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Gastroparesis

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What is gastroparesis?

Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. Normally, the stomach contracts to move food down into the small intestine for digestion. The vagus nerve controls the movement of food from the stomach through the digestive tract. Gastroparesis occurs when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.

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What causes gastroparesis?

The most common cause of gastroparesis is diabetes. People with diabetes have high blood glucose, also called blood sugar, which in turn causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves. Over time, high blood glucose can damage the vagus nerve.

Some other causes of gastroparesis are

  • surgery on the stomach or vagus nerve
  • viral infections
  • anorexia nervosa or bulimia
  • medications—anticholinergics and narcotics—that slow contractions in the intestine
  • gastroesophageal reflux disease
  • smooth muscle disorders, such as amyloidosis and scleroderma
  • nervous system diseases, including abdominal migraine and Parkinson’s disease
  • metabolic disorders, including hypothyroidism

Many people have what is called idiopathic gastroparesis, meaning the cause is unknown and cannot be found even after medical tests.

What are the complications of gastroparesis?

If food lingers too long in the stomach, it can cause bacterial overgrowth from the fermentation of food. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Gastroparesis can make diabetes worse by making blood glucose control more difficult. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person’s blood glucose levels can be erratic and difficult to control.

How is gastroparesis diagnosed?

After performing a full physical exam and taking your medical history, your doctor may order several blood tests to check blood counts and chemical and electrolyte levels. To rule out an obstruction or other conditions, the doctor may perform the following tests:

  • Upper endoscopy. After giving you a sedative to help you become drowsy, the doctor passes a long, thin tube called an endoscope through your mouth and gently guides it down the throat, also called the esophagus, into the stomach. Through the endoscope, the doctor can look at the lining of the stomach to check for any abnormalities.
  • Ultrasound. To rule out gallbladder disease and pancreatitis as sources of the problem, you may have an ultrasound test, which uses harmless sound waves to outline and define the shape of the gallbladder and pancreas.
  • Barium x ray. After fasting for 12 hours, you will drink a thick liquid called barium, which coats the stomach, making it show up on the x ray. If you have diabetes, your doctor may have special instructions about fasting. Normally, the stomach will be empty of all food after 12 hours of fasting. Gastroparesis is likely if the x ray shows food in the stomach. Because a person with gastroparesis can sometimes have normal emptying, the doctor may repeat the test another day if gastroparesis is suspected.

Once other causes have been ruled out, the doctor will perform one of the following gastric emptying tests to confirm a diagnosis of gastroparesis.

  • Gastric emptying scintigraphy. This test involves eating a bland meal, such as eggs or egg substitute, that contains a small amount of a radioactive substance, called radioisotope, that shows up on scans. The dose of radiation from the radioisotope is not dangerous. The scan measures the rate of gastric emptying at 1, 2, 3, and 4 hours. When more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.
  • Breath test. After ingestion of a meal containing a small amount of isotope, breath samples are taken to measure the presence of the isotope in carbon dioxide, which is expelled when a person exhales. The results reveal how fast the stomach is emptying.
  • SmartPill. Approved by the U.S. Food and Drug Administration (FDA) in 2006, the SmartPill is a small device in capsule form that can be swallowed.The device then moves through the digestive tract and collects information about its progress that is sent to a cell phone-sized receiver worn around your waist or neck. When the capsule is passed from the body with the stool in a couple of days, you take the receiver back to the doctor, who enters the information into a computer.

How is gastroparesis treated?

Treatment of gastroparesis depends on the severity of the symptoms. In most cases, treatment does not cure gastroparesis—it is usually a chronic condition. Treatment helps you manage the condition so you can be as healthy and comfortable as possible.

Medication

Several medications are used to treat gastroparesis. Your doctor may try different medications or combinations to find the most effective treatment. Discussing the risk of side effects of any medication with your doctor is important.

