Gastroparesis Diabeticorum:
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What is Gastroparesis Diabeticorum (GD)?

Gastroparesis literally translated means 'Stomach Paralysis'; GD is a chronic condition that reduces the ability of the stomach to empty its contents, a delayed gastric emptying, where there is no blockage; it can affect people with both Type 1 and Type 2 Diabetes; it can occur when the nerves to the stomach are damaged or stop working; the Vagus nerve controls the movement of food through the digestive tract and 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 cells located between the nerve endings and smooth muscle cells in the Gastrointestinal (GI) tract; these cells, called the interstitial cells of Cajal (ICC), serve as a pacemaker for the GI muscles, including those of the stomach; the ICC send out signals that regulate the strength and frequency of the GI muscle contractions; when these cells are damaged the stomach can't contract correctly and stomach emptying is delayed; loss of ICC is the most common defect in delayed stomach emptying due to diabetes; many people with idiopathic gastroparesis also have ICC damage; recent research has shown that in some people with diabetes, immune cells within the stomach wall are activated, which can also result in delayed gastric emptying.

If food stays too long in the stomach there may be an increased risk of bacterial overgrowth from the fermentation of food; undigested food in the stomach can harden into solid masses, called Bezoars, that may cause obstructions in the stomach; these can be dangerous if they block food from going into the small intestine; GD can also make it difficult to control your Blood Glucose Levels; when food that has stayed in the stomach for too long finally enters the small intestine and is absorbed, the Blood Glucose Levels rise and since GDs makes stomach emptying unpredictable, a person's Blood Glucose Levels can be erratic and difficult to control.
The Digestive System

What Causes Gastroparesis Diabeticorum (GD)?

The cause of GD is unknown, but it may be caused by a disruption of nerve signals to the stomach; the condition is a common Diabetic complication, but can also be be a complication of surgery.

What are the Risk factors of Gastroparesis Diabeticorum (GD)?

Known risk factors for developing GD include being a Diabetic; having Systemic Sclerosis and using medication that blocks certain nerve signals, such as Anticholinergic medication; Diabetes can damage the vagus nerve if Blood Glucose Levels remain high over a long period of time; High Blood Glucose Levels can cause chemical changes in the nerves and can damage the blood vessels that carry oxygen and nutrients to the nerves.

Gastrectomy:

Another major risk factor is having to have a Gastrectomy, which is surgery to remove part, or all, of the stomach; if only part of the stomach is removed, it is called Partial Gastrectomy; if the whole stomach is removed, it is called Total Gastrectomy; the surgery is done whilst you are under general anesthesia, asleep and pain-free.

The surgeon makes a cut in the abdomen and removes all, or part, of the stomach, depending on the reason for the procedure; depending on what part of the stomach was removed, the intestine may need to be re-connected to the remaining stomach, Partial Gastrectomy, or to the esophagus, Total Gastrectomy; these days some surgeons perform the Gastrectomy using a camera; the surgery is done with a few small surgical cuts; the advantages of this surgery, which is called a Laparoscopy, are a faster recovery, less pain and only a few small cuts.

What are the Symptoms of Gastroparesis Diabeticorum (GD)?

Abdominal Distention; Hypoglycemia, in people with Diabetes; Nausea; Premature Abdominal Fullness after meals; Weight loss without trying and Vomiting.

How is Gastroparesis Diabeticorum (GD) Diagnosed?

As the symptoms of GD are common and may be due to different reasons, you should discuss your symptoms with your doctor; there are specific tests that will confirm the diagnosis of GD and rule out obstruction or other conditions, the doctor may do the following tests:

Barium Study - When a meal that contains barium is eaten, it allows the radiologist to watch the stomach as it digests the meal; after this meal, you’ll be asked not to eat for the next 12 hours; the amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working; if there is any food in the stomach after the 12 hour fast this suggests GD.

Gastric Emptying Scan using Scintigraphy - When food containing a radioisotope, a slightly radioactive substance that will show up on the scan, is eaten; the scan measures the rate of gastric emptying at 1, 2, 3 and 4 hours; GD is diagnosed if more than 10% of the food remains in the stomach after 4 hours.

