Gastroparesis – Chronic complication of diabeties

Gastro = Stomach,
Paresis = Partial loss of ability to move

Gastroparesis is a chronic disorder when stomach emptying is delayed in the absence of any blockage. The vagus nerve controls the movement of food from the stomach to the intestines during digestion. When the nerve is damaged or its signals are disrupted, the muscles of the stomach cannot contract normally and this either slows down or stops the movement of food.

Uncontrolled diabetes is the most common cause of gastroparesis.Chemical changes occur in the nerves due to high blood glucose levels. Blood vessels that carry oxygen and nutrients to all parts of the body can get damaged. If this continues for a long time, nerves can get damaged.

Gastroparesis can also be the consequence of stomach surgery, viral infections, anorexia nervosa, bulimia, medications that slow contractions of the intestines, and diseases of the nervous system such as Parkinsons.

Nausea, vomiting, feeling of fullness after eating little food, weight loss, abdominal bloating, inconsistent blood glucose levels especially hypoglycemia because of poor absorption of food, heartburn, and poor appetite are the usual signs of gastroparesis. However, these symptoms can also occur due to other diseases.

Gastroparesis can result in :

Excessive bacterial growth because of fermentation of food,

Solid, hard masses of undigested food (bezoars) that cause obstruction in the stomach and which are dangerous if they block the passage of food into the small intestines,

Difficulty in controlling blood glucose levels because stomach emptying is irregular and this makes blood glucose levels inconsistent, and

Dehydration, malnutrition and loss of electrolytes.

Tests to be done for Gastroparesis are –

1. Upper endoscopy :
The doctor checks the stomach through along, thin tube called the endoscope which is gently passed through the mouth and into the stomach.

2. Barium study:

The radiologist studies the efficiency of digestion in the stomach after the patient has a mealcontaining barium to rule out other diagnoses.

Diagnosis is confirmed by-

A gastric emptying study that shows how long food takes a move out.

Gastric manometry, that shows how well the stomach is working.

There is no cure, but there are ways to control blood glucose levels and manage symptoms using medicines, and drugs, changing insulin injection timings, and the diet and eating habits. A low fibre, low residue and low fat diet is recommended. In severe cases, the doctor may recommend surgery.

Your dietitian may prescribe six small meals a day instead of three large ones to prevent the feeling of fullness.

If the condition is severe, a liquid or pureed diet may be prescribed.

You may be asked to have low-fat, low-residue and low-fiber foods because fat naturally slows digestion and fibre is difficult to digest.

In general, sources of high fiber include many fruits such as orange and pineapple, vegetables such as broccolli, leafy vegetables and beans, and whole grain breads and cereals. So use them very sparingly.

Source: Dr. Jaiganesh M, MD – Consultant Diabetologist, MV Hospital for Diabetes, Royapuram