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Provided Courtesy of Nutrition411.com Where Health Care Professionals Go for Information Gastroparesis, Diarrhea, Gallbladder Atony, and Thrush: Diabetes and the Gut D-0655 8/12 Diabetes and the Gut • • • • Gastroparesis Diarrhea Gallbladder Atony Thrush Gastroparesis: Definition • The vagus nerve, which generally controls the movement of food through the digestive tract, is damaged • The muscles of the stomach and intestines do not work properly • The movement of food is slowed or stopped • Can occur in either type 1 or type 2 diabetes Cause of Gastroparesis • Chronically high blood-glucose levels: – Causes chemical changes in nerves – Damages the blood vessels that carry oxygen and nutrients to the nerves Symptoms of Gastroparesis • • • • • • • • • Heartburn Nausea (especially in morning) Vomiting undigested food Early satiety Weight loss Abdominal bloating Erratic blood glucose levels Lack of appetite Gastroesophageal reflux Complications of Gastroparesis • More difficult to manage blood glucose • Bacterial overgrowth in stomach • Bezoar formation—may lead to obstruction Diagnosing Gastroparesis • Barium X-ray: – Fast for 12 hours and drink barium-containing liquid – If food is still present in stomach, diagnosis is made • Barium beefsteak meal: – Eat a meal that contains barium – Time of transit is monitored Diagnosing Gastroparesis (cont’d) • Radioisotope gastric-emptying scan: – Eat food that contains radioisotope – Imaging used to see food in stomach and to time transit – Diagnosis if more than half of food remains in stomach after 2 hours • Gastric manometry: – Thin tube passed down throat into stomach – Wire in tube measures electrical and muscular activity Keep in Mind • Liquids may empty normally from the stomach in spite of severe abnormalities in the ability to empty solid materials from the stomach into the duodenum Treating Gastroparesis • Decreased fat and fiber intake • Multiple small meals: – Liquid diet sometimes is necessary – Oral nutrition supplements often recommended • Smoking cessation • Light postprandial exercise, such as walking • Changes in insulin type and timing: – Take insulin after meals, instead of before meals – Take insulin more often Treating Gastroparesis (cont’d) • Oral medications: – Reglan® (metoclopramide) • Prokinetic that coordinates antral duodenal and pyloric muscle function • A powerful, centrally acting antiemetic • Can cause Parkinson’s disease-like symptoms • Generally well tolerated for 2–3 days • Benadryl® can help with relief of side effects Treating Gastroparesis (cont’d) • Nonspecific antiemetics, such as Phenergan® and Compazine®, often used for symptom relief • Intravenous erythromycin: – Binds to motilin receptors on gastrointestinal tract smooth muscle membranes, thereby mimicking motilin’s actions • Botox® injections into pylorus Treating Gastroparesis (cont’d) • Relief band: – Wrist device that sends electrical impulses and stimulates the median nerve – Can control nausea when medications are not effective or cannot be used secondary to negative side effects Treating Severe Gastroparesis • Jejunostomy (may use only at night): – Percutaneous endoscopic jejunostomy (PEJ) is discouraged because contents will regurgitate into stomach if patient is vomiting frequently • Parenteral nutrition: – Generally only used briefly during hospitalization, not on outpatient basis Treating Severe Gastroparesis (cont’d) • Gastric neurostimulators activate contraction of smooth muscle or nausea and vomiting control mechanisms • Total gastrectomy if intractable weight loss and vomiting in end-stage gastroparesis, if all other options have failed: – Usually patient already has had a partial gastric resection Diabetic Diarrhea • People with diabetes mellitus are more likely to suffer chronic diarrhea than the general population • Possible causes: – Nerve damage; autonomic neuropathy – Malabsorption of nutrients – Bacterial overgrowth in intestines Bacterial Overgrowth • Broad-spectrum antibiotics to decrease bacteria • Small bowel intubation sometimes is necessary for diagnosis • Breath hydrogen testing and the 14C-D-xylose test may prove helpful Short-term Treatment of Diabetic Diarrhea • • • • Imodium® Pepto-Bismol® Kaopectate® Lomotil® Long-term Treatment of Diabetic Diarrhea • Antibiotics such as tetracycline • Somatostatin analogs, such as Sandostatin® • Antispasmodics, such as Levsin®, Bentyl®, Librax®, Clindex® • Sometimes trial of pancreatic enzymes • Fiber supplementation with bran, Citrucel®, Metamucil®, or high-fiber foods Gallbladder Atony • People with diabetes mellitus have an increased incidence of gallstones • Primarily related to obesity of type 2 diabetes mellitus: – Other possible causes include autonomic neuropathy (bile not released normally and sludge forms) or increased triglycerides, which cause stone formation – Insulin-resistant mice are shown to have increased cholesterol content of the bile, which may lead to stone formation Gallbladder Atony (cont’d) • Symptoms of biliary colic include intermittent right upper abdominal pain, jaundice, or pancreatitis • Surgery usually only recommended for individuals with symptomatic gallstones Thrush • Poor glycemic control • Mouth: – Burning and pain with thick white coating of tongue and throat • Candida esophagitis: – Can cause intestinal bleeding, heartburn, dysphagia – Will require endoscopy for diagnosis • Antifungal medications, such as Mycostatin®, Nizoral®, or Diflucan® Sources • American Diabetes Association®. Gastroparesis. Available at: http://www.diabetes.org/living-withdiabetes/complications/gastroparesis.html. Accessed August 28, 2012. • eMedTV. Diabetic diarrhea. Available at: http://diabetes.emedtv.com/diabetes/diabetic-diarrhea.html. Accessed August 28, 2012. • McCallum RW, George SJ. Gastroparesis. Available at: http://www.oley.org/lifeline/gastro.html. Accessed August 28, 2012. • Stresing D. Gallbladder problems and diabetes. Available at: http://www.everydayhealth.com/gallbladder/gallbladder-problems-anddiabetes.aspx. Accessed August 28, 2012. • Wolosin JD, Edelman SV. Diabetes and the gastrointestinal tract. Available at: http://journal.diabetes.org/clinicaldiabetes/V18N42000/pg148.htm. Accessed August 28, 2012.