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Diabetic Gastroparesis: A Literature Review

A. Prendergast, BS, Dietetic Intern & M. Morgan, MS, RD


The Sage Colleges, Troy, NY

Abstract
Abstract

Introduction
Introduction

Gastroparesis refers to the delayed emptying of


stomach contents after eating due to decreased
motility of the gastric muscles. Etiologies
associated with this condition include diabetes,
post-surgery, or idiopathic. Uncontrolled
diabetics are at risk of developing diabetic
gastroparesis, in which complications include
hyperglycemia followed by hypoglycemia,
nausea, vomiting, epigastric pain, lower
quadrant pain, weight loss, malnutrition, and
death. With DM on the rise, research regarding
treatment and prevention of complications has
been completed. In this article, a patient with
diabetic gastroparesis is discussed, his history,
hospital course, the guidelines for gastroparesis
treatment, and nutrition therapy to negate
complications are discussed.

Etiology
Etiology of
of Type
Type 22 DM
DM
Insulin Deficiency the pancreas makes less
insulin than it did previously.1
Insulin Resistance Body cells (muscle,
adipose, etc.) are more resistant to insulin
action. More insulin is needed than once was.
Hyperglycemia High glucose levels in the
blood related to inadequate amounts of insulin,
cellular resistance of insulin, and overcorrection
by the liver.

Etiology
Etiology of
of Gastroparesis
Gastroparesis

Evidence
Evidence Based
Based Guidelines
Guidelines for
for Treatments
Treatments

Gastroparesis delayed emptying of stomach


contents after eating due to decreased motility
of the gastric muscles.1
Approximately 50% of patients with diabetes
will develop diabetic gastroparesis.2

Purpose
Purpose
Review the causes and etiology of diabetic
gastroparesis
Determine best practices to deliver optimum
patient care
.

Pathophysiology
Pathophysiology of
of Diabetic
Diabetic
Gastroparesis
Gastroparesis
Slowed or delayed emptying of stomach
contents3
Vagal nerve function the nerve responsible
for peristalsis of the stomach is damaged. The
stomachs ability to digest ingested food by
means of motility is diminished
Ghrelin regulation the hormone responsible
for hunger sensation is produced in the
stomach. Regulation is affected in
gastroparesis, resulting in early satiety and
poor appetite.
Symptoms/complications: early satiety,
abdominal pain & bloating, nausea, vomiting,
malnutrition, death
Insulin - hypoglycemia & hyperglycemia

Etiologies of Gastroparesis

Nutrition
Nutrition Intervention
Intervention

6%
5%
14%
8%

31%
38%

Post-surgical
Diabetes
Idiopathic
Parkinsons Disease
Pseudo-obstruction
Miscellaneous
Parrish C. Nutrition Intervention for the Patient with Gastroparesis: An Update.
Nutrition Issues in Gastroenterology. Series 30:29-66
http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-hea
lth/nutrition-support-team/nutrition-articles/ParrishArticle.pdf
. Published August 2005. Accessed November 7, 2015.

Escott-Stump S. Nutrition and Diagnosis-Related Care. 7th ed. China: Lippincott Williams & Wilkins; 2012.

Intervention

Detail

Antiemetics

To stop nausea and vomiting caused by gastroparesis3

Promotility drugs

To increase the motility of the stomach, causing stomach contents to be digested3

IV

To correct fluid and hydration imbalances caused by excessive epigastric pain and vomiting3

Pain Medication

To manage pain associated with gastroparesis3

Blood Glucose Regulation

If necessary, correct blood glucose levels with medication or nutrition intervention4,5

Diet Modification

Small, frequent meals in chopped or pureed form.4,5

Monitor and replace nutrients as needed

Look for deficiencies and correct if needed4,5

Education on nutrition-related recommendations to lessen unpleasant effects


of disease

Eat slowly4
Small meals
Low fat

Initiate tube feeding if patient experiences unintentional weight loss

If patient experiences unintentional weight loss4


If patient experiences multiple hospitalizations from complications with gastroparesis requiring IV hydration

Recommendations
Recommendations for
for the
the Future
Future
Conclusion
Conclusion
Education

When a patient is newly diagnosed with a condition related


to nutrition, the dietitian should receive notification and be
required to see the patient. Although there are preventative
measures in place to ensure patients are getting the care
they need, there are ways in which people can fall through
the cracks in the healthcare system. Patients need education
at the time of diagnosis. Its important the diagnosis is
understood as well as measures that can be taken to reduce
symptoms and discomfort. As members of the healthcare
team, everyone should be aware of the treatment options
that are most beneficial for the patient. Once a patient with
Diabetic Gastroparesis experiences severe problems with
eating despite diet/lifestyle changes, nutrition and mental
support should be considered. These people need to know
that there are changes they can make to help with their
symptoms as well as options for when these changes fail.
They need to know they can live with their disease, that this
condition isn

Preventative Measures
Control of blood glucose levels. Prevent large
fluctuations in glucose levels with diet/lifestyle
changes and taking medication as directed by
doctor or endocrinologist.4

Diagnosis
Once a patient is diagnosed with Diabetic
Gastroparesis, the patient should receive
education. It is important that the patient
understands his/her condition, treatment
options, symptoms, and what to do when
symptoms persist.

Diet modifications to prevent symptoms


After the patient understands his condition,
he/she will be better able to make diet/lifestyle
changes to decrease incidences of symptoms.
Meal size, consistency, and frequency may
need to be altered for patients.

Nutrition Support
Tube Feeding criteria:
Severe weight loss
Repeated hospitalizations requiring IV
hydration
Gastric decompression would be beneficial
Maintenance of UBW but experiences diabetic
ketoacidosis, cyclic nausea and vomiting,
poor quality of life due to gastroparesis
symptoms
Inability to meet weight goals set by
healthcare team and patient.4

References
References
1.
2.
3.

4.

5.

Escott-Stump S. Nutrition and Diagnosis-Related Care. 7th ed. China: Lippincott


Williams & Wilkins; 2012.
Mahan K, Escott-Stump S, Raymond J, and Marie V. Krauses Food & The Nutrition
Care Process. 2nd ed. St. Louis, Mo: Elsevier/Saunders; 2012.
Hasler W. Gastroparesis Current Concepts and Considerations. The Medscape
Journal of Medicine. 10(1):16.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258461/. Published January 23,
2008. Accessed November 7, 2015.
Parrish C. Nutrition Intervention for the Patient with Gastroparesis: An Update.
Nutrition Issues in Gastroenterology. Series 30:29-66
http://www.medicine.virginia.edu/clinical/departments/medicine/divisions/digestive-hea
lth/nutrition-support-team/nutrition-articles/ParrishArticle.pdf
. Published August 2005. Accessed November 7, 2015.
Parkman HP, Fass R, Foxx-Orenstein AE. Treatment of Patients With Diabetic
Gastroparesis. Gastroenterology & Hepatology. 2010;6(6 Suppl 9):116.Vanormelingen C. Diabetic Gastroparesis. British Medical Bulletin.
http://bmb.oxfordjournals.org/content/early/2013/01/29/bmb.ldt003.full. Published
April 9, 2013. Accessed November 7, 2015.