Gastroparesis

 

Gastroparesis can best be described as delayed stomach emptying. To better understand the process let’s first look at the gastrointestinal (GI) tract.

 

The human body is designed as a tube within a tube body plan. This inner tube, the GI tract, consisting primarily of smooth muscle runs from the mouth through to the anus. Along its length, areas of the tube become highly specialized to perform different functions. Following the mouth entrance, we have the esophagus which serves to move food by way of a series of wave like contractions down into the stomach. The food within the stomach is further ground by muscular contractions in this rich acid environment which aids the digestive process producing chyme. The chyme enters the upper region of the small intestine where digestive enzymes continue the process of breaking down complex food  molecules to simpler form.  The movement of these simpler molecules, such as glucose, down the intestine allows time for absorption through the intestinal lining.  Following absorption, these simple molecules enter into the circulatory system where they are carried to each and every cell of the body.  The waste or non-digestible food material moves through the large intestine or colon and is removed through the anus as solid waste. Any disruption in this process will result in a number of observable symptoms and at times serious complications.

 

In the case of idiopathic Gastroparesis (where the cause is not always known)  it is believed that damage to the vagus nerve that controls stomach muscle contractions allows food to remain in the stomach for longer than normal.  The failure of the stomach muscles to function normally, or at times not at all, results in inadequate grinding of food by the stomach muscles and a delay of food flow into the small intestine. In the case of diabetic gastroparesis damage to the vagus nerve occurs over years of exposure to high blood sugar levels.

 

As a result of delayed stomach emptying, the following symptoms are often noted: a feeling of fullness after consuming small amounts of food, nausea, vomiting undigested food, abdominal pain, heartburn,  a lack of appetite, fatigue, weight loss, and malnutrition. Symptoms may vary greatly over time and tend to mimic symptoms of other diseases compounding the physician’s job in his attempt to diagnose the problem.

 

Complications: For a diabetic, the fluctuations in blood glucose levels due to unpredictable digestion result in an increased risk of both hypo and hyperglycemia. This inability to manage glucose results in brittleness. Bacterial infections may occur due to over- growth of undigested food. The development of bezoars (solid masses of undigested food) can cause intestinal obstruction.                                                                                            

 

Risk factors or causes for Gastroparesis

Diabetes is the most common cause of gastroparesis. The vagus nerve becomes damaged as a result of years of exposure to high glucose levels.         

Gastrectomy – surgery to remove part of the stomach.  

Heavy smoking which causes damage to the stomach lining may be another cause.   

Connective tissue diseases such as Scleroderma have been associated with gastroparesis.      

Medications that block certain nerve signals may trigger this condition. 

 

Diagnosis

 

Gastric emptying scintigraphy and the gastric emptying breath test – both employ radioactive isotopes.                                                       

Gastric manometry – this test is designed to measure the stomach’s electrical and muscular activity. 

Ultrasound is used to eliminate the gall bladder and pancreas as the cause of a person’s digestive problems.

To rule out blockage, the physician may perform a GI endoscopy.                                                           

X-ray with barium as a liquid drink – Gastroparesis is likely if the x-ray shows food in the stomach after fasting for 8 hours.    

An electronic smart pill device is swallowed and relays information on how quickly food travels through the GI tract.

 

Treatment: There is no cure. It is a relapsing condition in which the symptoms can come and go for periods of time. A variety of medications are used: cholinergic drugs, erythromycin, and metoclopramide.

      WIn theIn the case of a diabetic, when employing insulin for blood glucose control your physician may suggest taking insulin more often, taking insulin after eating instead of before, or after eating check blood sugar levels frequently correcting with insulin if needed. An insulin pump will allow you to do all of the above efficiently, effectively and with ease.hen employing insulin

 

 

 

 

Brittle Diabetes Foundation Inc.

1547 Waterford Drive   Venice Florida 34292

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