February 7, 2014

Gastroparesis – The Good and Bad – Part 2

Part 2 of 3 parts

Treating gastroparesis is important if you have diabetes and often your diabetes medications will need to be changed. Gastroparesis can occur when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally. Food then moves slowly from the stomach to the small intestine or stops moving altogether.
It is known that elevated blood glucose levels directly interferes with normal stomach emptying. Excellent blood glucose management is needed to prevent gastroparesis and help food move through the stomach.

Gastric emptying is unpredictable with gastroparesis. It causes a person’s blood glucose levels to be erratic and difficult to control. “The primary treatment goals for gastroparesis related to diabetes are to improve gastric emptying and regain control of blood glucose levels. In addition to the dietary changes and treatments already described, a health care provider will likely adjust the person’s insulin regimen.

To better control blood glucose, people with diabetes and gastroparesis may need to
  • take insulin more often or change the type of insulin they take
  • take insulin after meals, instead of before
  • check blood glucose levels frequently after eating and administer insulin when necessary”

Your doctor should give you specific instructions for taking insulin based on the needs of the individual and the severity of gastroparesis. It is often suggested that you eat several liquid or pureed meals per day until gastroparesis symptoms improve and your blood glucose levels are more stable.

The problems of gastroparesis can include
  • severe dehydration due to persistent vomiting
  • gastroesophageal reflux disease (GERD), which is GER that occurs more than twice a week for a few weeks; GERD can lead to esophagitis— irritation of the esophagus
  • bezoars, which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form
  • difficulty managing blood glucose levels in people with diabetes
  • malnutrition due to poor absorption of nutrients or a low calorie intake
  • decreased quality of life, including work absences due to severe symptoms”

Bezoars is a hard indigestible mass of material, such as vegetable fibers, or the seeds and skins of fruits, formed in the alimentary canal.

Important points to keep in mind:
#1. Gastroparesis is a disorder that slows or stops the movement of food from the stomach to the small intestine.
#2. Gastroparesis normally occurs when the vagus nerve is damaged by illness or injury and the stomach muscles stop working normally.
#3. Idiopathic gastroparesis is often the diagnosis because the doctors cannot identify the cause, even with medical tests.
#4. Diabetes is the most common cause of gastroparesis. Over time, the people with unmanaged diabetes and have consistent high blood glucose levels cause damage to the vagus nerve.
#5. The most common symptoms of gastroparesis are nausea, a feeling of fullness after eating a small amount of food, and vomiting undigested food (this can occur several hours after a meal. Other symptoms include gastroesophageal reflux, pain in the stomach area, abdominal bloating, and lack of appetite.
#6. Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the gastrointestinal (GI) tract, and gastric emptying tests.
#7. Changing eating habits can sometimes help control the severity of gastroparesis symptoms. A health care provider may suggest eating six small meals a day instead of three large ones. When a person has severe symptoms, a liquid or puréed diet may be prescribed.
#8. Treatment of gastroparesis may include medications, botulinum toxin, gastric electrical stimulation, jejunostomy, and parenteral nutrition.
#9. For people with gastroparesis and diabetes, a health care provider will likely adjust the person’s insulin regimen.

Jejunostomy is an artificial opening from the jejunum through the abdominal wall, created for the drainage of jejunal contents or for feeding.

Jejunum is the middle portion of the small intestine, between the duodenum and the ileum.

No comments: