What is Diabetic Gastroparesis
Gastroparesis is a medical condition wherein the stomach is partially paralysed. It is defined as an aberrance in the digestive functioning of the stomach as a result of damaged nerves and muscles. The stomach is unable to empty itself normally from a reduction in nerve and muscle coordination.
What is Diabetic Gastroparesis?
Diabetic gastroparesis is a typical complication and the outcome of prolonged diabetes. This health condition can be misdiagnosed as stomach ulcers, allergic reactions, or heartburn. Acid reflux is linked to gastroparesis in diabetic people.
Symptoms of Diabetic Gastroparesis
Signs and symptoms of diabetic gastroparesis include:
- Gastroesophageal reflux: Stomach content flowing back into the oesophagus.
- Satiety in the early stages
- Bloating in abdomen
- Chronic abdominal pain
- Weight loss and poor appetite
- Reduction in blood sugar control levels
Risk Factors for Diabetic Gastroparesis
Women are at a higher risk of developing diabetic gastroparesis compared to men.
Factors inducing diabetic gastroparesis include:
- Type-1 diabetes
- Type-2 diabetes
- Coexisting autoimmune disorders
- History of gastric procedures
- Oesophagal and abdominal surgery
- Viral infections
- Narcotic medicines that reduce the stomach emptying rate
- Multiple sclerosis and Parkinson’s disease
Causes of Diabetic Gastroparesis
- Damages the vagus nerve, which regulates the functioning of the digestive system and other internal organs
- Gastroenteritis, a viral infection in the stomach
- Parkinson’s Disease
- Multiple sclerosis
- Amyloidosis: Protein fibre deposition in tissues and organs
- Scleroderma: a connective tissue condition affecting blood vessels, skin, skeletal muscles, and internal organs.
Complications from Diabetic Gastroparesis
- Microbial infection from the fermentation of undigested food in the stomach
- Bezoar: A hardened solid mass that causes blockage in the stomach and obstructs the passage of food through the small intestine
- Dehydration: decrease water content in the body
- Malnutrition: lack of nutrition
- Kidney damage
- Retinopathy and cataract
- Foot amputation
- Shakiness and seizures
- Diabetic coma
Diagnosis of Diabetic Gastroparesis
Diagnosis begins with the doctor examining the patient’s medical history and physical body examination, including blood sugar levels. Other diagnostic tests include:
- Gastric scintigraphy: A test to calculate the time taken by food to move through the stomach. The test involves feeding a meal tagged with a radioactive isotope. The image of the stomach is taken right after the meal and again after 4 hours.
- Barium X-ray: It is done to examine the upper gastrointestinal tract. The patient is made to drink a liquid containing barium that coats the oesophagus, stomach, and small intestine for becoming visible in the x-ray. This test is also known as gastrointestinal series or barium swallow.
- Gastric empty breath test: A non-radioactive diagnostic test used to measure the rate of meal digestion in the stomach when the chemical element 13C isotope is added.
- Gastric manometry: To ascertain the rate of digestion, a thin tube is inserted through the mouth into the stomach to measure the muscular and electrical activities of stomach muscles.
- Electrogastrography: It is done to measure the stomach's electrical activities by placing electrodes on the skin.
- Upper endoscopy: A thin, flexible tube called an endoscope is inserted via the oesophagus to examine the stomach lining.
- Ultrasound: Sound waves are used to create images of the stomach to rule out other conditions.
- SmartPill: Patients are made to swallow a capsule containing an electronic device to check how quickly it travels through the digestive tract.
Treatment of Diabetic Gastroparesis
1. Diet Control
- Changing one’s eating habits helps in arresting the symptoms of diabetic gastroparesis. Try to eat smaller meals at regular intervals of 3-4 hours, rather than indulging in heavy meals. This eases the load on the stomach.
- Drink soup, juices, and low-fat fluids and consume low-residue food such as applesauce. Avoid eating high-fat and high-fibre foods, as they take time to get properly digested.
- Take proper nutrients in meals. Do not lie down or sleep at least for 2 hours after meals. This will reduce risks of acid influx.
- Metoclopramide: This is a pre-meal drug. It helps in the easy digestion of food by contracting stomach muscles and moving food forward. It also works in cases of upset stomach and vomiting.
- Antiemetics: These drugs help control nausea.
- Jejunostomy: A jejunostomy tube or feeding tube is put inside the small intestine through the belly. While feeding, patients are required to insert nutrients into the tube that goes directly into the small intestine. This does away with the stomach’s job of having to digest the food, and the nutrients are directed straight to the bloodstream through the small intestine.
- Botulinum toxin injection: Botulinum toxin is injected into the pylorus, the stomach valve that connects it to the small intestine. The botox helps in keeping the pylorus in a relaxed state, giving the stomach adequate time to digest the food.
- Per-oral pyloromyotomy (POP): An endoscope is used to cut the pylorus valve to make it easier for the stomach to empty its contents.
- Intravenous or parenteral nutrition: Nutrients are directly administered into the bloodstream through a catheter into a vein.
- Gastric electrical stimulation: A small, battery-powered device is used to transmit low-powered electrical pulses to the nerves and muscles in the lower stomach. The device is inserted under the skin in the lower abdomen area and wires attached to it are connected to the muscles in the stomach wall. This procedure is conducted to reduce nausea and vomiting.
How to Prevent Diabetic Gastroparesis
Tips for prevention and management: Consume short, frequent meals that are low in fat and fibre. Fat, fibre, and heavy meals can cause worsen symptoms by delaying stomach emptying. Chew food completely before swallowing and eat soft, well-cooked food items. Strictly avoid carbonated beverages and alcohol, and drink plenty of water and liquids such as soups. Maintain optimal hydration and nutritional health, as well as keep glucose levels under control.
Individuals with diabetic gastroparesis will have varying risks of complications and different outcomes. One can enhance the overall outlook by learning how to manage blood sugar levels on a regular basis.