Diabetes Forecast

Feeling Full: Gastroparesis

This nerve disorder can leave your stomach out of sync

By Erika Gebel, PhD ,

Almost everyone knows the uncomfortable ache that comes from eating too much: You feel stuffed. But for some people with diabetes, a full sensation may have nothing to do with overindulging. Instead, it may be a sign of a serious complication called gastroparesis. Never heard of it? It's not uncommon; symptoms of gastroparesis have been reported in 5 to 12 percent of people with diabetes. Here's what you need to know about preventing and treating this complication before it creates more serious problems.

In normal digestion, food leaves the stomach and makes its way into the small intestine no more than three hours after eating. However, in people with gastroparesis this journey is delayed and food remains in the stomach longer than it should, leading to a variety of symptoms.

The most common symptoms of gastroparesis are feeling full early in a meal, upper abdominal pain, heartburn, erratic blood glucose levels, nausea, bloating, and vomiting of undigested food. If food lingers in the stomach too long, it may fuel bacterial overgrowth or form hard lumps called bezoars, which can cause a dangerous blockage. Severe gastroparesis can lead to malnutrition and weight loss.

Surprising Origins

Gastroparesis is most common in people who've had diabetes for longer than 10 years and affects those with both types 1 and 2. It is often found in people with microvascular complications: retinopathy, nephropathy, and neuropathy, diseases of the eyes, kidneys, and nerves, respectively.

The cause of diabetic gastroparesis is rooted in the nervous system. Movement of food through the digestive tract is governed by nerves that send signals from the brain for digestive muscles to contract; these contractions maneuver food from the stomach into the small intestine. Yet unchecked neuropathy can cut off the signals that keep food flowing, leading to gastroparesis.

Because the symptoms of gastroparesis may have other causes, a doctor will run some tests to diagnose this disease. First, he or she may want to rule out an obstruction as the cause of digestive problems. Then, if gastroparesis remains a possibility, the doctor will probably measure the rate at which foods leave the stomach.
The best way to detect gastroparesis is a technique called scinti­scanning. The patient eats a meal containing traces of radioactive particles, and as digestion occurs, the emitted radiation is tracked. If, after four hours, more than 10 percent of the meal remains in the stomach, that is considered abnormal and may
signal gastroparesis.

Glucose Matters

Neuropathy can be prevented with good blood glucose control, so bringing blood glucose levels down to prevent further damage to the nerves is the first step in managing gastroparesis. Plus, high blood glucose itself can delay food in the stomach, which is another reason to get control. Unfortunately, though, gastroparesis can make blood glucose more difficult to control. Since, with gastroparesis, it may take hours after eating for food to enter the small intestine—where glucose is absorbed into the body—blood glucose levels may behave erratically, spiking or dropping at unanticipated times. Diabetes treatments may need to be adjusted to accommodate gastroparesis.

Some diabetes medications, including pramlintide acetate (Symlin) and exenatide (Byetta), may delay gastric emptying. These medications, and others that can delay food from moving out of the stomach, may need to be used with caution, if at all, in people with gastroparesis.

While gastroparesis usually is a chronic condition, numerous therapies can improve its symptoms and ensure proper nutrition. Gastroparesis can vary widely in its severity, and therapy should of course be tailored by a doctor to the particular case.

Minor cases can often be treated through simple dietary changes. Eating six small meals a day instead of three bigger ones may help with feeling overly full. Doctors may also recommend cutting down on high-fat foods, which slow digestion, and high-fiber foods, which can be difficult to digest. In more severe cases, a liquid or pureed diet may be necessary.

Prescription medications may help relieve gastroparesis. These meds are usually either prokinetics, which act on the central nervous system to increase contractions of the intestines, or antiemetics, which reduce nausea and vomiting. Other gastroparesis treatments under study include botulinum toxin injections and electrical stimulation of the stomach. If all else fails, surgically installing a feeding tube allows nutrients to be fed directly into the small intestine, bypassing the stomach.

While treatments generally can't cure gastroparesis, therapies can often keep people with this complication of diabetes healthy and comfortable. And if you don't have gastroparesis, avoiding it is certainly one more compelling reason to keep blood glucose levels under control.



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