  • Metoclopramide (Reglan). This drug stimulates stomach muscle contractions to help emptying. Metoclopramide also helps reduce nausea and vomiting. Metoclopramide is taken 20 to 30 minutes before meals and at bedtime. Side effects of this drug include fatigue, sleepiness, depression, anxiety, and problems with physical movement.
  • Erythromycin. This antibiotic also improves stomach emptying. It works by increasing the contractions that move food through the stomach. Side effects include nausea, vomiting, and abdominal cramps.
  • Domperidone. This drug works like metoclopramide to improve stomach emptying and decrease nausea and vomiting. The FDA is reviewing domperidone, which has been used elsewhere in the world to treat gastroparesis. Use of the drug is restricted in the United States.
  • Other medications. Other medications may be used to treat symptoms and problems related to gastroparesis. For example, an antiemetic can help with nausea and vomiting. Antibiotics will clear up a bacterial infection. If you have a bezoar in the stomach, the doctor may use an endoscope to inject medication into it to dissolve it.

Dietary Changes

Changing your eating habits can help control gastroparesis. Your doctor or dietitian may prescribe six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full. In more severe cases, a liquid or pureed diet may be prescribed.

The doctor may recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion—a problem you do not need if you have gastroparesis—and fiber is difficult to digest. Some high-fiber foods like oranges and broccoli contain material that cannot be digested. Avoid these foods because the indigestible part will remain in the stomach too long and possibly form bezoars.

Feeding Tube

If a liquid or pureed diet does not work, you may need surgery to insert a feeding tube. The tube, called a jejunostomy, is inserted through the skin on your abdomen into the small intestine. The feeding tube bypasses the stomach and places nutrients and medication directly into the small intestine. These products are then digested and delivered to your bloodstream quickly. You will receive special liquid food to use with the tube. The jejunostomy is used only when gastroparesis is severe or the tube is necessary to stabilize blood glucose levels in people with diabetes.

Parenteral Nutrition

Parenteral nutrition refers to delivering nutrients directly into the bloodstream, bypassing the digestive system. The doctor places a thin tube called a catheter in a chest vein, leaving an opening to it outside the skin. For feeding, you attach a bag containing liquid nutrients or medication to the catheter. The fluid enters your bloodstream through the vein. Your doctor will tell you what type of liquid nutrition to use.

This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult period with gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.

Gastric Electrical Stimulation

A gastric neurostimulator is a surgically implanted battery-operated device that releases mild electrical pulses to help control nausea and vomiting associated with gastroparesis. This option is available to people whose nausea and vomiting do not improve with medications. Further studies will help determine who will benefit most from this procedure, which is available in a few centers across the United States.

Botulinum Toxin

The use of botulinum toxin has been associated with improvement in symptoms of gastroparesis in some patients; however, further research on this form of therapy is needed.

What if I have diabetes and gastroparesis?

The primary treatment goals for gastroparesis related to diabetes are to improve stomach emptying and regain control of blood glucose levels. Treatment includes dietary changes, insulin, oral medications, and, in severe cases, a feeding tube and parenteral nutrition.

Dietary Changes

The doctor will suggest dietary changes such as six smaller meals to help restore your blood glucose to more normal levels before testing you for gastroparesis. In some cases, the doctor or dietitian may suggest you try eating several liquid or pureed meals a day until your blood glucose levels are stable and the symptoms improve. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

Insulin for Blood Glucose Control

If you have gastroparesis, food is being absorbed more slowly and at unpredictable times. To control blood glucose, you may need to

  • take insulin more often or change the type of insulin you take
  • take your insulin after you eat instead of before
  • check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Your doctor will give you specific instructions for taking insulin based on your particular needs.

Hope Through Research

The National Institute of Diabetes and Digestive and Kidney Diseases’ Division of Digestive Diseases and Nutrition supports basic and clinical research into gastrointestinal motility disorders, including gastroparesis. Among other areas, researchers are studying whether experimental medications can relieve or reduce symptoms of gastroparesis, such as bloating, abdominal pain, nausea, and vomiting, or shorten the time the stomach needs to empty its contents following a meal.

Points to Remember

  • Gastroparesis is the result of damage to the vagus nerve, which controls the movement of food through the digestive system. Instead of moving through the digestive tract normally, the food is retained in the stomach.
  • Gastroparesis may occur in people with type 1 diabetes or type 2 diabetes. The vagus nerve becomes damaged after years of high blood glucose, resulting in gastroparesis. In turn, gastroparesis contributes to poor blood glucose control.
  • Symptoms of gastroparesis include early fullness, abdominal pain, stomach spasms, heartburn, nausea, vomiting, bloating, gastroesophageal reflux, lack of appetite, and weight loss.
  • Gastroparesis is diagnosed with tests such as x rays, manometry, and gastric emptying scans.
  • Treatment includes dietary changes, oral medications, adjustments in insulin injections for people with diabetes, a jejunostomy tube, parenteral nutrition, gastric neurostimulators, or botulinum toxin.

For More Information

American College of Gastroenterology
P.O. Box 342260
Bethesda, MD 20827–2260
Phone: 301–263–9000
Internet: www.acg.gi.org

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1–800–342–2383
Email: AskADA@diabetes.org
Internet: www.diabetes.org

International Foundation for Functional Gastrointestinal Disorders
P.O. Box 170864
Milwaukee, WI 53217
Phone: 1–888–964–2001 or 414–964–1799
Fax: 414–964–7176
Email: iffgd@iffgd.org
Internet: www.iffgd.org

Sources:http://digestive.niddk.nih.gov/ddiseases/pubs/gastroparesis/index.htm

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Diverticular Disorders

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Description:
Diverticular disease is a condition that occurs when a person has problems from small pouches, or sacs, that have formed and pushed outward through weak spots in the colon wall. Each pouch is called a diverticulum. Multiple pouches are called diverticula.

The colon is part of the large intestine. The large intestine absorbs water from stool and changes it from a liquid to a solid form. Diverticula are most common in the lower part of the colon, called the sigmoid colon.

The problems that occur with diverticular disease include diverticulitis and diverticular bleeding. Diverticulitis occurs when the diverticula become inflamed, or irritated and swollen, and infected. Diverticular bleeding occurs when a small blood vessel within the wall of a diverticulum bursts.

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When a person has diverticula that do not cause diverticulitis or diverticular bleeding, the condition is called diverticulosis. Most people with diverticulosis do not have symptoms. Some people with diverticulosis have constipation or diarrhea. People may also have chronic

cramping or pain in the lower abdomen—the area between the chest and hips
bloating.

One in ten Americans over age 40 and half of those over age 60 have a diverticular disorder. But this isn’t a disease of aging per se; it’s a disease of lifestyle, particularly lack of fiber and exercise. A few simple measures can help.

Diverticular disease is a condition that occurs when a person has problems from small pouches, or sacs, that have formed and pushed outward through weak spots in the colon wall.

Other conditions, such as irritable bowel syndrome and stomach ulcers, cause similar problems, so these symptoms do not always mean a person has diverticulosis. People with these symptoms should see their health care provider.

Diverticulosis becomes more common as people age, particularly in people older than age 50.3 Some people with diverticulosis develop diverticulitis, and the number of cases is increasing. Although diverticular disease is generally thought to be a condition found in older adults, it is becoming more common in people younger than age 50, most of whom are male.

 

Symptoms

Often there are no symptoms.
In some cases, bloating, gas, nausea, and constipation alternate with diarrhea.

People with diverticulitis may have many symptoms, the most common of which is pain in the lower left side of the abdomen. The pain is usually severe and comes on suddenly, though it can also be mild and then worsen over several days. The intensity of the pain can fluctuate. Diverticulitis may also cause

*fevers and chills
*nausea or vomiting
*a change in bowel habits—constipation or diarrhea
*diverticular bleeding

In most cases, people with diverticular bleeding suddenly have a large amount of red or maroon-colored blood in their stool. Diverticular bleeding may also cause

*weakness
*dizziness or light-headedness
*abdominal cramping

 

When to Call Your Doctor

If you have fever, chills, and abdominal swelling or are vomiting — these may be signs of a ruptured diverticulum.
If you have blood or mucus in the stool or any other symptoms of diverticulitis.
If diverticular pain does not subside despite self-care.
Reminder: If you have a medical condition, talk to your doctor before taking supplements.

What It Is

There are two main types of diverticular disorders: diverticulosis and the more serious diverticulitis. In diverticulosis, the inner lining of the large bowel pushes through the muscular layer that usually confines it, forming pouches (diverticula) ranging from pea-size to more than an inch in diameter. Though diverticulosis often produces no symptoms, food can get trapped in these pouches, which then become inflamed and infected. The result is diverticulitis, whose symptoms are impossible to ignore.

What Causes It

Most cases of diverticulosis probably stem from a low-fiber diet. A lack of fiber means the colon must work harder to pass the stool, and straining during bowel movements can aggravate the condition. A diet low in fiber also increases the likelihood of diverticulitis because waste moves slowly, allowing more time for food particles to become trapped and cause inflammation or infection. And lack of exercise makes the colon contents sluggish. The tendency toward such disorders may run in families.

