Gastroparesis: That Gut Feeling (Part 1)

A couple of weeks ago, we looked at celiac disease, an often-overlooked but increasingly prevalent digestive disorder that can be seen in people with diabetes. Along that same line, a complication of diabetes that, too, often gets overlooked is gastroparesis. While technically a form of neuropathy, gastroparesis refers to delayed stomach emptying due to damage to the vagus nerve (the nerve that helps the ear, tongue, larynx, pharynx, and abdominal organs work), as well as damage to the muscles in the stomach.

What causes gastroparesis?
Diabetes is the most common cause of gastroparesis, although other factors may play a role, such as stomach surgery, infection, eating disorders, certain medications, Parkinson disease, and hypothyroidism. Gastroparesis can affect people with both Type 1 and Type 2 diabetes, and usually appears after a long time of high blood glucose levels. High blood glucose levels, in turn, can damage both the vagus nerve and the muscles of the stomach, causing them to malfunction.

Advertisement

Gastroparesis can also make managing diabetes more challenging due to the effect on stomach emptying; delayed stomach emptying can make it harder to control blood glucose levels.

How many people with diabetes get gastroparesis?
About one in five people with Type 1 diabetes will develop some degree of gastroparesis. People with Type 2 diabetes have a lower risk.

What are symptoms of gastroparesis?
Some of the most common symptoms of gastroparesis are:

  • Nausea
  • Vomiting of undigested food
  • Early feeling of fullness soon after eating
  • Heartburn
  • Bloating
  • Abdominal pain
  • Lack of appetite
  • Weight loss due to decreased food intake
  • Hard-to-control blood glucose levels
  • Malnutrition

Vomiting can occur several hours after you’ve eaten, before food is fully digested. Some people may vomit without having had eaten at all. The severity of symptoms can vary from person to person. And some people do fine with liquids but not with solid food, for example.

Food that stays in the stomach too long can lead to overgrowth of bacteria. Usually, the gut contains healthful bacteria that help keep the bad bacteria in check, but this balanced can be disrupted by fermenting food in the stomach.

Another problem that can result from gastroparesis is the formation of bezoars. Think of a bezoar as almost like a hairball (you cat lovers will know what I mean!)—except made out of undigested food. Bezoars can cause nausea and vomiting and worsen gastroparesis, because they can block food from passing from the stomach into the small intestine. Bezoars can sometimes be life-threatening, too.

How is gastroparesis diagnosed?
If you have any of the above symptoms and think you may have gastroparesis, talk to your health-care provider. There are a number of ways to diagnose this condition and rule out other conditions, as well. You may not have all of these tests, by the way:

  • Upper endoscopy: This test is used to rule out other causes of your symptoms
  • Ultrasound: This test may be given to rule out problems with your gallbladder or pancreas
  • Gastroduodenal manometry: This test measures muscle contractions in your stomach, using a pressure-sensitive plastic tube that’s threaded down your throat
  • Gastric-empyting study: This is probably the most accurate way to diagnose gastroparesis. In these studies, you eat a solid food, such as egg or oatmeal, that contains a small amount of radioactive material. A scanner machine then measures how quickly food leaves your stomach and how well your stomach muscles contract. If more than half of the eaten food stays in your stomach after a couple of hours, there’s a high probability that you have gastroparesis.

Your health-care provider may order other tests, too, such as a barium X-ray of your stomach, magnetic resonance imaging (MRI) of your abdomen, or an electrogastrogram, which measures electrical signals in your stomach (much like an electrocardiogram measures electrical signals in your heart).

Next week: Treatment for gastroparesis.

  • Vernetta Andrews van Putten

    I have been a Type 1 diabetic for fifteen years and approximately five years ago I developed gastroparesis. Unfortunately, it took several tests and months of pain, sleeplessness, vomiting and hospitalizations to determine why my stomach would not allow me to contain even a half glass of water.

    Once I was diagnosed, I was put on dozens of medications including morphine, medications for cancer patients, etc., all of which did not provide consistent relief to the sever pain, sleeplessness and of course “never-ending” vomiting. In essence, modern medicine failed…I subsequently found a Lifestyle Center & Hospital in TN and with their help they reduced my medications to a small fraction of the medications that I was previously on, and applied hydrotherapy, charcoal treatments, herbal mixtures, extreme dietary adjustments, AND helped me MANAGE MY DIABETES!!!

    I am proud to say that it has been two years since my last episode of gastroparesis. I continue to manage my diabetes with four injects of insulin (on a sliding scale) per day, along with probiotics, digestive enzymes, fiber supplements, ginger teas (and I have greatly reduced my caffeine and sugar substitute intake).

  • j_lee1007

    I live in Tennessee. Where is this hospital located? I have a severe case of gastroparesis and have not found anything that helps.

  • Karen

    I have experienced gastroparesis several times. The first time I went through all the testing but doctors found no problems; this was right before I went from oral medication to insulin. Since going on insulin, I rarely have this problem unless my Lantus insulin goes inactive and then it flares up.

    I highly recommend that anyone having this problem first look at their insulin activity. Either their body is producing no insulin and they should be on insulin, or the insulin they are taking may be inactive.

    Thanks,
    Karen
    Diabetes for 10 years

  • acampbell

    Thanks Karen. Although many people with type 2 diabetes are reluctant to go on insulin, your experience helps to reinforce the benefits of insulin therapy, particularly in the management and prevention of diabetes complications.

  • Vernetta Andrews van Putten

    Wildwood Lifestyle Center and Hospital in TN helped me both manage my diabetes, curb my diabetic complications and most importantly the sever cases of gastroparesis.

  • jennifersue77

    I was just recently diagnosed with gastroparesis. I do not have diabetes or any of the other things that usually go with this disorder. I did have an annular pancreas that i had surgery on Sept of last year. We all thought that was the problem. I had an opening the size of a dime because of the obstruction. So after the surgery the constipation and the fullness have gotten worse. Sometimes I wonder if the surgery caused this or if I was just born with it like the annular pancreas. What do you guys think. I am also having problems being able to eat mostly anything without a very full belly.

    Please help

    Jennifer

  • acampbell

    Hi Jennifer,
    My first question for you is – have you discussed your symptoms with your physician/surgeon to rule out other issues, or are these symptoms the side effects of your surgery? If, structurally, nothing appears to be wrong, what kind of changes have you made to your food choices and eating schedule?

  • marlene

    I have suffered with gastric issues due to my diabetes.. I vomit several times a week and found that I must keep barf bags with me at all times.. I just wanted to share my experiences and what I was able to find on the internet to keep on me for emergencies.

    i used Momma’s chic sicbags that have the travel logo… they are disposable and each came with its own sanitizing wipe… they fold into my wallet or my purse and I carry them with me always.. go to http://www.mommasicbags.com.

    Good luck, my fellow sufferers..