Managing Gastrointestinal Complications of Diabetes

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A health care provider may also recommend avoiding certain foods. People with gastroparesis should avoid eating large portions of these foods. A dietitian can help plan meals that minimize symptoms and ensure proper nutrition. Several drugs are used to treat gastroparesis. Your doctor may try different drugs or combinations of drugs to find the most effective treatment. A battery-operated device called a gastric neurostimulator is a surgically implanted.

It sends mild electrical pulses to the stomach muscles to help control nausea and vomiting. Botulinum toxin, or Botox, is a nerve blocking agent. To treat you with Botox, the doctor will first pass an endoscope into your stomach, then inject the Botox into your pylorus, the opening from the stomach into the duodenum the first part of the small intestine. Botox is supposed to help keep the pylorus open for longer periods of time and improve symptoms of gastroparesis. Although some initial research trials showed modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections, other studies have failed to show the same degree of effectiveness.

The feeding tube bypasses the stomach and delivers a special liquid food directly into the jejunum. A jejunostomy is used only when gastroparesis is extremely severe. When gastroparesis is so severe that dietary measures and other treatments are not helping, a health care provider may recommend parenteral nutrition, an IV liquid food mixture supplied through a special tube in the chest. This approach is usually a temporary measure to get through a difficult period of gastroparesis. Food and Drug Administration.

Updated March Published on March 31, By : dLife Editors. Print this page. Sources U. Functional Evaluation: Delayed gastric emptying is diagnosed with scintigraphy, typically measuring gastric retention after the patient consumes a 99m Tc-labeled egg-substitute meal. An important part of diagnostic testing requires holding medications i. Breath tests can determine gastric emptying after consuming nonradioactive 13 C-labeled meals. Wireless motility capsules can detect gastric emptying by measuring the pH increase as the capsule passes from the antrum to the duodenum.

GI Bleed: Diagnosis & Treatment- Dr. Rami G. El Abiad, 6/13/12

Both breath testing and wireless motility capsule studies have been correlated with scintigraphy but require further validation before widespread use clinically. Laboratory tests are most useful for assessing nutritional and metabolic consequences but cannot diagnose SIBO. Laboratory Studies: Patient with diarrhea due to SIBO may have vitamin deficiencies secondary to maldigestion or malabsorption if mucosal damage has occurred.

Labs suggestive of this process include hypoalbuminemia and fat soluble vitamin A, D, E, K deficiencies, vitamin B12, or iron.

Nonalcoholic Fatty Liver Disease

Elevated folate levels may be seen due to the production by bacteria in the small bowel. Workup should also evaluation for concomitant celiac disease. Potential limitations with this method include the need for invasive testing endoscopy , false negative results due to sample obtained from the proximal rather than mid-distal small bowel, false positive results from contamination with oral and esophageal flora, and limited availability of microbiology labs to perform bacterial quantitation.

Normal intestinal gas contains primarily hydrogen, carbon dioxide, methane. Therefore, an alternate, less invasive method for diagnosing SIBO is the use of breath tests. Breath samples are obtained after ingestion of a carbohydrate substrate e.

GI Complications of Diabetes: What Are the Treatment Options? - MPR

SIBO is diagnosed if there is a rise 10 or 20 parts per million in methane or hydrogen levels, respectively, above the baseline. False negative results may be seen in patients with SIBO due to a non-hydrogen or methane producing bacteria or delayed gastric emptying with metabolism of the substrate prior to reaching the small bowel. False positive results may be seen in patients with carbohydrate malabsorption due to other causes, such as celiac disease or chronic pancreatitis, nonadherence to prep prior to testing, or rapid transit with metabolism of substrate and gas production in the colon.

The third management option is empiric treatment with oral antibiotics instead of diagnostic testing.

A Practical Approach to Gastrointestinal Complications of Diabetes

With this approach, symptom reduction after antibiotic therapy is considered to be evidence of SIBO. Diagnostic testing may not be necessary in patients with diabetic constipation unless presentation suggests the need to exclude other potential causes of symptoms. Laboratory Studies: In the absence of additional localizing symptoms, laboratory workup may not be necessary but consideration may be given to check a basic metabolic panel rule out electrolytes disturbance e. Structural Evaluation: Colonoscopic evaluation should be considered in patients patients with alarm symptoms e. Additionally, all patients should be screened appropriately for colorectal neoplasia per guidelines.

Laboratory Studies: Routine laboratory tests include a basic metabolic panel to exclude disturbances that may suggestive of dehydration e. Though not diagnostic, erythrocyte sedimentation rate or C-reactive protein may be an indication to consider inflammatory bowel disease. Tissue transglutaminase antibody is checked to rule out concomitant celiac disease. If clinically suspected with additional symptoms, hyperthyroidism and adrenal insufficiency should be ruled out. Stool studies are obtained in patients with exposure to well water, recent contact with sick individuals, or travel history.

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Fecal fat determination may indicate pancreatic insufficiency, SIBO, celiac disease, or even rapid small bowel transit. Structural and Functional Evaluation: If the noninvasive studies do not reveal an underlying cause of diarrhea, colonoscopy with biopsies from the colon and ileum are obtained to exclude inflammatory bowel disease and microscopic colitis. Upper endoscopy with duodenal biopsies and small bowel aspirate for culture may also be considered. Diagnostic evaluation of the diabetic with fecal incontinence parallels that of diabetic diarrhea if there is a diarrhea component to this complaint.

Otherwise, testing focuses on characterizing functional anorectal deficits underlying this problem. Functional Evaluation: Impaired motor and sensory function can be characterized by anorectal manometry. This test quantifies anal tone, anorectal squeeze pressure, and rectal sensation. In some cases, electromyographic testing of pudendal nerve latencies is included to exclude damage to this nerve.

Esophageal: Upper endoscopy is indicated for persistent esophageal reflux symptoms to assess for esophagitis and associated complications. If the patient complains of dysphagia, a barium swallow can screen for mechanical causes and may also detect evidence of dysmotility, though this can be better characterized with an esophageal manometry study. Acid reflux can be quantified using catheter- or capsule-based ambulatory pH monitoring methods. Addition of catheter-based impedance techniques can assess for non-acid reflux. Intestinal: Screening tests for celiac disease include tissue transglutaminase IgA level.

Upper endoscopy with duodenal biopsies may be obtained to diagnose or determine severity of celiac disease. Testing for SIBO should be considered in any patient with suspected intestinal dysmotility given the high prevalence of bacterial overgrowth. Biliary: Ultrasound should be obtained to evaluate the gallbladder and biliary tree in any patients with abnormal liver chemistries or symptoms raising suspicion of such conditions.

Pancreatic: Despite the association between longstanding diabetes and pancreatic disorders, current guidelines do not suggest widespread screening programs. Workup for pancreatic involvement is considered in patients with steatorrhea, malnutrition, or cholestatic liver chemistries. Pancreatic enzymes amylase, lipase may be elevated in diabetics in the setting of ketoacidosis or frequent vomiting. Ultrasound may be able to visualize the pancreas, but the images are often inadequate due to the presence of intestinal gas.

GI Complications of Diabetes: What Are the Treatment Options?

Fecal elastase levels may be used to screen for pancreatic insufficiency. Hepatic: Most patients with non-alcoholic fatty liver disease are asymptomatic until the end stages of the disease. If elevated liver chemistries are found, additional work up to rule out other causes of chronic liver diseases include viral hepatitis, autoimmune hepatitis, metabolic storage disorders. Ultrasound commonly shows heterogeneous echotexture with steatosis. The previous section detailed the diagnostic evaluations that typically may be performed to assess each of the potential GI complications of diabetes.

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The following text discusses additional testing that may be considered for patients unresponsive to appropriate therapy or for whom alternate rare diagnoses are possibilities.

Managing Gastrointestinal Complications of Diabetes Managing Gastrointestinal Complications of Diabetes
Managing Gastrointestinal Complications of Diabetes Managing Gastrointestinal Complications of Diabetes
Managing Gastrointestinal Complications of Diabetes Managing Gastrointestinal Complications of Diabetes
Managing Gastrointestinal Complications of Diabetes Managing Gastrointestinal Complications of Diabetes
Managing Gastrointestinal Complications of Diabetes Managing Gastrointestinal Complications of Diabetes
Managing Gastrointestinal Complications of Diabetes Managing Gastrointestinal Complications of Diabetes

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