Diabetic Gastroparesis: Symptoms, Complication, Causes, Diagnosis & Treatment

Gastroparesis is a disease condition in which the motility or the normal rhythmic movement of the muscles in the stomach is affected. Gastroparesis is also called chronic delayed stomach emptying despite any mechanical obstruction in the digestive passage.

When gastroparesis is caused due to diabetes, it is termed diabetic gastroparesis.

It affects 40% of patients who have type 1 diabetes and 30% of patients with type 2 diabetes; particularly those type 2 diabetes patients who have been suffering from diabetes for more than 10 years.

For unknown reasons, it is found that the prevalence of diabetic gastroparesis is higher in women than in men.

What causes diabetic gastroparesis?

Under normal circumstances, there are strong and involuntary contractions of the muscles found in the digestive tract. These contractions are important to propel the food through the digestive tract. But in gastroparesis, the movement of the stomach is either slowed down or in some cases, it is completely absent. This prevents the stomach from emptying properly.

The cause of gastroparesis is usually unknown. However, in some patients, gastroparesis results from damage to the vagus nerve.

The vagus nerve is responsible for managing the complex process of digestion. It sends signals to the muscles in the stomach to contract and further push the food into the small intestine. If the vagus nerve gets damaged it can’t send signals to the stomach in the muscles usually. This causes the food to remain in the stomach much longer instead of moving further into the small intestine for digestion.

Some conditions which can damage the vagus nerve are:-

• Diabetes
• Surgery of the stomach and small intestine
• Certain medications such as antidepressants, opioid pain killers, anti-allergy medicines, and anti-hypertensives.
• Certain diseases such as thyroid dysfunction, Parkinson’s disease, collagen vascular disorder, intestinal pseudo-obstruction, liver disease and chronic renal insufficiency.

Diabetes adversely affects the nervous system of the human body. Thus it has the potential to cause gastroparesis by damaging the vagus nerve.

What are the sign and symptoms of diabetic gastroparesis?

The various signs and symptoms resulting from diabetic gastroparesis are:-

• Nausea
• Vomiting
• Pain in abdomen
• Bloated abdomen
• An easy feeling of fullness in the stomach
• Vomiting of food in an undigested form that had been eaten a few hours before.
• Acid reflux
• Altered blood sugar levels
• Loss of appetite
• Malnutrition
• Unintended weight loss

The severity of diabetic gastroparesis varies from patient to patient. It is seen that the severity of diabetic gastroparesis signs and symptoms does not necessarily correlate with the rate at which gastric contents empty.

Most of the patients have mild-moderate symptoms. However, in other patients, gastroparesis impedes the normal digestion process. Therefore despite having a normal diet it can lead to malnutrition in these patients. There are a large number of diabetic gastroparesis patients who suffer from a severe form of the disease. It is characterized by malnutrition, inadequate oral intake, weight loss, and frequent hospitalization.

What are the complications of diabetic gastroparesis?

Diabetic gastroparesis is not associated with a higher risk of death. However, it can lead to many complications. The various complications of diabetic gastroparesis are:-

• Esophagitis due to acid reflux.
• Mallory- Weiss tear from prolonged nausea and vomiting
• Dehydration- Diabetic gastroparesis can cause severe vomiting, which can lead to dehydration. Volume depletion and electrolyte disturbance can end up in acute renal failure.
• Malnutrition- As gastroparesis interferes with digestion, the person may suffer from malnutrition despite taking a proper diet. Also, in some patients, gastroparesis can lead to loss of appetite, which can also contribute to the problem of malnutrition.
• Bezoars or undigested food in the stomach- Bezoars refer to the solid mass that is formed due to the hardening of the undigested food in the stomach. Bezoars can cause vomiting and may become life-threatening if they obstruct the food from passing further into the small intestine.
• Worsening of diabetes- Gastroparesis causes fluctuations in the amount and rate of food that passes into the small intestine. This in turn leads to erratic changes in blood glucose levels. Due to these changes in blood glucose, the condition of diabetes becomes worse.
• Overgrowth of fungus and bacteria in the stomach.
• Lowered Quality of life- Due to the symptoms caused by gastroparesis it becomes difficult for the person to carry out other responsibilities properly. This affects the quality of life.

Also Read Top 7 Homeopathic Medicines for Indigestion & Gas

What are the diagnostic tools for diabetic gastroparesis?

For the diagnosis of diabetic gastroparesis three conditions are essential. These are:-

• The presence e of symptoms in the upper GI is suggestive of delay in gastric emptying in diabetics.
• Absence of any mechanical obstruction that can cause upper GI symptoms
• Demonstration of the presence of delayed stomach emptying.

Abdominal radiography, magnetic resonance imaging, computed tomography and upper endoscopy can be used to rule out any stricture, ulcer, or mass obstructing the intestine and stomach.

Along with this, laboratory tests are done to rule out the metabolic, infectious and immunologic causes of upper GI symptoms.

