Common Health Issues

Diabetes Gastroparesis and Gastroesophageal Reflux

• By Rich Health Editorial Team
• November 07, 2021

Your gastrointestinal (GI) tract carries out an important job. It processes all the food your body takes in, directs all the energy and nutrients to where they are needed, decides what your body doesn’t need, and eliminates the waste. Food enters your mouth and travels down your esophagus to your stomach where it is digested. 

 

A powerful system of muscles propels the food and waste from your stomach, through your large and small intestines, and to your rectum for elimination. As your food moves along, specialized cells along the GI tract absorb the needed nutrients and shuttle them off to where they are needed.

 

The muscles that propel food along your GI tract are controlled by a network of nerve fibers. These nerve fibers are part of the autonomic nervous system. They carry out their job without you even being aware that they are working. But when these nerves become damaged, you can develop autonomic neuropathy. When this happens, your GI tract can’t do its job efficiently. 

 

Food stays in your stomach longer and moves more slowly through the tract. You can often feel the effects as gastrointestinal discomfort. If you have diabetes, you are more likely to have neuropathy, or nerve damage, and are more likely to experience problems with the gastrointestinal tract, from the mouth to the rectum.

 

DIABETES GASTROPARESIS

Your stomach is a big, hollow, muscular organ. Through strong, regular contractions, it grinds up the food that you eat, breaking down big pieces into tiny particles. At the same time, gastric juices chemically digest your food to break it down further. Once pieces of food are small enough, they can pass through the pyloric sphincter, a kind of valve between the stomach and small intestine. Larger pieces are propelled back to the stomach for further processing. In between meals, when your stomach is not actively digesting food, larger, undigested particles are pushed through to the intestines.

If you have diabetes, you are more likely to have autonomic neuropathy. If this happens, damage to the nerves that control the stomach muscles can prevent or slow down their action. As a result, your stomach muscles can prevent or slow down their action. As a result, your stomach can’t efficiently break down your food into smaller pieces, and food remains in your stomach too long. In a person who does not have autonomic neuropathy, liquids empty out of the stomach in 10 or 30 minutes and solid remains for 1 to 2.5 hours. But if you have neuropathy, both liquids and solids can remain for much longer. The mechanism that allows undigested matter to pass through is also disturbed. Sometimes food particles can remain in your stomach for days

 

DIABETES GASTROPARESIS SYMPTOMS

If you have gastroparesis, or delayed stomach emptying, you may experience frequent bouts of nausea and vomiting. This often occurs along with weight loss. Episodes of nausea and vomiting may last for days, or less frequently, for months. Or you may experience these symptoms in cycles. You may feel bloated in your abdomen and have an uncomfortable feeling of fullness after a meal. Often, you feel full before you have eaten very much. If you vomit, you may notice food that you ate several days ago.

 

Blood glucose levels may be difficult to control, because glucose is delivered to your bloodstream erratically. You might have frequent bouts of hypoglycemia because it is more difficult to match your insulin doses to your meals, because your meals are not being processed in a timely manner.

 

Gastroparesis often occurs when you have other complications of diabetes, especially those caused by neuropathy. These include retinopathy, nephropathy, and peripheral neuropathy. You may also experience the symptoms of other autonomic neuropathies. These include a sluggish pupil response to changing light conditions, lack of sweating, facial sweating while eating certain foods, dizziness when you stand up, impotence or diminished ejaculation if you are male, and poor bladder function with frequent bladder infections. If you experience any of these other problems related to neuropathy, it is likely that your stomach discomfort may also be due to neuropathy.

 

What You Should Do When You Have Diabetes Gastroparesis

If you have recurrent bouts of nausea and vomiting, notify your doctor. You will want to rule out other causes that could be contributing. If you do have gastroparesis, your doctor may need to conduct several tests to correctly diagnose the problem and to come up with the proper treatment.

Any time you have nausea and/or vomiting, check your blood glucose level. If you have any signs of dehydration, diabetic ketoacidosis, or hyperglycemic hyperosmolar state, you may need emergency help. If your blood glucose level is above 250mg/dl, call a member of your health care team at once. You may need to treat the hyperglycemia. If your blood glucose level is over 500mg/dl, call for emergency help or have someone take you to a hospital immediately.

