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What Is Gastroparesis?
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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
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Symptoms of gastroparesis are
 | Nausea
| Vomiting
| An early feeling of fullness when eating
| Weight loss
| Abdominal bloating
| Abdominal discomfort. |
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These symptoms may be mild or severe, depending on the person.
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Complications of Gastroparesis
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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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| Diabetes.
| Postviral syndromes.
| Anorexia nervosa.
| Surgery on the stomach or vagus nerve.
| Medications, particularly anticholinergics and narcotics (drugs
that slow contractions in the intestine).
| Gastroesophageal reflux disease (rarely).
| Smooth muscle disorders such as amyloidosis and scleroderma.
| Nervous system diseases, including abdominal migraine and
Parkinson's disease.
| Metabolic disorders, including hypothyroidism. |
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Diagnosis
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The diagnosis of gastroparesis is confirmed
through one or more of the following tests:
| Barium x-ray: After fasting for 12 hours, you will drink a
thick liquid called barium, which coats the inside of the stomach,
making it show up on the x-ray. Normally, the stomach will be empty
of all food after 12 hours of fasting. If the x-ray shows food in
the stomach, gastroparesis is likely. If the x-ray shows an empty
stomach but the doctor still suspects that you have delayed
emptying, you may need to repeat the test another day. On any one
day, a person with gastroparesis may digest a meal normally, giving
a falsely normal test result. If you have diabetes, your doctor may
have special instructions about fasting.
| Barium beefsteak meal: You will eat a meal that contains
barium, thus allowing the radiologist to watch your stomach as it
digests the meal. 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. This test can help detect emptying
problems that do not show up on the liquid barium x-ray. In fact,
people who have diabetes-related gastroparesis often digest fluid
normally, so the barium beefsteak meal can be more useful.
| Radioisotope gastric-emptying scan: You will eat food that
contains a radioisotope, a slightly radioactive substance that will
show up on the scan. The dose of radiation from the radioisotope is
small and not dangerous. After eating, you will lie under a machine
that detects the radioisotope and shows an image of the food in the
stomach and how quickly it leaves the stomach. Gastroparesis is
diagnosed if more than half of the food remains in the stomach after
2 hours.
| Gastric manometry: This test measures electrical and
muscular activity in the stomach. The doctor passes a thin tube 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.
| Blood tests: The doctor may also order laboratory tests to
check blood counts and to measure chemical and electrolyte levels. |
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To rule out causes of gastroparesis other than diabetes, the doctor
may do an upper endoscopy or an ultrasound.
| Upper endoscopy. After giving you a sedative, the doctor
passes a long, thin, tube called an endoscope through the mouth and
gently guides it down the esophagus into the stomach. Through the
endoscope, the doctor can look at the lining of the stomach to check
for any abnormalities.
| Ultrasound. To rule out gallbladder disease or pancreatitis
as a source of the problem, you may have an ultrasound test, which
uses harmless sound waves to outline and define the shape of the
gallbladder and pancreas. |
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Treatment
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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
| Take insulin more often.
| Take your insulin after you eat instead of before.
| Check your blood glucose levels frequently after you eat,
administering insulin whenever necessary. |
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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.
| Metoclopramide (Reglan). This drug stimulates stomach
muscle contractions to help empty food. It also helps reduce nausea
and vomiting. Metoclopramide is taken 20 to 30 minutes before meals
and at bedtime. Side effects of this drug are fatigue, sleepiness,
and sometimes depression, anxiety, and problems with physical
movement.
| Cisapride (Propulsid). Cisapride stimulates stomach
movement and also causes intestinal contractions, which can be
helpful. This drug is generally more potent than metoclopramide, but
causes fewer side effects (headache, abdominal cramps, diarrhea).
Cisapride is also taken 20 to 30 minutes before meals and at
bedtime. Metoclopramide and cisapride are called promotility agents.
| Erythromycin. This antibiotic also improves stomach
emptying. It works by increasing the contractions that move food
through the stomach. Side effects are nausea, vomiting, and
abdominal cramps.
| Domperidone. The Food and Drug Administration is reviewing
domperidone, which has been used elsewhere in the world to treat
gastroparesis. It is a promotility agent like cisapride and
metoclopramide. Domperidone also helps with nausea.
| Other medications. Other medications may be used to treat
symptoms and problems related to gastroparesis. For example, an
antiemetic can help with nausea and vomiting. Antibiotics will clear
up a bacterial infection. If you have a bezoar, the doctor may use
an endoscope to inject medication that will dissolve it. |
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Meal and food changes
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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| Gastroparesis is a common complication of type 1 diabetes.
| Gastroparesis is the result of damage to the vagus nerve, which
controls the movement of food through the digestive system. Instead
of the food moving through the digestive tract normally, it is
retained in the stomach.
| The vagus nerve becomes damaged after years of poor blood glucose
control, resulting in gastroparesis. In turn, gastroparesis
contributes to poor blood glucose control.
| Symptoms of gastroparesis include early fullness, nausea,
vomiting, and weight loss.
| Gastroparesis is diagnosed through tests such as x-rays, manometry,
and scanning.
| Treatments include changes in when and what you eat, changes in
insulin type and timing of injections, oral medications, a
jejunostomy, or parenteral nutrition. |
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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 Clearinghouse
2 Information Way
Bethesda, MD 20892-3570
E-mail: nddic@info.niddk.nih.gov
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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