Treatment of Gastroparesis in Diabetics & Non-Diabetics
What Is Gastroparesis?
Gastroparesis is a pathological condition in which the stomach takes excessive time to eliminate the food inside. This condition is also known by the name of Delayed Gastric Emptying. This condition is caused due to weak muscles in the stomach. At present, there is no definitive cure for gastroparesis, but adequate treatment goes a long way in managing symptoms caused by Gastroparesis.
What Are The Causes Of Gastroparesis?
The root cause of Gastroparesis is unknown, but researchers believe that it is caused due to some type of disruption in the nerve signals in the stomach. It is opined that the vagus nerve, the function of which is to control movement of food through the digestive tract gets damaged resulting in food to be digested slowly resulting in Gastroparesis. The main cause for damage to the vagus nerve is diabetes. Apart from this, surgical procedures done to the stomach may also cause damage to the vagus nerve.
Facts About Gastroparesis
- Gastroparesis which is also known by the name of Delayed Gastric Emptying is a pathological condition in which the food is not able to traverse from the stomach to the small intestine
- The root cause of Gastroparesis is some sort of damage to the vagus nerve as a result of which the muscles of the stomach start to malfunction causing the food to stay in the stomach and not move to the intestine.
- Majority of the people with Gastroparesis are not able to know as to why they are having this disease even after consulting various physicians or undergoing a battery of tests, although diabetes is thought to be one major cause of gastroparesis since people with diabetes usually have high blood sugar levels which in time causes significant damage to the vagus nerve resulting in gastroparesis
- An individual with Gastroparesis usually experiences early satiety, frequent vomiting of undigested food, stomach pain, frequent reflux, abdominal bloating, and appetite loss
- The usual way of diagnosing Gastroparesis is by a detailed physical assessment of the individual along with medical history, blood draws, screening to rule out obstructions in the stomach
- Dietary modification goes a long way in controlling symptoms caused due to Gastroparesis. Usually, a dietician formulates a comprehensive diet plan for the patient but it is generally recommended that the affected individual eats more small meals than a single large one
- Some pharmacological forms of treatment for Gastroparesis involve use of medications, Botox injections, although it is still in the experimental stage, gastric stimulation, use of a jejunostomy tube in some acute cases, and TPN diet.
- In case of Gastroparesis is caused due to diabetes then the treating physician may adjust the dosages of insulin taken by the individual.
What Are The Risk Factors For Developing Gastroparesis?
Some of the risk factors for developing Gastroparesis are:
- Treatments for some types of cancer
- Eating disorders
- Parkinson's disease.
What Are The Symptoms Of Gastroparesis?
Symptoms of Gastroparesis Include:
- Upper abdominal pain
- Reduced appetite
- Alteration in levels of sugars
- Early satiety
- Weight loss
- Abdominal swelling.
How Is Gastroparesis Diagnosed?
In order to diagnose Gastroparesis, the treating physician will take a detailed history of the individual and perform a physical examination. The physician will also order some tests in order to rule out other potential conditions causing symptoms. Some of the tests conducted are:
- Ultrasound to rule out pancreatitis and gallbladder conditions.
- X-ray after consuming barium to look at the stomach and examine whether the stomach is functioning normally.
- Upper endoscopy to look at the lining of the stomach.
Once all other potential conditions have been ruled out by the physician then tests for confirming Gastroparesis will be performed which include
- Gastric Emptying Scintigraphy Test: In this test, a small amount of radioactive substance is given to the individual to eat and the physician investigates as to how much time it takes for the food to get digested
- A capsule called as SmartPill which has an inbuilt device which tracks down the rate at which the food is being digested by the stomach
What Are The Treatments For Gastroparesis In Non-Diabetics?
The basic treatment of Gastroparesis is solely dependent on the frequency and severity of the symptoms experienced by the affected individual. It has been noted that majority of the cases treatment is aimed at controlling symptoms, maintaining the individual's activity level, and prevention of relapses as Gastroparesis is a condition which has a tendency to recur with time.
Treating Gastroparesis With Dietary Modifications: Modification of dietary habits goes a long way in controlling symptoms of Gastroparesis. A dietician will formulate a comprehensive dietary plan and will recommend to eat frequent smaller meals in a day instead of a single large meal. The thought behind this is that when the amount of food entering the stomach is less then it becomes easier for the stomach to digest it and pass it into the intestine than when it is overly full. It is also helpful to avoid high fiber diet or foods with high fat content like oranges or broccoli. In cases of acute Gastroparesis, then a pureed diet is recommended for easy digestion of food. Pureed vegetables or soups are also very helpful. Apart from this, it is imperative for the affected individual to walk for some time after eating a meal and not lie down immediately so as to help the food get digested. The dietician may also recommend noncarbonated drinks in the diet.
Medications For Gastroparesis: Some of the medications used to treat Gastroparesis are
- Reglan: This medication helps in stimulating the stomach muscles thus helping the food move into the intestine more quickly.
- Metoclopramide: This medication also helps in controlling episodes of nausea and vomiting. It is usually taken half an hour before meals. Thus far, this is the only effective medications identified for treatment of Gastroparesis.
- Erythromycin: This medication when used in small dosages has shown to help people with Gastroparesis
- Antiemetics: These medications are also used for control of nausea and vomiting.
- Botox Injections: Some researchers are of the belief that Botox injections tend to relax the pyloric muscles and thus helping the stomach move the food to the intestines, although the true benefit and the longevity of the treatment is still under question.
Gastric Stimulation: It is an alternative form of treatment for Gastroparesis specifically for individuals whose symptoms do not improve with the above mentioned medications or dietary alterations. In this procedure, a gastric stimulatory device is implanted surgically whose function is to stimulate the stomach muscles and control nausea and vomiting. This procedure is usually done as an outpatient.
Jejunostomy: This is also an alternative form of treatment for Gastroparesis and is done when dietary modifications and medications are of no use and there is significant loss of weight due to lack of proper nutrition. In this procedure, an NG tube is inserted through which food is passed directly into the jejunum. This procedure can also be done as an outpatient. This procedure is only done for individuals with acute forms of Gastroparesis.
Parenteral Nutrition: In cases of acute forms of Gastroparesis, where dietary modifications and medications are not helpful then the treating physician may recommend parenteral nutrition which is providing nutrition through intravenous lines in the chest using a specially made tube. This is usually a temporary form of treatment and ultimately the patient does require jejunostomy procedure for definitive correction.
Treatment Of Gastroparesis In Diabetics
As stated above, diabetes is one of the major causes of Gastroparesis in individuals, so it is imperative that an individual who is diabetic take good control of blood sugars as elevated blood sugars affect the stomach muscles adversely. This is more important in diabetics with a history of Gastroparesis as this disease makes it quite difficult to control blood sugars.
The main aim of treatment for Gastroparesis in diabetics is to improve the motion of food from the stomach into the intestine along with maintaining adequate control of blood sugars. Thus in addition to the dietary modifications mentioned above for non-diabetics regular monitoring of insulin dosage is also done by the treating physician
In order to main adequate blood sugar levels, diabetics with Gastroparesis may need to do the following:
- Change the type of insulin being taken and increase the frequency of usage
- Taking insulin post-meals instead of before eating
- Checking blood sugar levels frequently and taking insulin whenever it becomes necessary.
Also, the dietician may recommend maintaining a liquid or pureed diet till the time the symptoms of Gastroparesis are controlled.