Gastric Manometry - This test measures electrical and muscular activity in the stomach; a thin tube is passed down the throat into the stomach; the tube contains a wire that takes measurements of the stomach's electrical and muscular activity as it digests liquids and solid food; the measurements show how the stomach is working and whether there is any delay in digestion.

Upper Endoscopy - This is where a long, thin, tube called an endoscope is passed through the mouth down the Oesophagus into the stomach; through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities; this test will normally be done under general anaesthetic.

How is Gastroparesis Diabeticorum (GD) Treated?

Once diagnosed, the treatment for GD is to optimise the Blood Glucose Levels and relieve the symptoms; it is important to note that in most cases treatment does not cure GD; it is usually a chronic condition, but treatment helps you to manage the condition so that you can be as healthy and comfortable as possible; if you have GD, your food is being absorbed more slowly and at unpredictable times; therefore, if you are an Insulin user in order to control Blood Glucose Levels, you may be advised to take your insulin more often; take your insulin after you eat instead of before and/or check your Blood Glucose Levels frequently after you eat; several drugs are used to treat GD and your doctor and diabetes care team may try different drugs, or combinations of drugs, to find the most effective treatment for you.

Changing your eating habits may also help control GD; your dietitian will be able to give specific advice depending on your symptoms and may take several approaches to help you to manage your symptoms; these may include changing the consistency of your meals to a more liquid or semi-solid consistency, or chewing your food well, which helps reduce the work of the stomach; reducing your fat intake, as foods high in fat take longer to leave your stomach, but if you are underweight fat contained in drinks may be better tolerated; reducing your fibre intake, which may go against advice you have previously been given, but it is still important to have five portions of fruit and vegetables a day, but, puréed, tinned and peeled fruit may be better tolerated than fresh fruit; taking milk based supplement drinks, which are often well tolerated and useful if you have a poor dietary intake and reducing your meal portions, but eating more frequently.

Treatments for Severe cases of Gastroparesis Diabeticorum (GD):

You may need to be hooked up to receive special liquid food nutrients through a tube, which is inserted through the nose into the stomach or the small intestine, as a temporary measure until symptoms improve and in very severe cases, surgical intervention may be needed to manage the symptoms of GD, which include:

Using a Feeding Tube - This is where a tube called a jejunostomy tube is inserted through the skin on the abdomen into the small intestine; this allows nutrients to be delivered directly into the small intestine, bypassing the stomach altogether; a special liquid food is used with this tube; a jejunostomy tube is used as a temporary measure until symptoms improve.

Parenteral Nutrition - This is where nutrients are directly delivered into the bloodstream, bypassing the digestive system; a thin tube called a catheter is inserted in a chest vein, leaving an opening to it outside the skin; a fluid containing nutrients is then used which enters the blood stream through the vein; this is an alternative approach to the jejunostomy tube and is also a temporary method.

Enterra Therapy - This is an electronic device that is surgically inserted in the upper, or mid, abdomen region; this device uses mild electrical impulses to stimulate the stomach; this electrical stimulation may help to control the symptoms of nausea and vomiting associated with GD.

Diabetics should aim to have good control over their Blood Sugar Levels; doing so may well improve the GD symptoms; eating small meals and soft, well cooked foods may also help relieve some of the symptoms; medications that may help include Cholinergic drugs, which act on Acetylcholine nerve receptors; Erythromycin; Metoclopramide, a medicine that helps empty the stomach and Serotonin antagonist drugs, which act on serotonin receptors.

Other treatments for GD may include using Botulinum Toxin 'Botox', which is injected into the Pylorus, the outlet of the stomach or having a Gastroenterostomy, a surgical procedure that creates an opening between the stomach and small intestine to allow food to move through the digestive tract more easily.


Expectations 'Prognosis' - Unfortunately, none of these treatments are cures, but may still be beneficial to relieve symptoms in people with GD; many of the treatments provide temporary benefit and possible complications are Persistent nausea and vomiting, which may cause Dehydration, Electrolyte Imbalances and Malnutrition.

Gastroparesis Related Information Leaflets

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