One of the most insightful aspects of question of the day is getting your questions as responses appear. Because so many of you have weighed in on gastroparesis, our research team went straight to work to give you an overview of this common but not-often-discussed condition.
What is Gastroparesis?
Gastroparesis occurs when there is a delayed emptying of the stomach when there is no mechanical obstruction. Normally, the muscles of the stomach controlled by the vagus nerve contract to break up food. The food then moves through the gastrointestinal tract. When the vagus nerve is damaged due to injury or illness, gastroparesis can occur. When this occurs the stomach muscles stop working together to move food to the small intestine. This causes food to transfer from the stomach to the small intestine slowly or not at all.
Gastroparesis effects women more than men and has a substantial impact on quality of life. Type 1 diabetes (T1D) is the most common systemic disease associated with gastroparesis. Additionally, alcohol and smoking delay gastric emptying and can put people at long-term risk for gastroparesis.
We asked the Glu community back in April of 2014 if they had been screened for gastroparesis and over three quarters of responders said no:
What are the Symptoms of Gastroparesis?
Nausea and vomiting are the two most common symptoms of gastroparesis with nausea occurring in 92% or those diagnosed and vomiting occurring in 84%. Additional symptoms include bloating (75%) and early satiety or fullness (60%). Abdominal pain and discomfort are also common in patients and are difficult symptoms to control when treating the condition. In severe cases, daily vomiting may occur along with dehydration and malnutrition (Aljarallah, 2011).
How is Gastroparesis Diagnosed?
The most common method to diagnose gastroparesis is to measure gastric emptying. This is usually done using a scintigraphy. After ingesting a meal that generally contains eggs, radioactive scans are done every hour are done to measure the percentage of food emptied through the stomach. Retention of more than 10% of the meal after four hours is considered abnormal. However, different variables come into play, and some testing facilities have different standards. For example, it’s noted that the gastric emptying rate for women is much slower than that of men.
A test using a stable carbon isotope can also be used in diagnosis. After first ingesting the meal with the isotope, breath samples are collected frequently and analyzed for the carbon dioxide levels with the measured carbon isotope. This test is done to find to the half-time of gastric emptying. However people with lung, small bowel, pancreatic, and liver diseases are not eligible for this type of testing.
Additional tests include an endoscopy to ensure that there is no obstruction to gastric emptying as well as MRIs, but neither of these methods are widely used.
How is Gastroparesis Treated?
The management of gastroparesis generally takes a team of doctors including gastroenterologists, dieticians, endocrinologists, and diabetes educators. Dieticians are especially important in those with a dual diagnosis of T1D and gastroparesis in order to maintain optimal blood sugar control.
The aim of therapy is to relieve the symptoms of nausea and vomiting. There are two main classes of drugs to help treat gastroparesis: prokinetic and antiemetic, with prokinetic being the most common.
Prokinetic drugs are the most commonly used drugs to help manage gastroparesis. The two most common drugs are metoclopramide (brand name Reglan) and domperidone. Prokinetics help to stimulate the movement of food through the stomach. Clinical trials have shown that these agents have improved gastric emptying by 25% to 72%. Additionally they have shown to reduce the severity of symptoms by 25% to 68%.
The use of these drugs long-term have shown to have bad side effects. Reglan specifically has had pronounced central nervous system (CNS) side effects. Long-term use of Reglan can cause a permanent movement disorder called tardive dyskinesia which is characterized by involuntary movements of the tongue, lips, face, and other extremities (Stein, 2015).
Antiemetic drugs are helpful in relieving vomiting. There are few clinical trials to support the use of these drugs on those diagnosed with gastroparesis. Other drug options currently used include Botox, gastric electrical stimulation (GES), and acupuncture. Gastric electrical stimulation is generally given to people who do not achieve relief from prokinetic or antiemetic drugs.
Gastroparesis and T1D
Symptoms suggestive of gastroparesis occur in 5 to 12 percent of patients with diabetes (Aljarallah, 2011). People with diabetes who develop gastroparesis generally have had diabetes for at least ten years. Gastroparesis can develop due to long-term high blood glucose levels in those with T1D. These high blood glucose levels cause damage to the vagus nerve and gastroparesis can develop.
Once this occurs gastric emptying in unpredictable and causes people with a dual diagnosis to have erratic blood glucose levels. Treatment for those with a dual diagnosis of T1D and gastroparesis is similar to those without one. Generally people will take a prokinetic drug or an antiemetic drug. More importantly people must have greater control over their blood glucose levels. Generally improving glucose levels can help to improve stomach function. People with a dual diagnosis generally have to:
- Check their blood glucose levels often after eating
- Take insulin after meals instead of before
- Take insulin more often or change the type of insulin they are taking
- Eat liquid or pureed meals to help control blood glucose levels as these meals generally pass through the gastroinstestinal tract much quicker.
Do you or anyone you know have experience with gastroparesis? Comment below and tell us your story.
Abell, T.; Bernstein, V.; Cutts, T.; Farrugia, G.; Forster, J.; Hasler, W.; Mccallum, R.; Olden, K.; Parkman, H.; Parrish, C.; Pasricha, P.; Prather, C.; Soffer, E.; Twillman, R.; Vinik, A. Treatment of Gastroparesis: A Multidisciplinary Clinical Review. Nuerogastroenterology & Motility. 2006. 18(4): 263-283.
Aljaralla, B. Management of Diabetic Gastroparesis. Saudi Journal of Gastroenterology. 2011. 17(2): 97-104.
Stein, B.; Everhart, K.; Lacy, B. Gastroparesis: A Review of Current Diagnosis and treatment Options. Journal of Clinical Gastroenterology. 2015. 49(7): 550-558.