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January 1, 2008

Aches and Pains

Question from Willamina, Oregon, USA:

My 21-year-old son has consistent problems with his stomach. He belches a lot (does not chew gum) and feels like he is going to throw up, which he does often. His doctor ran some gastrointestinal tests and the results came back normal. The doctor doesn't feel that any other tests are needed even though my son still has daily problems. He has not been tested for celiac disease. Please let me know if this type of condition is normal with diabetes and how we can proceed with taking care of the problem.


With diabetes for more than ten years, it is possible he has acquired some form of dysmotility related to diabetic autonomic neuropathy. This refers to the nerves in the gut being unable to coordinate the movement of food through the gastrointestinal tract. When this happens, patients have persistent fullness, nausea, vomiting, and the emesis often contains the contents of foods eaten at a previous meal. This is not the only gastrointestinal tract problem that a person with diabetes can have. Celiac disease is a form of malabsorption where patients have persistent nausea, abdominal pain, diarrhea, and a predominance of fatty stools. It is more common in patients with type 1 diabetes. There are several tests that can be done to clarify his status. They include the following:

Gastrointestinal motility study. This study gives a test meal and determines how much of the test meal is cleared from the stomach over a given amount of time. It is often performed in a nuclear medicine department.

Serology for celiac disease. There are antibodies that an be ordered to screen for celiac disease. If they are positive, it is recommended that an upper endoscopy be performed with a small bowel biopsy for confirmation.

Other possibilities include esophagitis caused by virus or fungus, peptic ulcer not seen with the barium swallow test, and other less common entities. If diabetic dysmotility is diagnosed, there are some medicines that may offer relief by stimulating the motility in the upper gastrointestinal tract.