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What Is Gastroparesis? |
Gastroparesis is a disorder in which the stomach
takes too long to empty its contents. Gastroparesis is most often a
complication of type 1 diabetes. At least 20 percent of people with type 1
diabetes develop gastroparesis. It also occurs in people with type 2
diabetes, although less often.
Gastroparesis happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped. Diabetes can damage the vagus nerve if blood glucose (sugar) levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.
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Symptoms |
Symptoms of gastroparesis are
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Complications of Gastroparesis |
If food lingers too long in the stomach, it can
cause problems like bacterial overgrowth from the fermentation of food.
Also, the food can harden into solid masses called bezoars that may cause
nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous
if they block the passage of food into the small intestine.
Gastroparesis can make diabetes worse by adding to the difficulty of controlling blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person's blood glucose levels can be erratic and difficult to control.
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Major Causes of Gastroparesis |
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Diagnosis |
The diagnosis of gastroparesis is confirmed
through one or more of the following tests:
To rule out causes of gastroparesis other than diabetes, the doctor may do an upper endoscopy or an ultrasound.
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Treatment |
The primary treatment goal for gastroparesis
related to diabetes is to regain control of blood glucose levels.
Treatments include insulin, oral medications, changes in what and when you
eat, and, in severe cases, feeding tubes and intravenous feeding.
It is important to note that in most cases treatment does not cure gastroparesis--it is usually a chronic condition. Treatment helps you manage the condition so that you can be as healthy and comfortable as possible. Insulin for blood glucose control in people with diabetes If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To control blood glucose, you may need to
Some doctors recommend taking two injections of intermediate insulin every day and as many injections of a fast-acting insulin as needed according to blood glucose monitoring. The newest insulin, lispro insulin (Humalog), is a quick-acting insulin that might be advantageous for people with gastroparesis. It starts working within 5 to 15 minutes after injection and peaks after 1 to 2 hours, lowering blood glucose levels after a meal about twice as fast as the slower-acting regular insulin. Your doctor will give you specific instructions based on your particular needs. Medication Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment.
Changing your eating habits can help control gastroparesis. Your doctor or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. Or the doctor or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis is corrected. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly. The doctor may also recommend that you avoid fatty and high-fiber foods. Fat naturally slows digestion--a problem you do not need if you have gastroparesis--and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars. Feeding tube If other approaches do not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy tube, is inserted through the skin on your abdomen into the small intestine. The feeding tube allows you to put nutrients directly into the small intestine, bypassing the stomach altogether. You will receive special liquid food to use with the tube. A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream. By avoiding the source of the problem--the stomach--and putting nutrients and medication directly into the small intestine, you ensure that these products are digested and delivered to your bloodstream quickly. A jejunostomy tube can be temporary and is used only if necessary when gastroparesis is severe. Parenteral nutrition Parenteral nutrition refers to delivering nutrients directly into the bloodstream, bypassing the digestive system. The doctor places a thin tube called a catheter in a chest vein, leaving an opening to it outside the skin. For feeding, you attach a bag containing liquid nutrients or medication to the catheter. The fluid enters your bloodstream through the vein. Your doctor will tell you what type of liquid nutrition to use. This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult spell of gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.
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Points to Remember |
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The U.S. Government does not endorse or favor
any specific commercial product or company. Brand names appearing in this
publication are used only because they are considered essential in the
context of the information reported herein.
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National Digestive Diseases Information Clearinghouse2 Information Way The National Digestive Diseases Information Clearinghouse (NDDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1980, the clearinghouse provides information about digestive diseases to people with digestive disorders and to their families, health care professionals, and the public. NDDIC answers inquiries; develops, reviews, and distributes publications; and works closely with professional and patient organizations and Government agencies to coordinate resources about digestive diseases. Publications produced by the clearinghouse are reviewed carefully for scientific accuracy, content, and readability. This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.
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NIH Publication No. 99-4348 May 1999 e-text posted: May 1999 |