Gastroparesis: That Gut Feeling (Part 1)

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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.

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.

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