 

If your blood glucose level is below 60mg/dl, you have hypoglycemia. You should take a fast-acting carbohydrate right away. However, delivering glucose to your bloodstream can be difficult if you have gastroparesis, especially if you are vomiting. Try taking a fast-acting carbohydrate that contains 10 to 15 grams of carbohydrate (2 tablespoons of raisins, 113 grams of orange juice, 6 jelly beans, 2 teaspoons of sugar, 10 gumdrops, or 2 to 5 glucose tablets, for example.) Wait 15 minutes and then retest your blood glucose level. If it is still below 60mg/dl, take another dose of carbohydrate. If your blood glucose level remains low and vomiting makes you unable to keep down any food, call your doctor immediately. If you show any signs of severe hypoglycemia, seek emergency help at once.

 

If you have frequent bouts of nausea and vomiting, talk to your doctor about what to do in an emergency situation, should your blood glucose level rise too high or fall too low. Know what signs to look for and make sure you and those around you know what to do.

 

DIABETES GASTROPARESIS TREATMENT

If have severe nausea and vomiting and are at risk for dehydration, you will need emergency treatment. If your dehydration becomes severe, you will need hospitalization. In the hospital, your stomach will be pumped to quickly remove the contents and relieve the symptoms. You will be given intravenous fluids containing the appropriate nutrients and metabolites to rehydrate you and restore any metabolic imbalance due to hypoglycemia, hyperglycemia, low potassium or ketoacidosis. If you are malnourished, you may be given a feeding tube that bypasses the stomach.

 

Once you are stable, your doctor will want to first rule out any conditions that have symptoms similar to gastroparesis. These include chronic peptic ulcer, cancer, uremia, pregnancy or the side effects of any medications you may be taking. Medications used to treat high blood pressure and depression frequently cause a delay stomach emptying.

 

Once your doctor has ruled out other factors, she may want to conduct a stomach-emptying test. To do this, you will be asked to eat a meal containing a radioactive tracer. After eating the meal, the level of radioactivity will be measured at different times to determine the rate of stomach emptying. You will be given specific instructions about what to eat before the test. It will be important that your blood glucose level remains below 240mg/dl throughout the test. This is because hyperglycemia itself slows the emptying of the stomach. If your glucose levels are too high, it will be difficult to know whether your gastroparesis is due to a true neuropathic condition or simply a reflection of hyperglycemia at the time of the test.

Your doctor may also conduct a gastroscopy test. This is a method used to look inside your stomach. Your doctor will insert a probe that contains a tiny camera. This will provide a view of the inside of your stomach and will alert your doctor to any abnormalities.

 

Once diagnosed, treatment for gastroparesis may include a combination of diet and drug therapy. Your doctor or dietitian may suggest that you eat small meals more frequently rather than a few large meals each day. Avoid eating high-fat and high-fiber foods, including uncooked vegetables. You do not want to eat foods that are difficult to digest, such as legumes, lentils and citrus fruits. This can aggravate the symptoms of gastroparesis. In addition, undigested food can form hard lumps, known as bezoars, that remain in the stomach. These bezoars will further worsen your symptoms of gastroparesis, contributing to feelings of bloating, nausea and abdominal discomfort. They can be very difficult for your doctor to remove.

You may also be given medication that stimulates your stomach to contract and empty its contents. If one drug doesn’t work for you, you may be given a different drug or a combination of drugs. Sometimes a particular medication works for a while, then stops working. If this happens, make sure to tell your doctor so she can switch you to a different drug. Also notify your doctor if you experience any side effects of medication. Some people have symptoms of gastroparesis for years and then they mysteriously disappear. Others deal with gastroparesis for years, managing it through diet and drug therapy. But if you find that your symptoms make your life unpleasant and uncomfortable, keep talking to your doctor until you find a suitable way to manage your condition. This may require referral to a specialist.

 

Also, if you have gastroparesis, especially if it is accompanied by bouts of vomiting, you need to keep close tabs on your blood glucose levels. This means testing more frequently and treating hypoglycemia and hyperglycemia when they occur.

 

DIABETES GASTROPARESIS PREVENTION

The best way to prevent gastroparesis from occurring is to keep your blood glucose levels under control. Over the long term, if you keep your blood glucose levels as close to normal as possible, you can delay or prevent any neuropathy from occurring in the first place.

