As a saying goes thus : “ to eat is human, to digest is divine; a number of people find it difficult to utilize their digestive tracts after enjoying a sumptuous meal. Really, it’s saddening to be afraid to eat that very delicious meal because you know you would probably be bloated or even constipated. So, what to do?
Let’s take a look at this exciting digestive disorder called gastroparesis, shall we?
Gastroparesis (abbreviated as GP) represents a clinical syndrome characterized by sluggish emptying of solid food (and more rarely, liquid nutrients) from the stomach, which causes persistent digestive symptoms especially nausea and primarily affects young to middle-aged women, but is also known to affect younger children and males.
It’s thought to be the result of a problem with the nerves (vagus) and muscles that control how the stomach empties.
Sadly, If these nerves are damaged, the muscles of your stomach might become dysfunctional and the motility of food can slow down.
“While delayed emptying of the stomach is the clinical feature of gastroparesis, the relationship between the degree of delay in emptying and the intensity of digestive symptoms does not always match”. For instance, some diabetics may exhibit pronounced gastric stasis yet suffer very little from the classical gastroparetic symptoms of: nausea, vomiting, reflux, abdominal pain, bloating, fullness, and loss of appetite. “Rather, erratic blood-glucose control and life-threatening hypoglycemic episodes may be the only indication of diabetic gastroparesis. In another subset of patients (diabetic and non-diabetic) who suffer from disabling nausea that is to the degree that their ability to eat, sleep or carry out activities of daily living is disrupted gastric emptying may be normal, near normal, or intermittently delayed”. In such cases, a gastric neuro-electrical dysfunction, or gastric dysrhythmia (commonly found associated with gastroparesis syndrome), may be at fault.
DIABETES AND GASTROPARESIS
Over time, diabetes can affect many parts of your body (especially nerves). One of those is the vagus nerve, which controls how quickly your stomach empties. “When it’s damaged, your digestion slows down and food stays in your body longer than it should”.
Although it’s more common in people with type 1 diabetes, people with type 2 can also get it.
From a study carried out by Phillips LK et al., 2015 :
Glucose and gastric emptying: bidirectional relationship. The rate of gastric emptying is a critical determinant of postprandial glycemia. Glucose entry into the small intestine induces a feedback loop via CCK, peptide YY (PYY) and glucagon-like peptide 1 (GLP-1), which are secreted from the intestine in response to nutrient exposure. GLP-1 and gastric inhibitory polypeptide (GIP) induce the release of insulin, and GLP-1 inhibits glucagon secretion, which attenuates postprandial glycemic excursions. Amylin, which is co-secreted with insulin, also slows gastric emptying. At the same time, the blood glucose concentration modulates gastric emptying, such that acute elevations of blood glucose levels slow gastric emptying (effects are evident even within the physiological range) and emptying is accelerated during hypoglycemia.
Diagnosis of gastroparesis begins with a doctor asking about symptoms and past medical and health experiences (history), and then performing a physical exam. Any medications that are being taken need to be disclosed.
Tests will likely be performed as part of the examination. These help to identify or rule out other conditions that might be causing symptoms. Tests also check for anything that may be blocking or obstructing stomach emptying. Examples of these tests include:
- a blood test,
- an upper endoscopy, which uses a flexible scope to look into the stomach,
- an upper GI series that looks at the stomach on an x-ray, or
- an ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.
The digestive symptom profile of nausea, vomiting, abdominal pain, reflux, bloating, early satiety, and anorexia can vary in patients both in combination and severity.
Others may include weight loss/weight gain, constipation and/or diarrhea, wide glycemic fluctuations in diabetics, belching and bloating-again, developing soon after meal ingestion and lasting for hours-along with visible abdominal distention. The distention and bloating may push up against the diaphragm making breathing uncomfortable.
“A poorly emptying stomach additionally predisposes patients to regurgitation of solid food, as well as gastroesophageal reflux disease (GERD)”. The reflux may range from mild through to severe. GERD complications can create esophageal spasm (also called non-cardiac chest pain) and can add to the burden of chronic pain. In severe cases, reflux aspiration pneumonitis compounds the clinical picture.
Reports from one tertiary referral center found that out of their 146 patients with gastroparesis: 36% were idiopathic (unknown causes), 29% were diabetic, 13% were post-surgical, 7.5% had Parkinson’s disease and 4.8% had collagen diseases. Any disease of metabolic, neurological (psychiatric, brainstem, autonomic including sympathetic and parasympathetic or enteric), or connective tissue (autoimmune) origin has the potential to disrupt gastric neural circuitry.
Other causes of gastroparesis include:
- Injury to your vagus nerve from surgery
- A lack of thyroid hormone (hypothyroidism)
- Viral stomach infections (gastroenteritis)
- Medications such as narcotics and some antidepressants
- Parkinson’s disease
- Multiple sclerosis
- Rare conditions such as amyloidosis (deposits of protein fibers in tissues and organs) and scleroderma (a connective tissue disorder that affects your skin, blood vessels, skeletal muscles, and internal organs).
A stomach motor disturbance known as “dumping syndrome” whereby food or liquids empty too quickly from the stomach can present with similar symptoms as are found in gastroparesis. Other disorders that may clinically present as gastroparesis (gastritis, gastric ulcers, pyloric stenosis, celiac disease, and GI obstructions) need to be ruled out.
You may find these tips helpful:
- instead of 3 meals a day, try smaller, more frequent meals – this means there’s less food in your stomach and it will be easier to pass through your system
- try soft and liquid foods, or even semi solid foods which are easier to digest. In severe cases, broths might be advisable.
- Masticate well before swallowing ( i tried to check how long it’ll take to carefully grind a spoon of rice and i got 21seconds; you should try eating slowly. winks).
- drink non-fizzy liquids with each meal
It may also help to avoid certain foods that are hard to digest, such as apples with their skin on or high-fibre foods like oranges and broccoli, plus foods that are high in fat, which can also slow down digestion.
Use of drugs like domperidone, erythromycin, anti-emetics. Also note that these drugs might have side effects so it’s important to discuss with your doctor before using them.
Domperidone should only be taken at the lowest effective dose for the shortest possible time because of the small risk of potentially serious heart-related side effects.
Other options like electric stimulation, botulinum toxin injections, a feeding tube, surgery
FOOTNOTE FOR DIABETICS
The nerves to the stomach can be damaged by high levels of blood glucose, so it’s important to keep your blood glucose levels under control if you have diabetes.
Your doctor alongside a dietitian can advise you about any changes you may need to make to your diet or medicine. For example, if you’re taking insulin, you may need to divide your dose before and after meals and inject insulin into areas where absorption is typically slower, such as into your thigh.