DIABETIC GASTROPARESIS

DIABETIC GASTROPARESIS

  • Diabetic gastroparesis, or delayed gastric emptying, is a medical condition caused by partial paralysis of the stomach muscles.
  • It leads to food remaining in the stomach for much longer than normal, and can occur in both type 1 and type 2 diabetes.
  • It is more common in type 1 diabetics, particularly those with poor glycemic control.
  • Normally, strong muscular contractions squeeze the food down from the stomach into the small intestine in peristaltic waves for further digestion.
  • Gastroparesis occurs when the vagus nerve, which controls these contractions, is damaged, affecting the contraction of the gastrointestinal muscles, and preventing the stomach from emptying its content at a normal pace.
  • Diabetes can damage the vagus nerve if blood glucose levels remain high over a prolonged period.

SIGNS AND SYMPTOMS
  • Nausea
  • Vomiting of undigested food
  • Early satiety and lack of appetite
  • Heartburn
  • Abdominal bloating
  • Pain in the upper abdomen due to spasms of the stomach wall
  • Erratic blood glucose levels
  • Weight loss
  • Consumption of high-fibre, oily and spicy foods and carbonated drinks increase these symptoms.

COMPLICATIONS
  • General malnutrition, chronic fatigue and weight loss because of poor calorie intake.
  • Bacterial infection from the fermentation of undigested food.
  • Intestinal obstruction due to solid masses of undigested food.
  • Fluctuations in blood glucose levels because of delayed and unpredictable gastric emptying.

DIAGNOSIS AND MANAGEMENT
  • Evaluate any gastrointestinal symptoms in diabetics to rule out gastroparesis.
  • Adequate glycemic control remains the primary goal of treatment.
  • Appropriate dosage and intake of diabetic medications, monitoring of food intake and blood glucose levels are of utmost importance.
  • The mainstay of medical treatment includes anti-emetic and pro-kinetic therapy.
  • Therapeutic endoscopy may be beneficial in some cases.
  • For patients not responding to medical therapy, there are other medical interventions possible.

SUGGESTIONS FOR DIETARY MODIFICATIONS
  • Eat smaller, but more frequent meals.
  • Include low-fibre diet.
  • Avoid tea, coffee, alcohol, tobacco and chewing gum.
  • Avoid late evening snacks.
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