====================================================================== Frequently asked question: What is gastroparesis? Written by Loren Buhle and Jim Reed Last updated 27June96: Added section written by Loren Buhle ----------------------------------------------------------------------- [The following section was written by E. Loren Buhle, Jr., Ph.D.] Gastroparesis is the eventual paralysis of the GI system. Neuropathy... stoppage or incorrect functioning of the autonomic nervous system (enteropathy). The result is a cessation of gastric motility...meaning food tends to sit in your intestines for a long time. Your stomach may have delayed emptying...meaning your stomach feels full of your breakfast when you sit down to dinner/supper. Additionally, there may be disturbances in the release of gut hormones and other metabolic abnormalities that also alter the GI motility. The typical symptoms are anorexia, nausea, vomiting, and abdominal pain. Gastroparesis is detected in about 25 percent of people with DM. Although it is clinically silent in most patients, severe diabetic gastroparesis is the most debilitating of all the GI complications of diabetes. Liquid emptying is controlled by the proximal stomach (fundus) and is dependent on the volume of gastric contents. Solid-phase emptying is determined by powerful circular contractions of the distal stomach (antrum). These contractions grind and mix solid food into particles less than 1mm in size, so they may pass through the pylorus into the duodenum. Particles too large to escape through the pylorus during the postprandial period must be emptied during the stomach's interdigestive phase. During periods of fasting, a coordinated wave of activity, known as the migrating motor complex (MMC), sweeps through the stomach and small bowel every 90 minutes or so to clear the gut of indigestible debris and prevent bacterial overgrowth. With diabetic gastroparesis, normal antral contractility is lost; therefore, there are particular problems with solid-food emptying. Loss of gastric MMC activity also occurs, leading to gastric statis and possible bezoar (collection of fibers, hair, and other indigestible matter...think hairball) formation. Some individuals also experience prolonged pylorospasms, which further impairs gastric emptying. Symptoms again: - nausea - vomiting - early satiety - abdominal bloating - epigastric pain - anorexia --------------------------------------------------------------------- [The following section was written by Jim Reed.] Gastroparesis sufferers may experience any or all of the following: nausea, vomiting, early satiety (you feel full almost immediately after starting to eat), abdominal bloating, epigastric pain, and sometimes anorexia. With gastroparesis, you can often burp food that you consumed many hours previous or even throw it up. Sometimes the nausea may be delayed, but more frequently it happens soon after eating. At times the nausea and vomiting can become so bad that hospitalization may be required. That is often why anorexia can be a factor. Since food may not be properly digested, the person simply chooses not to eat rather than be sick all the time. Obviously that doesn't work out in the long run. The stomach has several areas, and as the digestion process occurs, food moves through it via powerful contractions (the proximal stomach [fundus] controls liquid emptying, and the distal stomach [antrum] controls the emptying of solids). Food is ground up to about 1mm-sized particles and mixed with digestive juices. It then passes from the pylorus and into the duodenum. There are other contractions that take care of larger sized particles and migrating motor waves that sweep through the stomach during fasting periods to "clean it out." With gastroparesis, the normal movement of food is lost, at least some of the time, because of damage to the nerves involved in the digestive process. As a result, food sits undigested and results in great discomfort for the individual experiencing the problem. For those people with gastroparesis who also take insulin and, presumably, oral agents, there can be substantial problems with hypo- and hyperglycemia. With the process of food delivery to the small bowel interrupted, there can be real problems from the previous delivery of insulin to the body but with no food available to cover it. Often later, when digestion does occur, then the person is faced with hyperglycemia since now the body has food but little or no insulin to cover it. This can and does result in wide swings in blood glucose. As an example, my last 90 day average for bg's was 124 mg/dl but my HbA1c was 8.6! Like many people with gastroparesis, I never know if it will be a factor today or not. Gastroparesis is very often inconstant. I may or may not digest food within the correct timeframe. I can't tell prior to eating if it will "strike" or if my food will be digested normally. That makes planning of exogenous insulin delivery very difficult. I have noted that the higher in fat my food, the greater will be the probability of significantly delayed stomach emptying. There can exist gastrointestinal tract disorders in upwards of 75% of diabetics. Not all diabetics experience the problems and not all diabetics with gastrointestinal problems (encompasses the entire digestive tract from the esophagus to the anorectum) are aware of the problems they do have. Perhaps 25% of longer-term diabetics have some level of gastroparesis, although it can also be silent even though it is present. Routinely, other gastrointestinal problems should be considered before a diagnosis of gastroparesis is determined. These may include cancer, severe gastritis, ulcers, or gallstones. Tests can include nuclear solid-phase emptying studies, "scope" tests, or upper-GI barium series tests. Treatment for gastroparesis may include the use of a variety of pharmacological agents such as Metoclopramide, Bethanecol, Domperidone, Cisapride (becoming quite popular, such as Propulsid), and Erythromycin. Glucose control is also very important since hyperglycemia increases the problem and exacerbates it. Other gastro-related problems with which diabetics face increased risk include severe gastritis/hemorrhagic gastritis, gallstones (although it is not certain that the increased risk is anything more than incidental), pancreatic insufficiency, diabetic diarrhea, fecal incontinence, and constipation.