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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 women.  

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:
  • Nausea
  • Vomiting
  • An early feeling of fullness when eating
  • Weight loss
  • Abdominal bloating
  • Abdominal discomfort (These symptoms may be mild or severe, depending on the person.) 
Complications Of Gastroparesis
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:
  • Diabetes.
  • 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 and Parkinson's
  • Metabolic disorders, including hypothyroidism
The diagnosis of gastroparesis is confirmed through one or more of the following tests:
  • Barium x-ray
  • Barium beefsteak meal
  • Radioisotope gastric-emptying scan
  • Gastric manometry
To rule out causes of gastroparesis other than diabetes, the doctor may do an upper endoscopy or an ultrasound.

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.
  • Metoclopramide (Reglan). This drug stimulates stomach muscle contractions to
    help empty food. It also helps reduce nausea and vomiting. Metoclopramide is
    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 works by
    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.
Other medications may be used to treat symptoms and problems related to
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 altogether.

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
President, DrDonnica.com

Created: 7/18/2001  -  Donnica Moore, M.D.

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