 

 

DIABETES GASTROESOPHAGEAL REFLUX

Your GI tract has the job of moving food through your body from your mouth to your rectum. Fortunately, your GI tract has a built-in mechanism for preventing food from backing up along the way. Your GI tract is compartmentalized, and at each juncture specialized valves operate to keep your food from backing up. This is especially important at the junction of the stomach and esophagus, because the environment of the stomach is extremely acidic and can damage the tissues of the esophagus. At this junction, a special muscle called a sphincter muscle closes once food make it into your stomach. This keeps food and stomach acid from backing up into the esophagus. If the sphincter muscle does not close as it should, you can develop a condition called gastroesophageal reflux.

 

DIABETES GASTROESOPHAGEAL SYMPTOMS

Gastroesophageal reflux is marked by heartburn, a burning pain behind the breastbone, or any burning sensation in the chest or throat. This can occur after eating a meal, when lying down, or when bending over. These feelings can even awaken you from sleep. You could simply feel that you have a sour taste in your mouth and throat. You may also experience chest pain during a meal or after eating or drinking. You may also have a physical sensation that liquid or solid food stops or passes with great difficulty through your throat and into your stomach.

 

People with type 1 diabetes may have a lower incidence of heartburn than people with type 2 diabetes or people without diabetes. This appears to be due to a decrease in stomach acid production in people with type 1 diabetes, because of neuropathy that affects the acid producing cells of the stomach

 

What You Should Do

If you experience heartburn or any of the symptoms of Gastroesophageal reflux, talk to your doctor. It is not an emergency situation, but it can be very uncomfortable. Over time, the excess stomach acid can damage the lining of the esophagus and make you more prone to esophageal problems, such as esophageal cancer. If you are experiencing chest pain, call your doctor right away. Do not dismiss any sort of chest pain as indigestion, since it may be something more serious, such as a heart attack.

 

DIABETES GASTROESOPHAGEAL TREATMENT

If you experience heartburn or pain in the throat and chest, your doctor will probably conduct a series of tests to rule out other conditions and properly diagnose your condition. If you have chest pain, you may require a series of tests to rule out poor circulation to the heart. Your doctor will probably also conduct an upper-GI X-ray or an examination of the upper GI with an endoscope. This will rule out esophagitis (inflammation of the esophagus) or other conditions, such as a yeast infection or cancer of the esophagus.

 

Your doctor may first suggest changes in lifestyles to minimize the symptoms of Gastroesophageal reflux. These include losing weight, stopping smoking, and avoiding foods that trigger acid reflux, such as caffeine, chocolate, tomato sauce and high-fat foods. Avoid lying down for 2 hours after a meal. Also, elevate your head 6 inches when you do lie down to prevent stomach contents from traveling up the esophagus.

If these measures provide little relief or if your condition is more serious than feelings of mild discomfort, your doctor may prescribe a medication to help relieve symptoms. The choice of drug will depend on the severity and frequency of your particular symptoms, and whether your esophagus shows signs of inflammation. Your doctor could prescribe an antacid or other medication to decrease the production of stomach acid. Antacids can be taken an hour after meals and before bedtime to reduce stomach acidity. Or you could be given a drug that acts as a proton pump inhibitor. These are the most effective drugs for healing ulcers in the esophagus that may be caused by excess stomach acid.

 

If your symptoms are mild, and you have heartburn less than once a week, you may find that altering lifestyle patterns and taking antacids will provide the relief you need. However, if you have heartburn more than once a week, you may need stronger treatment.

 

DIABETES GASTROESOPHAGEAL PREVENTION

To prevent Gastroesophageal reflux, you should first consider a long-term approach to prevent neuropathy from occurring in the first place. Try to keep your blood glucose levels as close to normal as possible. Also, avoid lifestyle habits that may encourage acid reflux. Stop smoking and avoid drinking alcohol to excess. Avoid chocolate, caffeine, high-fat containing foods and certain drugs, such as anticholinergics.

Sources and References

The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

Diabetic Gastroparesis by Adil Bharucha, Yogish Kudva and David Prichard

Gastrointestinal complications in patients with diabetes mellitus by A Zawada, M Moszak et al

Gastroesophageal Reflux Disease by Rick Kellerman and Thomas Kintanar