44 Gastroparesis
Description
This article is from the Diabetes FAQ, by Edward Reid edward@paleo.org with numerous contributions by others.
44 Gastroparesis
J K Drummond (no longer on the net, but well) contributed this section.
Gastroparesis (gastroparesis diabeticorum if a diabetes complication) is
nerve damage caused delayed gastric emptying. This more common than
recognized irregular digestive slowdown interferes with blood glucose
regulation and oral medicine absorption.
Severity ranges from occasionally recurring bothersome symptoms like
nausea, vomiting, constipation and diarrhea to total "stomach paralysis"
-- the inability to consume/absorb any food. This worst stage requires
tube feedings as the sole source of nutrition, IVs for hydration, and
gastric suction for waste elimination. Be aware that "stomach trouble" may
be more serious for one with diabetes and report digestive problems to
your physician. Do not wait until you have had gastroparesis for several
years or end up in the emergency room because you cannot eat. If you
are a health professional, please routinely ask diabetics if they have
digestive problems.
Many with gastroparesis are undiagnosed or misdiagnosed and find little
information about it. Often they have been used as guinea pigs in
guessing games of hit or miss treatment trials. The scary quest has
only just begun to find answers, reason, and solutions to this lesser
known and mystifying complication of diabetes. There are people who
have found answers in their lonely struggle with gastroparesis.
Most folks with gastroparesis are female, with type 1 diabetes for 20-25
years and are age 25-45 at onset of gastroparesis.
These incomplete lists of symptoms, treatments, helpful & stressful
foods, and social aspects have been compiled mostly from patient reports.
There is no all-patient guarantee of experience. CHECK WITH YOUR DOCTOR!
S Y M P T O M S
Physical Psychological nausea fatigue- muscle weakness vomiting fear constipation frustration diarrhea stress bloating lack of hunger indigestion high stomach acidity reflux weight loss inability to control blood sugars
DIAGNOSIS**
Symptoms together with gender &/or years of diabetes (clinical intuition)
Gastric Mobility Transit Test
Manometric Motility Study
Diabetics are also subject to all forms of non-diabetic gastropathy so be
aware that tests are necessary to eliminate and/or verify other diagnoses.
TREATMENTS
NUTRITION - MALNUTRITION Dietitians recommend 6 small meals daily
Foods more easily digested Foods increasing symptoms fruit juices protein foods - meat, eggs canned fruits & vegetables raw fruits & vegetables soft starches (white bread dairy products & rice, mashed potatoes, cereals) caffeine, chocolate soups nuts & seeds baby foods non-carbonated beverages jello
Liquid Nutritional Supplement Drinks
Diabetic: Choice dm (Mead-Johnson), Glucerna (Ross Labs)
Ensure Glucerna OS (Ross Labs)
Non-diabetic: Ensure/Ensure plus, Sustacal (Ross Products Div)
Nutrition via:
IVs (fluids or TPN)
Tube feedings (eq. Osmolite or Supplena)
PHYSICAL - Remaining upright at least a half hour after eating,
stomach massage, enemas, glycerine suppositories, stool softeners
(for example, psyllium husk powder: Metamucil and other brands)
DRUGS - May have adverse side effects on other conditions. Ask your MD!
Reduce stomach acid: Zantac, Pepcid, Prilosec, Axid, Cytotec
Increase motility:
Reglan (metoclopramide)
erythromycin
Propulsid (cisapride) (in U.S. only under compassionate use protocol)
bethanechol
domperidone (U.S. availability: compassionate use only, and for veterinary
use -- it's used to treat fescue toxicosis in horses)
Zelnorm (tegaserod maleate), labeled in the US as of 2002 to treat
women with irritable bowel syndrome (IBS) dominated by
constipation. Zelnorm increases serotonin activity in the bowel by
activating some 5HT4 receptors, which increases serotonin in the
bowel and increases motility. The percentage of IBS patients who
benefit is small but significant. It's not clear why the labeling
is limited to women, though it seems likely to be a combination of
the fact that 2/3 of IBS patients are women and the clinical
studies barely reached statistical significance. If the effects in
gastroparesis follow those in IBS, a small percentage of patients
will see improvement, and some of those will be helped a lot.
Information from the Zelnorm prescribing information on the
http://www.zelnorm.com web site.
Reduce digestive system spasm: dicyclomine
Diarrhea: immodium, clonidine
Nausea/vomiting: marinol, thorazine, ativan, inapsine, zephran, phenergan
Surgical (physical implants or alterations)
portacath or Hickman - IV hydration or Total Peritoneal Nutrition
jejunostomy - tube feedings
gastrostomy - for stomach suction (PEG tube)
gastric resectioning or stomach removal
gastric pacing - digestive pacemakers (experimental). Enterra Therapy by
Medtronic, gastric electrical stimulation (GES) neurostimulator implants
are approved as a humanitarian use device (HUD) since severe gastroparesis
(refractory to drugs) has less then 4,000 cases per year. More info at
http://www.medtronic.com/neuro/enterra/patient.html
insulin pumps
SOCIAL & PSYCHOLOGICAL ASPECTS
Frustration for patient and physician from the difficulty in balancing
insulin dosages and food intake to achieve level blood sugars with
unpredictable slowed digestion.
Additional psychological impact from delayed treatment due to relative
medical unrecognition causing underdiagnosis and even misdiagnosis (ex. as
anorexia nervosa if accompanied by vomiting).
Lack of ostomy education.
If/when eating ability returns following thinking that a normal diet could
never again be eaten it may cause physical & emotional anorexia.
Often felt burden to friends and family.
Most information was collected by the pioneering health professionals of
the defunct Gastroparesis Communication Network, updated by J K Drummond.
There's an excellent web page on gastroparesis at
http://www.uoflhealthcare.org/digestivehealth/gastroparesis.htm
** If you have been or are out of work pursue Medicare/Medicaid & Social
Security Options IMMEDIATELY!
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