up on X-ray. This test is also known as an upper GI (gastrointestinal) series or a barium swallow.
Radioisotope gastric-emptying scan (gastric scintigraphy): You eat food that contains a very small amount of radioisotope (a radioactive substance), then lie under a scanning machine; if the scan shows that more than 10% of food is still in your stomach 4 hours after eating, you are diagnosed with gastroparesis.
Gastric manometry: A thin tube that is passed through your mouth and into the stomach measures the stomach’s electrical and muscular activity to determine the rate of digestion.
Electrogastrography: This test measures electrical activity in the stomach using electrodes placed on the skin.
The smart pill: This is a small electronic device that is swallowed. It sends back information about how fast it is traveling as it moves through the digestive system.
Ultrasound : This is an imaging test that uses sound waves to create pictures of body organs. Your doctor may use ultrasound to eliminate other diseases.
Upper endoscopy : This procedure involves passing a thin tube (endoscope) down the esophagus to examine the lining of the stomach.

What Is the Treatment for Gastroparesis?
Gastroparesis is a chronic (long-lasting) condition. This means that treatment usually doesn’t cure the disease. But there are steps you can take to manage and control the condition.
Some patients may benefit from medications, including:
Reglan (metoclopramide): You take this drug before eating and it causes the stomach muscles to contract and move food along. Reglan also decreases the incidence of vomiting and nausea. Side effects include diarrhea, drowsiness, anxiety, and, rarely, a serious neurological disorder.
Erythromycin: This is an antibiotic that also causes stomach contractions and helps move food out. Side effects include diarrhea and development of resistant bacteria from prolonged exposure to the antibiotic.
Antiemetics: These are drugs that help control nausea.
People who have diabetes should try to control their blood sugar levels to minimize the problems of gastroparesis.
Dietary Modifications for Gastroparesis
One of the best ways to help control the symptoms of gastroparesis is to modify your daily eating habits. For instance, instead of three meals a day, eat six small meals. In this way, there is less food in the stomach; you won’t feel as full, and it will be easier for the food to leave your stomach. Another important factor is the consistency of food; liquids and low residue foods are encouraged (for example, applesauce should replace whole apples with intact skins).
You should also avoid foods that are high in fat (which can slow down digestion) and fiber (which is difficult to digest).
Other Treatment Options for Gastroparesis
In a severe case of gastroparesis, a feeding tube, or jejunostomy tube, may be used. The tube is inserted through the abdomen and into the small intestine during surgery. To feed yourself, put nutrients into the tube, which go directly into the small intestine; this way, they bypass the stomach and get into the bloodstream more quickly.
Using an instrument through a small incision, botulinum toxin (such as Botox) can be injected into the pylorus, the valve that leads from the stomach to the small intestine. This can relax the valve, keeping it open for a longer period of time to allow the stomach to empty.
Another treatment option is intravenous or parenteral nutrition. This is a feeding method in which nutrients go directly into the bloodstream through a catheter placed into a vein in your chest. Parenteral nutrition is intended to be a temporary measure for a severe case of gastroparesis.
Electrical stimulation for Gastroparesis
Electrical gastric stimulation for gastroparesis uses electrodes that are attached to the stomach wall and, when stimulated, trigger stomach contractions. Further studies are needed to help determine who will benefit most from this procedure. Currently, only a few centers across the country perform electrical gastric stimulation.

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Diabetes and Neuropathy

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Gastroparesis and Diabetes: Another Aspect of Neuropathy
Posted on June 26, 2015 by Joslin Communications
This entry was posted in Complications, Diabetes Day2Day and tagged gastroparesis, neuropathy. Bookmark the permalink.
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Patients with long standing diabetes usually have some evidence of damage to the nervous system, or neuropathy. If you have neuropathy you may be familiar with pain, tingling, numbness or loss of feeling in the feet or hands (called peripheral neuropathy), but it can affect any organ system, including the stomach and its related organs.

Nerve damage associated within the gastrointestinal tract can result in the motility disorders of gastroparesis and small bowel bacterial overgrowth (SBBO). Gastroparesis is 2 to 3 times more common in type 1 diabetes than type 2 diabetes and may affect as many as 50 percent of those with type 1.

If you eat a low-fat, mixed meal your blood glucose will peak in about 1.5 hours. With normal bowel function, this peak coincides with the peak action of rapid acting insulin.

But damage to the nerves (the vagus nerve) of the gastrointestinal tract causes a loss of stomach and intestinal motor control. This can lead to a mismatch between when you digest food and glucose enters the blood stream and the action time of insulin.

If you have gastroparesis you may experience erratic blood glucose, with a pattern of low glucose readings shortly following the meal and elevated readings hours after eating.

Symptoms include nausea, early satiety, vomiting and in severe cases weight loss. Because of gastric stasis and slower bowel transit times, patients are also prone to constipation.

Gastroparesis is diagnosed by gastric emptying studies. In this test, patients are fed a meal containing a marker isotope and x-ray pictures are taken of the stomach over a 4 hour period.

Severe gastroparesis can lead to malnutrition due to continued vomiting and poor consumption of calories and protein. The goals of nutrition therapy are to prevent muscle loss, provide adequate vitamin and mineral intake, control blood glucose levels and relieve symptoms.

Nutrition recommendations include

1. Eat smaller, more frequent meals;

2. Consume more of your calories with liquids. Liquids pass more quickly than solids through the stomach;

3. Limit dietary fiber especially, for patients prone to bezoars (those are hairball like accumulations of hardened food fibers, and they can lead to obstruction of the passage from the stomach to the intestine)

4. Reduce dietary fats –especially solid fats – as they delay gastric emptying. Fats in liquid form appear better tolerated

5. Consume adequate calories to achieve or maintain a healthy weight

Other recommendations include:

1. Control of blood glucose- high levels (greater than 270 mg/dl) delay GI transit time.

2. Taking insulin after the meal or for patients using an insulin pump, use the extended action bolus.

3. Using a combination of prokinetic (movement stimulating) and antiemetic (anti nausea and vomiting) agents to improve gastric motility and control symptoms of nausea and vomiting.

For patients who do not find relief with the above measures, gastric electric stimulation can be attempted. A small pulse generator is placed under the skin and wires are attached to the stomach. The generator emits a small charge stimulating stomach emptying.

But, as always, talk to your doctor before making any changes to your diet or care.

More information about gastroparesis can be found on the NIH website.

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