What is it about?
About 12% of global health care expenditure (727 billion USD) is spent on diabetes.The cost is expected to rise to a staggering 958 billion USD by 2045. Up to 50% of patients with type 1 and 2 diabetes mellitus (DM) have delayed gastric emptying. Also, 29% of patients with gastroparesis (GP) had diabetes mellitus. In the USA, an estimated 5 million patients suffer from some form of GP, and the female: male ratio is 4:1. GP can markedly impair quality of life and up to 50% of patients have significant anxiety and/or depression, 94% of patients had resolution of their symptoms (epigastric, postprandial and nocturnal pain; early satiety, bloating) a year after their operation. Concomitant in 25% of patients with GERD, has been shown to improve after Nissen fundoplication. Most patients respond to conservative treatment with frequent small meals and an upright eating position, in combination with motility agents, such as oral erythromycin analogs, metoclopramide, and domperidone (the last of these is not FDA approved in the US). However, approximately 30% of patients do not respond to conservative management. Gastric electrical stimulation (GES) (Enterra, Medtronics Inc.) was approved by FDA in 2000 as a Humanitarian Use Device. GES improved symptoms in 75% of patients with 43% being at least moderately improved. Nausea, loss of appetite, and early satiety responded the best.
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This page is a summary of: Domination of gastric Complications Among Diabetic Patients, Biomedical Journal of Scientific & Technical Research, July 2019, Biomedical Research Network, LLC,
DOI: 10.26717/bjstr.2019.19.003331.
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Resources
Gastrointestinal Symptoms in Diabetes: Prevalence, Assessment, Pathogenesis, and Management
Gastrointestinal (GI) symptoms represent an important and often unappreciated cause of morbidity in diabetes, although the significance of this burden across the spectrum of patients and the underlying pathophysiology, including the relationship of symptoms with glycemic control, remain poorly defined. The relevance of GI symptoms and the necessity for their accurate assessment have increased with the greater focus on the gut as a therapeutic target for glucose lowering. This review addresses the prevalence, assessment, pathogenesis, and management of GI symptoms in diabetes, beginning with broad principles and then focusing on specific segments of the GI tract. We initially performed a literature search of PubMed by using synonyms and combinations of the following search terms: “gastrointestinal symptoms”, “diabetes”, “prevalence”, “pathogenesis”, “diagnosis”, and “management”. We restricted the search results to English only. Review papers and meta-analyses are presented as the highest level of evidence where possible followed by randomized controlled trials, uncontrolled trials, retrospective and observational data, and expert opinion.
Alternative Treatments for Minor GI Ailments
About 80% of the population worldwide use a variety of traditional medicine, including herbal medicines, for the diagnosis, prevention and treatment of illnesses, and for the improvement of general well-being. Total consumer spending on herbal dietary supplements in the United States reached an estimated $8.085 billion in 2017. In addition, the 8.5% increase in total sales from 2016 is the strongest growth for these products in more than 15 years. The main reason to use herbal products in these countries is the assumption of a better tolerability compared to synthetic drugs. Whereas in developing countries herbal medicines are mostly the only available and affordable treatment option. Surveys from industrialized countries reveal as main health areas in which herbal products are used for upper airway diseases including cough and common cold; other leading causes are gastrointestinal, nervous and urinary complaints up to painful conditions such as rheumatic diseases, joint pain and stiffness. Gastrointestinal disorders are the most widespread problems in health care. Many factors may upset the GI tract and its motility (or ability to keep moving), including: eating a diet low in fiber; lack of motion or sedentary lifestyle; frequent traveling or changes in daily routine; having excessive dairy products; anxiety and depression; resisting the urge to have a bowel movement habitually or due to pain of hemorrhoids; misuse of laxatives (stool softeners) that, over time, weaken the bowel muscles; calcium or aluminum antacids, antidepressants, iron pills, narcotics; pregnancy. About 30% to 40% of adults claim to have frequent indigestion, and over 50 million visits are made annually to ambulatory care facilities for symptoms related to the digestive system. Over ten million endoscopies and surgical procedures involving the GI tract are performed each year. Community-based studies from around the world demonstrate that 10% to 46% of all children meet the criteria for RAP. Gastrointestinal disorders such as chronic or acute diarrhea, malabsorption, abdominal pain, and inflammatory bowel diseases can indicate immune deficiency, present in 5% to 50% of patients with primary immunodeficiencies. The gastrointestinal tract is the largest lymphoid organ in the body, so it is not surprising that intestinal diseases are common among immunodeficient patients. Gastroenterologists therefore must be able to diagnose and treat patients with primary immunodeficiency. Further, pathogens do influence the gut function. On the other hand, dietary habits and specific food types can play a significant role in the onset, treatment, and prevention of many GI disorders. Many of these can be prevented or minimized by maintaining a healthy lifestyle, and practicing good bowel habits.
What to know about diabetic gastroparesis
A comprehensive review in the journal Diabetes Therapy on diabetic gastroparesis suggests that people with this condition have more hospitalizations, emergency room visits, and other complications from diabetes than people with diabetes who do not have gastroparesis. People with diabetic gastroparesis are also more likely to experience eye damage, kidney damage, and heart disease than those with diabetes alone. This increased risk of complications may raise a person's risk of early death due to diabetes-related causes. The likelihood of complications and overall outlook for a person with diabetic gastroparesis will vary between individuals. In general, people can improve their outlook by learning how to best manage their blood sugar levels each day.
Fluoroscopic images of the Gastric Electrical Stimulator (GES) and its leads during Gastric Peroral Endoscopic Pyloromyotomy (G-POEM)
Gastric electrical stimulators (GESs) have been used to treat refractory gastroparesis in patients who fail initial therapies such as dietary modifications, control of psychological stressors and pharmacologic treatment. More recently, gastric peroral endoscopic pyloromyotomy (G-POEM) has emerged as a novel endoscopic technique to treat refractory gastroparesis. A series of fluoroscopic images, each from a different G-POEM case, show the implanted gastric electrical stimulator (blue arrow) and its leads (red arrow). The GES leads are located in different parts of the stomach during each case.
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