What is fiber?
Fiber is a substance in foods that comes from plants. Fiber helps soften stool so it moves smoothly through the colon and is easier to pass. Soluble fiber dissolves in water and is found in beans, fruit, and oat products. Insoluble fiber does not dissolve in water and is found in whole-grain products and vegetables. Both kinds of fiber help prevent constipation.

Constipation is a condition in which an adult has fewer than three bowel movements a week or has bowel movements with stools that are hard, dry, and small, making them painful or difficult to pass.

High-fiber foods also have many benefits in preventing and controlling chronic diseases, such as cardiovascular disease, obesity, diabetes, and cancer.

Diagnosis:
Based on symptoms and severity of illness, a person may be evaluated and diagnosed by a primary care physician, an emergency department physician, a surgeon, or a gastroenterologist—a doctor who specializes in digestive diseases.

The health care provider will ask about the person’s health, symptoms, bowel habits, diet, and medications, and will perform a physical exam, which may include a rectal exam. A rectal exam is performed in the health care provider’s office; anesthesia is not needed. To perform the exam, the health care provider asks the person to bend over a table or lie on one side while holding the knees close to the chest. The health care provider slides a gloved, lubricated finger into the rectum. The exam is used to check for pain, bleeding, or a blockage in the intestine.

The health care provider may schedule one or more of the following tests:

Blood test. A blood test involves drawing a person’s blood at a health care provider’s office, a commercial facility, or a hospital and sending the sample to a lab for analysis. The blood test can show the presence of inflammation or anemia—a condition in which red blood cells are fewer or smaller than normal, which prevents the body’s cells from getting enough oxygen.

*Computerized tomography (CT) scan. A CT scan of the colon is the most common test used to diagnose diverticular disease. CT scans use a combination of x rays and computer technology to create three-dimensional (3–D) images. For a CT scan, the person may be given a solution to drink and an injection of a special dye, called contrast medium. CT scans require the person to lie on a table that slides into a tunnel-shaped device where the x rays are taken. The procedure is performed in an outpatient center or a hospital by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. CT scans can detect diverticulosis and confirm the diagnosis of diverticulitis.

*Lower gastrointestinal (GI) series. A lower GI series is an x-ray exam that is used to look at the large intestine. The test is performed at a hospital or an outpatient center by an x-ray technician, and the images are interpreted by a radiologist. Anesthesia is not needed. The health care provider may provide written bowel prep instructions to follow at home before the test. The person may be asked to follow a clear liquid diet for 1 to 3 days before the procedure. A laxative or enema may be used before the test. A laxative is medication that loosens stool and increases bowel movements. An enema involves flushing water or laxative into the rectum using a special squirt bottle. These medications cause diarrhea, so the person should stay close to a bathroom during the bowel prep.

For the test, the person will lie on a table while the radiologist inserts a flexible tube into the person’s anus. The colon is filled with barium, making signs of diverticular disease show up more clearly on x rays.
For several days, traces of barium in the large intestine can cause stools to be white or light colored. Enemas and repeated bowel movements may cause anal soreness. A health care provider will provide specific instructions about eating and drinking after the test.

*Colonoscopy. The test is performed at a hospital or an outpatient center by a gastroenterologist. Before the test, the person’s health care provider will provide written bowel prep instructions to follow at home. The person may need to follow a clear liquid diet for 1 to 3 days before the test. The person may also need to take laxatives and enemas the evening before the test.
In most cases, light anesthesia, and possibly pain medication, helps people relax for the test. The person will lie on a table while the gastroenterologist inserts a flexible tube into the anus. A small camera on the tube sends a video image of the intestinal lining to a computer screen. The test can show diverticulosis and diverticular disease.

Cramping or bloating may occur during the first hour after the test. Driving is not permitted for 24 hours after the test to allow the anesthesia time to wear off. Before the appointment, people should make plans for a ride home. Full recovery is expected by the next day, and people should be able to go back to their normal diet.

Treatment:
A health care provider may treat the symptoms of diverticulosis with a high-fiber diet or fiber supplements, medications, and possibly probiotics. Treatment for diverticular disease varies, depending on whether a person has diverticulitis or diverticular bleeding.

