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May 5, 2015

Complications

Question from Bogota, Colombia:

I went to a Special Medical Care Center for an endoscopy to check the development of gastritis. The full exam was not made since my stomach was full of food even though I had fasted for 14 hours before the test. According to the physician, it was possible that I had diabetic gastroparesis. What type of disease is it? Why does it happen? Is there an easy treatment? I do not suffer from other complications like kidney disease or heart disease. I am in good sugar control. My last hemoglobin test was 6.3. Can you provide me with more information about gastroparesis?

Answer:

Gastroparesis refers to a condition where the movement of food along the GI tract is inhibited. This is usually a manifestation of autonomic neuropathy where the nerves of the stomach and intestine are affected by the diabetes. The result is chaotic and inefficient movement of food through the stomach and then the intestine. The fact that food was present in a large amount in the stomach after a prolonged fast is evidence for poor movement of the food. Blood sugars that go high or low can have negative effects on gastric movement. Balls of plant fiber, called bezoars, can accumulate in the stomach causing discomfort. Post-meal nausea and bloating with vomiting is sometimes evident. The treatment is not satisfactory. There are few medications that work well for this condition. In addition, some of those that have been used are also dangerous to use because of an association with movement disorders years after their use. The lack of coordinated emptying of food and its effects on blood sugars make glucose control difficult. I was glad to see your HbA1c was good at 6.3%. Finally, gastroparesis can wax and wane over time. When it is bad, it is difficult to eat and keep down fluids. This problem is usually handled by a specialist, either an endocrinologist or a gastroenterologist.

JTL

[Editor’s comment: There is one newer therapy available here in the U.S. and we are unaware if it is available in Colombia, the Enterra Neurostimulater. You may wish to ask your doctors about this.

BH]