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A condition associated with diabetes, in which the emptying of the stomach is slowed. Normally, the digestion of food is facilitated by steady, rhythmic contractions of the stomach muscles that break down food into smaller particles. These muscle contractions are also what push food into the small intestine, where it is further digested and its nutrients absorbed.
After having diabetes for many years, some people develop a condition known as diabetic autonomic neuropathy, in which the nerves that control automatic functions in the body, such as heartbeat and digestion, are damaged. If the vagus nerve, which controls the movement of food through the digestive tract, is damaged, the stomach and intestinal muscles may not function properly, and the passage of food through the digestive tract may be slowed.
The most common symptoms of gastroparesis are heartburn, nausea, vomiting, bloating, and an early feeling of fullness when eating. Some other signs and symptoms include weight loss, erratic blood glucose levels, lack of appetite, gastroesophageal reflux (stomach contents backing up into the esophagus), and spasms of the stomach wall.
When a doctor suspects gastroparesis based on a person’s symptoms, he may use one or more of the following tests to confirm it:
Other tests may be performed to rule out other conditions or causes of gastroparesis other than diabetes.
Although the exact cause of neuropathy (and hence gastroparesis) isn’t known, it is clearly associated with high blood glucose levels. In addition, high blood glucose can directly cause delayed gastric emptying. Good blood glucose control, therefore, is the mainstay of treatment for gastroparesis. However, because gastric emptying can be so unpredictable, maintaining blood glucose control can be difficult. It may involve frequent blood glucose monitoring and additional insulin injections.
In the United States, there are a few drugs either available or in development to treat gastroparesis. The antibiotic erythromycin increases the muscle contractions that push food through the stomach and is sometimes prescribed to treat gastroparesis. Metoclopramide (brand name Reglan) is a “prokinetic” drug, which means it stimulates stomach muscle contractions; it also reduces nausea and vomiting. Unfortunately, it can have troubling side effects such as depression, anxiety, and movement disorders. Domperidone, a prokinetic drug like metoclopramide, helps with stomach muscle contraction and eases nausea. It has been used elsewhere in the world and is currently under review by the U.S. Food and Drug Administration.
Dietary changes may also help alleviate symptoms of gastroparesis. In some cases, people are instructed to eat five or six small meals a day rather than fewer large ones to prevent the stomach from becoming too full. Sometimes a doctor or dietitian prescribes special liquid meals until the gastroparesis resolves, because liquid meals pass through the stomach more easily. Doctors often recommend avoiding foods high in fat or high in fiber because fat and fiber are difficult to digest.
For cases of gastroparesis that don’t respond adequately to lifestyle changes and medication, some more invasive procedures might help:
Diabetic gastroparesis can be a very difficult condition to treat. However, by making lifestyle changes and taking steps to get medical help, many people eventually find relief from its symptoms.
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