Diverticulosis
High-fiber diet. Studies have shown that a high-fiber diet can help prevent diverticular disease in people who already have diverticulosis.2 A health care provider may recommend a slow increase in dietary fiber to minimize gas and abdominal discomfort. For more information about fiber-rich foods, see “Eating, Diet, and Nutrition.”

Fiber supplements. A health care provider may recommend taking a fiber product such as methylcellulose (Citrucel) or psyllium (Metamucil) one to three times a day. These products are available as powders, pills, or wafers and provide 0.5 to 3.5 grams of fiber per dose. Fiber products should be taken with at least 8 ounces of water.

Medications. A number of studies suggest the medication mesalazine (Asacol), given either continuously or in cycles, may be effective at reducing abdominal pain and GI symptoms of diverticulosis. Research has also shown that combining mesalazine with the antibiotic rifaximin (Xifaxan) can be significantly more effective than using rifaximin alone to improve a person’s symptoms and maintain periods of remission, which means being free of symptoms.4

Probiotics. Although more research is needed, probiotics may help treat the symptoms of diverticulosis, prevent the onset of diverticulitis, and reduce the chance of recurrent symptoms. Probiotics are live bacteria, like those normally found in the GI tract. Probiotics can be found in dietary supplements—in capsules, tablets, and powders—and in some foods, such as yogurt.

To help ensure coordinated and safe care, people should discuss their use of complementary and alternative medical practices, including their use of dietary supplements and probiotics, with their health care provider. Read more at www.nccam.nih.gov/health/probioticsExternal NIH Link.

How Supplements Can Help

Although supplements cannot reverse diverticulosis once a pouch has developed, they (and changes in your diet) can help prevent or ease flare-ups. Providing fiber that forms bulk, psyllium acts to relieve or prevent constipation. Ground flaxseeds are also rich in fiber and ward off infection by keeping intestinal pouches clear. These two can be taken together long term first thing in the morning to assist with the initial bowel movement, along with probiotics such as acidophilus. The fiber helps protect the acidophilus from stomach acids and carries it into the intestine, where it alters the bacterial balance in the digestive tract, enabling the body to fight off intestinal infections. Acidophilus is especially important if you’re taking antibiotics during a flare-up.

What Else You Can Do

Eat plenty of fruits, vegetables, and whole grains to boost your fiber intake to 20 to 30 grams a day.
Drink at least eight 8-ounce glasses of water or other fluids every day.
Exercise regularly to help prevent constipation. And if you become constipated, take advantage of natural laxatives, such as prunes.

Supplement Recommendations

Psyllium
Flaxseeds
Acidophilus
Aloe Vera Juice
Glutamine
Slippery Elm
Chamomile
Wild Yam/Peppermint/ Valerian

Psyllium
Dosage: 1 tbsp. powder dissolved in water or juice twice a day.
Comments: Be sure to drink extra water throughout the day.

Flaxseeds
Dosage: 2 tbsp. ground flaxseeds in glass of water twice a day.
Comments: Be sure to drink extra water throughout the day.

Acidophilus
Dosage: 2 pills twice a day between meals.
Comments: Get 1-2 billion live (viable) organisms per pill.

Aloe Vera Juice
Dosage: 1/2 cup juice twice a day.
Comments: Containing 98% aloe vera and no aloin or aloe-emodin.

Glutamine
Dosage: 500 mg L-glutamine twice a day on an empty stomach.
Comments: When using for longer than 1 month, add a mixed amino acid complex (follow package directions).

Slippery Elm
Dosage: 1 cup bark powder, prepared like hot cereal each morning.
Comments: Or use tea (1 tsp. per cup) 3 times a day.

Chamomile
Dosage: As a tea, 1 cup 3 times a day.
Comments: Use 2 tsp. dried herb per cup of hot water; steep for 10 minutes, then strain. Alternatively, try melissa tea.

Wild Yam/Peppermint/ Valerian
Dosage: 1 cup tea 3 or 4 times a day.
Comments: Use 2 parts wild yam, 1 part peppermint, 1 part valerian per cup of hot water; steep 10 minutes, strain. Sweeten to taste.

Resources:

 http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/diverticular-disease/Pages/facts.aspx#cause

 Your Guide to Vitamins, Minerals, and Herbs(Reader’s Digest)

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.

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