Q: Do you have any information on Gastroparesis? My wife is suffering through
this since she had her thyroid oblated with radioactive iodine 2 months ago.
Dr. Donnica: I am not familiar with any relationship between gastroparesis
and thyroid ablation per se, but hypothyroidism IS one of the causes
of gastroparesis. Has your wife discussed this with her endocrinologist? Has
she had her thyroid function tests done recently to see if her blood levels
of replacement thyroid hormone are normal?
Gastroparesis is a disorder in which the stomach takes too long to empty its
contents. Gastroparesis is usually a complication of type 1 diabetes and may
affect approximately 20% of people with type 1 diabetes. It may also affect
people with type 2 diabetes, although less often. Has your wife been tested
for diabetes? Type 2 diabetes is increasingly common, especially in menopausal
What causes gastroparesis? It happens when nerves affecting the stomach
(especially the vagus nerve) are damaged or stop working. The vagus nerve controls
the movement of food through the digestive tract. If the vagus nerve is damaged,
the muscles of the stomach and intestines do not work normally, and the movement
of food is slowed or stopped. Diabetes can damage the vagus nerve if blood
glucose (sugar) levels remain high over a long period of time. High blood glucose
causes chemical changes in nerves and damages the blood vessels that carry oxygen
and nutrients to the nerves.
Symptoms Of Gastroparesis:
Complications Of Gastroparesis
- An early feeling of fullness when eating
- Weight loss
- Abdominal bloating
- Abdominal discomfort (These symptoms may be mild or
severe, depending on the person.)
If food lingers too long in the stomach, it can cause problems like bacterial
overgrowth from the fermentation of food. Also, the food can harden into solid
masses called "bezoars" that may cause nausea, vomiting, and even obstruction
in the stomach. Bezoars can be dangerous if they block the passage of food into
the small intestine. Gastroparesis can worsen diabetes by increasing the difficulty
of controlling blood glucose. When food that has been delayed in the stomach finally
enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis
makes stomach emptying unpredictable, a person's blood glucose levels can be erratic
and difficult to control.
Major Causes Of Gastroparesis:
- Postviral syndromes
- Anorexia nervosa
- Surgery on the stomach or vagus nerve
- Medications, particularly anticholinergics and narcotics
(drugs that slow contractions in the intestine)
- Gastroesophageal reflux disease (rarely)
- Smooth muscle disorders, such as amyloidosis and scleroderma
- Nervous system diseases, including abdominal migraine
- Metabolic disorders, including hypothyroidism
The diagnosis of gastroparesis is confirmed through one or more of the following
To rule out causes of gastroparesis other than diabetes, the doctor may
do an upper endoscopy or an ultrasound.
- Barium x-ray
- Barium beefsteak meal
- Radioisotope gastric-emptying scan
- Gastric manometry
Treatment Of Gastroparesis:
The primary treatment goal for gastroparesis related to diabetes is to regain
control of blood glucose levels. In most cases treatment does not cure gastroparesis
-- it is a chronic condition. Treatment helps you manage the condition so
that you can be as healthy and comfortable as possible.
Several drugs are used to treat gastroparesis. Your doctor may try different
drugs or combinations of drugs to find the most effective treatment.
Other medications may be used to treat symptoms and problems related to
- Metoclopramide (Reglan). This drug stimulates stomach muscle contractions
help empty food. It also helps reduce nausea and vomiting. Metoclopramide
taken 20 to 30 minutes before meals and at bedtime. Side effects of this drug
include fatigue, sleepiness, and sometimes depression, anxiety, and problems
with physical movement.
- Erythromycin. This antibiotic also improves stomach emptying. It
increasing the contractions that move food through the stomach. Side effects
are nausea, vomiting, and abdominal cramps.
- Domperidone. The Food and Drug Administration is currently reviewing
domperidone, which has been used elsewhere in the world to treat gastroparesis.
It is a promotility agent like cisapride and metoclopramide. Domperidone also
helps with nausea.
gastroparesis. For example, an antiemetic can help with nausea and vomiting.
Antibiotics will clear up a bacterial infection. If you have a bezoar, the
doctor may use an endoscope to inject medication that will dissolve it.
Meal And Food Changes
Changing your eating habits can help control gastroparesis. Your doctor
or dietitian will give you specific instructions. You may be asked to eat
six small meals a day instead of three large ones. If less food enters the
stomach each time you eat, it may not become overly full. Instead, they may
suggest that you try several liquid meals a day until your blood glucose levels
are stable and the gastroparesis is corrected. Liquid meals provide all the
nutrients found in solid foods, but can pass through the stomach more easily
and quickly. The doctor may also recommend that you avoid fatty and high-fiber
foods. Fat naturally slows digestion -- a problem you do not need if you have
gastroparesis -- and fiber is difficult to digest. Some high-fiber foods like
oranges and broccoli contain material that cannot be digested. Avoid these
foods because the indigestible part will remain in the stomach too long and
possibly form bezoars.
Feeding tube: In severe cases, if other approaches do not work, you
may need surgery to insert a feeding tube. This tube (a jejunostomy tube) is inserted
through the skin on your abdomen into the small intestine. The feeding tube allows
you to put nutrients directly into the small intestine, bypassing the stomach
Parenteral nutrition: Parenteral nutrition refers to delivering
nutrients directly into the bloodstream, bypassing the digestive system. The
doctor places a thin catheter in a chest vein, leaving an opening to it outside
the skin. For feeding, you attach a bag containing liquid nutrients or medication
to the catheter. This approach is an alternative to the jejunostomy tube and
is usually a temporary method. Parenteral nutrition is used only when
gastroparesis is severe and is not helped by other methods.
For more information on gastroparesis, go to www.niddk.nih.gov/health/digest/pubs/gastro/gastro.htm
I hope this information is helpful to you.
With best regards,
Donnica Moore, MD
Created: 7/18/2001  - Donnica Moore, M.D.
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