Gastroparesis and Other Stomach Problems With Diabetes

Gastroparesis (delayed stomach emptying) is a digestive condition that's associated with diabetes. Most often gastroparesis occurs in people with type 1 diabetes; however, it can also occur in those with type 2 diabetes. Most have had diabetes for at least 10 years and have other complications of diabetes. With gastroparesis, the stomach cannot empty itself of food in a normal fashion.

What causes gastroparesis in diabetes?

Gastroparesis is caused by damage to the vagus nerve, which regulates the digestive system and makes muscles function. Diabetes is a leading cause of gastroparesis, accounting for about one-third of cases. Damage to the vagus nerve keeps the muscles of the stomach and intestine from functioning properly. In gastroparesis, food remains in your stomach because it is not processed and pumped through the intestines.

Other causes of gastroparesis include:

• Viral infections
• Abdominal surgery with injury to the vagus nerve
• Medications such as narcotics and some antidepressants
• Amyloidosis (deposits of protein fibers in tissues and organs) and scleroderma (a connective tissue disorder that affects the skin, blood vessels, skeletal muscles, and internal organs)

What are the symptoms of gastroparesis in diabetes?

• Heartburn or reflux (backup of stomach contents into the esophagus)
• Nausea
• Vomiting undigested food
• Poor control of blood sugar in diabetes
• Feeling full quickly when eating
• Abdominal bloating
• Poor appetite and weight loss

What are the complications of gastroparesis in diabetes?

• Food that stays in the stomach for a long time can spoil, which can lead to the growth of bacteria.
• Food in the stomach can harden into a lump called a bezoar. Bezoars can cause blockages in the stomach that keep food from moving into the small intestine.
• Gastroparesis can cause additional health problems for people who have diabetes. When food finally does leave the stomach and enter the small intestine, there is a rise in blood sugar levels. Gastroparesis can make it difficult for the person with diabetes to control his or her blood sugar levels consistently.
• In severe cases, daily vomiting may occur.

How is gastroparesis diagnosed in diabetes?

If you have diabetes and your doctor suspects gastroparesis, he or she will review your symptoms and medical history with you. Your doctor will also perform a physical examination and may order certain blood tests, including blood sugar levels. Your doctor will want to make sure an obstruction is not the cause of your symptoms. Tests used to diagnose gastroparesis may include:

• Barium X-ray: You drink a liquid (barium), which covers your esophagus, stomach, and small intestine and shows up on X-ray. This test is also known as an upper GI (gastrointestinal) series or a barium swallow.
• Barium beefsteak meal: You eat a meal with barium in it, and the doctor uses an X-ray to watch how your stomach digests the meal. The rate of digestion will tell your doctor how quickly your stomach is emptying.
• Radioisotope gastric-emptying scan: You eat food that has a radioisotope (a radioactive substance) in it, and then lie under a scanning machine that detects the radiation. If the scan shows that more than half of the food is still in your stomach after one-and-a-half hours, you have gastroparesis.
• Gastric manometry: A thin tube that is passed through your mouth and into your stomach measures the stomach's electrical and muscular activity to determine how quickly it is digesting food.
• Electrogastrography: This test measures electrical activity in the stomach using electrodes placed on the skin.
• Ultrasound: This imaging test uses sound waves to create pictures of body organs. Your doctor may use ultrasound to eliminate other diseases.
• Upper endoscopy: This procedure involves passing a thin tube (endoscope) through your esophagus to examine the lining of your stomach.