The various tests that help to rule out other conditions with similar signs and symptoms and diagnose diabetic gastroparesis are:-

• Gastric emptying tests- This further involves one or more of the following tests to determine how much time the stomach takes to empty its contents.
• Scintigraphy- This is the most important test to diagnose gastroparesis. In this, a light meal such as toast and egg is taken with a small amount of radioactive material in it. A scanner is placed over the abdomen to help detect the movement of the radioactive material eaten. This helps to monitor how much time the food takes to leave the stomach.
• Breath test- In this one eats solid or liquid food that can be absorbed by the body and which can be detected in the breath eventually. After a few hours, the breath samples are collected, and the amount of that substance in the breath is measured. Thus by measuring the amount of substance in the breath it can be seen how fast the stomach empties after eating the food.
• Upper gastrointestinal endoscopy(GI)- This procedure helps to visually examine the upper digestive tract including the oesophagus, stomach and initial part of the small intestine. A tiny camera at the end of a long and flexible tube is used for this procedure. This test can also help diagnose other conditions such as pyloric stenosis or peptic ulcer disease with similar symptoms to gastroparesis.
• Ultrasound- For this procedure, high-frequency sound waves are used to produce images of structures present within the body. This test can also be used to diagnose problems with kidneys or gall bladder that may have similar symptoms as gastroparesis.

What are the management tips for gastroparesis?

Some of the tips to manage gastroparesis are :-

• Eat small and more frequent meals throughout the day
• Thoroughly chew the food before swallowing
• Avoid raw vegetables and even fruits and instead eat well-cooked vegetables and fruits.
• Avoid high-fibre fruits and vegetables such as broccoli and oranges as they may cause bezoars
• Prefer to have low-fat foods. However, if one can tolerate fats adding a small portion of fatty foods to the diet is advisable.
• If it is easier to swallow liquid foods, add pureed food and soups to the diet.
• Take 1-1.5 litres of water daily
• Post meals gentle exercise such as walking is advisable.
• Avoid taking carbonated drinks
• Avoid alcohol consumptions
• Avoid smoking
• Try and avoid lying down for at least two hours after meals
• Have a multivitamin a day
• One can refer a dietician for a list of food items that are recommended for people with gastroparesis

Also Read What is Dyspepsia & How to cure it?

What is the treatment available for diabetic gastroparesis?

In conventional treatment, diabetic gastroparesis is considered incurable and provides only symptomatic relief for this problem. Also, it is seen that these medicines prescribed for symptomatic relief lose their effectiveness with time. Not only this, prolonged use of such medications has serious side effects.

The homeopathic system of medicine provides a safe and effective answer to this problem. Homeopathic treatment helps to treat this condition by controlling diabetes, strengthening the vagus nerve and at the same time stimulating the muscles in the stomach to enable them to contract more efficiently. Homeopathy provides symptomatic relief to the patient and reduces the patient’s dependency on medications for this problem. The potentized homoeopathic medicines don’t cause any side effects to the patient. The best homeopathic medicine for diabetic gastroparesis is the well-selected constitutional medicine.

Other commonly indicated homeopathic medicines to treat diabetic gastroparesis are:-

• BISMUTH– It is suitable to treat cases where fluids are vomited as soon as taken and food is retained longer. This food is vomited in enormous quantities at intervals of several days when the food fills the stomach.
• CARBO VEGETABILIS– It is suitable to treat cases where drunken debauch, spoiled fish, meats and fats trigger the symptoms. There is excessive flatulence. Eructation and constant fanning make the patient feels better.
• LYCOPODIUM CLAVATUM– It is suitable to treat cases where there is excessive flatulence and bloating of the abdomen. The patient feels full after a few mouthfuls of food. The symptoms tend to aggravate around 4-8 pm.
• NUX VOMICA– It is suitable to treat cases where stimulants, spicy food, allopathic medicines, and loss of sleep trigger the symptoms. The patient tends to complain of frequent and ineffectual urging for stools. This accompanies various other symptoms of diabetic gastroparesis.
• PULSATILLA NIGRICANS- It is suitable to treat cases where the patient has aversion and aggravation to fatty food and ice- cream etc. The patient feels thirstless and sensitive to cold along with various digestive symptoms.

Conclusion

Gastroparesis or delayed stomach emptying is a chronic disease. It is commonly caused by diabetes. It is then called diabetic gastroparesis. Nausea, vomiting, easy satiety, bloating, pain abdomen and unintended weight changes are associated with diabetic gastroparesis. When left untreated it can lead to complications such as esophagitis, overgrowth of bacteria and fungus in the stomach, malnutrition, dehydration and further worsening of diabetes. Scintigraphy and breath tests are used for the diagnosis of diabetic gastroparesis. For the management of diabetic gastroparesis, it is advisable to eat foods that are easier to digest and yet at the same time provide enough nutrients and calories to the person. It is also important to maintain optimal glycemic control. It is important to avoid repeated changes in glucose levels as gastroparesis is very sensitive to fluctuations in blood glucose levels. For the treatment of diabetic gastroparesis, homoeopathy provides a safe and effective treatment solution. It is advisable to refer to a trained homoeopathic physician to treat this condition.