Diabetes Forecast

How To Spot And Treat Gastroparesis


For years, Laura Schmidt was plagued by frequent bloating that caused her belly to balloon after meals. Her episodes were so severe that she could pass for a pregnant woman in her final trimester. But she powered through the discomfort and simply lived with it.

Then, one night 18 years ago, things suddenly changed. She began to vomit and continued, on and off, for seven hours until finally she was taken to the emergency room. She spent a week in the hospital hooked up to an IV as doctors tried to control her heaving stomach and keep her hydrated. Several more hospital visits followed before Schmidt, who has type 1 diabetes, received her diagnosis: gastroparesis.

The Basics

When things work as they should, your stomach muscles break down the food you eat and move it along to your intestines. It gets digested there, and your body absorbs its nutrients. Gastroparesis slows this process.

Diabetes is the most common cause of gastroparesis, a form of neuropathy. Over time, elevated blood glucose can damage the vagus nerve, which controls the muscles in the digestive system. As a result, the vagus nerve’s ability to control the stomach muscles is compromised. So food takes longer to exit the stomach and, in some cases, doesn’t move at all.

Women account for four out of five cases of gastroparesis. How prevalent the condition is among people with type 1 or type 2 diabetes is up for debate. That’s because gastroparesis is often confused with other health problems, such as gallstones, pancreatitis, and heartburn.

Even physicians mistake gastroparesis for more common problems. “It is under-recognized by primary care doctors,” says gastroenterologist Gokulakrishnan Balasubramanian, MD, of The Ohio State University Wexner Medical Center. “By the time I see a patient, they’ve often already had their gallbladder removed.”

The Symptoms

Early signs include nausea, bloating, stomach cramps, and feeling full after eating even a small meal. For people with diabetes, fluctuating blood glucose levels may indicate gastroparesis. “Your blood glucose can be erratic for seemingly no reason,” says Margaret Doyle, RD, LD, CDE, a certified diabetes educator and registered dietitian at the Cleveland Clinic. “It can be really high after a meal or really low.” That’s a sign that you should see your doctor.

Gastroparesis can lead to serious complications. Solid masses, known as bezoars, may develop in the stomach and block food from exiting into the intestines. They can contribute to stomach discomfort, loss of appetite, and feelings of fullness after eating, leading to unintentional weight loss and malnutrition. Bezoars, says Balasubramanian, are more common in severe forms of the disease.

The Diagnosis

If symptoms continue, see your primary care doctor, who will likely refer you to a gastroenterologist—a doctor who specializes in diagnosing and treating diseases of the digestive system. He or she will rule out other causes, such as inflammation of the gallbladder and pancreatitis. You may undergo an upper GI endoscopy, in which a camera-tipped tube is passed into your stomach to look for problems. Your doctor may also order an abdominal ultrasound.

Next comes a test to see how long it takes food to pass through your stomach and into your intestines. After fasting overnight, you eat a small meal mixed with a tiny amount of radioactive material. This allows your doctor to measure how quickly that meal exits your stomach. The longer it takes, the likelier it is that you have gastroparesis.

The Treatments

First, your gastroenterologist will treat any medical complications, such as bezoars and infections. You’ll work with your diabetes care team to adjust your diabetes medications to account for the slow pace that your body absorbs food. For example, to avoid low blood glucose levels, you may need to take your insulin after a meal rather than before it, as Schmidt must do.

You’ll need to keep a closer watch on your glucose levels. High blood glucose in itself can slow stomach emptying and worsen gastroparesis. “As people improve their blood glucose management, they may see improvements in their gastroparesis symptoms,” says Doyle. A continuous glucose monitor (CGM) can be useful to help track the variations in glucose that can be associated with gastroparesis.

If you have less-severe gastroparesis, dietary changes alone may treat symptoms. Eat four to six small meals per day rather than two or three large ones. Chew your food thoroughly, sip liquids while you eat, and take a short walk after your meal—all can help your stomach move food along. Also avoid fatty foods, which take longer to digest, as well as high-fiber foods, including whole grains and many fruits and vegetables. They increase your risk of bezoars.

Often, the foods that are tolerable, such as pasta and mashed potatoes, lack balanced nutrition and are high in carbs. Work with a registered dietitian to develop an eating plan that meets your nutritional needs (it may include liquid nutritional supplements). “Gastroparesis is self-managed, like diabetes,” says Valari Taylor, MS, RDN, LDN, a spokesperson for the American Association of Diabetes Educators and a dietitian in Albuquerque, New Mexico. “You must become attuned to how your body responds when you eat certain things.”

Your doctor may prescribe medications that help improve your stomach’s ability to move food to your intestines or help with nausea and vomiting. They’re not cure-alls, though. “The problem with these drugs is they’re effective for only 40 to 50 percent of patients and they have a lot of side effects,” says Balasubramanian.

Metoclopramide, for example, aids gastric emptying and relieves nausea, but it can cause negative effects in the central nervous system if used for more than three months at a time. A similar medication, domperidone, does not have the same side effects, but it isn’t approved by the Food and Drug Administration (FDA) and can only be obtained under special circumstances. The antibiotic erythromycin stimulates the stomach and encourages better movement, but you can build up a tolerance to it over time.

Severe cases of gastroparesis may require surgery, though Balasubramanian says only a very small number of people will need it.

The Long Term

Gastroparesis can take a toll on your quality of life. Schmidt, who needed surgery to control her gastroparesis, battles depression. “It’s very isolating and unpredictable,” she says. “You can be perfectly fine one second and horribly sick the next.”

It helps to be involved with the patient community. She wants to share what she’s learned about gastroparesis, so she’s active in several Facebook groups for people with the condition. “I have all this knowledge, and there’s nothing that makes me happier than giving helpful tips to others,” she says.



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