Stomach lining problems due to Diabetes

[karendugan]

My father is 65 years old and has had Adult type II diabetes since 1984.  In the past year he has been having increased bouts of nausea and vomiting.  It has progressed to the stage where he vomits several times a day and is constantly nauseaus.  He has been under the care of a Gastro Dr. who states that the diabetes has ruined his stomach lining and nothing more can be done.  He prescribed Zoloft.  They have run every test possible (he was just released from the hospital again (He was admitted for vomiting) Nothing was found. They have tried several anti-vomiting drugs such as Zofran and nothing works.  If he eats, then he feels better for a few minutes.  Where do we go from here? He can't go on like this.  Is there a treatment or surgery that could work? We live withing driving distance to the Houston Medical Center.

[Kevin Pho, MD]

Hello - thanks for asking your question.

In diabetes, gastrointestinal autonomic neuropathy can result in disorders of esophageal motility, gastric emptying (gastroparesis), and intestinal function.

The symptoms of gastrointestinal autonomic neuropathy vary with the site of involvement:

Patients with esophageal motility disorders have dysphagia, retrosternal pain and "heartburn." However, esophageal disease is rarely clinically important in diabetics, even among those with autonomic neuropathy.

Patients with delayed gastric emptying have anorexia, nausea, vomiting, early satiety, and postprandial fullness. The diagnosis may be established by radiolabeled breath tests, radionuclide gastric emptying studies, ultrasonography, or measurement of gastric impedance.

Diabetic enteropathy reflects widespread gastrointestinal autonomic neuropathy. Affected patients present with constipation, diarrhea, or even incontinence.

You may want to discuss these tests with your personal gastroenterologist.  If there is evidence of diabetic gastroparesis, there are various treatments including a consult with a dietician for dietary habit modification, the drug reglan or the antibiotic erythromycin may be of benefit.

I strongly suggest followup with your personal gastroenterologist.

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[4gpact]

It sounds very much like he is suffering from gastroparesis, which can be caused by diabetes. Your description of what the doctor said suggests that he might have this condition. The nerve endings of the stomach can be damaged, and therefore not send the right signals to digest food, thus the nausea and vomiting. Look up gastroparesis in a search engine. I belong to a support group for gastroparesis through Yahoo, so I have learned a lot about it. It is certainly a miserable condition to have. His doctor should ask for a gastric empyting scan, which measures the rate at which his food digests. There are medications that can help, and also a gastric pacemaker that is relatively new, but shows promise. First thing to do is get a correct diagnosis. Gastroparesis is not "visible", in the way that an ulcer is, for example. you identify it by function, or lack of it. Other conditions often accompany gastroparesis (or GP for short), such as GERD, bowel problems, etc, because motility problems often affect the entire digestive tract. Good luck, and keep searching for the answers.

[karendugan]

Thanks so much for the suggestions.   I will do the research and hopefully a correct diagnosis can ascertained.  We are in the process of locating a new Dr. since my dad's current Dr. doesn't seem able to help.  I will start my research immediately.

Thanks again.

[4gpact]

I wanted to add one last word about medication. There was mention by the doctor of only two; reglan and erythromycin. These are used, but there is another drug called domperidone that I think is much better and has more success. Although it has to be ordered from out of the country, it is WIDELY used by the top motility specialists in the country. I should know, I have been to see them. This drug can be ordered from Canada, Mexico, and also from a pharmacy in New Zealand, which is where I have found it to be the cheapest. I get it from the original manufacturer, not a generic, in a sealed blister pack. A prescription is not required. This drug is sold in many countries over the counter, and has been around for about 40 years. Its side effects are minimal and well known. If the doctor is hesitant because it is not "FDA approved", you should find a doctor who specializes in stomach motility disorders for more information. Reglan has some nasty side effects, and many cannot tolerate it, though some do. Erythromycin becomes less effective over time. The domperidone is like the reglan, in that it stimulates stomach contractions to help it empty. I hate to think what would have happened to me if I hadn't started taking it. By all means, do some research on your own, and ask lots of questions. Good luck.

[karendugan]

Thanks again for the additional info. The reglan does not seem to have any impact on my father's condition.

How do you find a stomach motility expert?  I feel that his current Dr. is out of his league and not aggressive enough in the treatment.(Just a week ago he told my dad "...to live with it and there is NOTHING more that can be done and here are some anidepressants..." We are close to the Houston medical center and should have good resources, but where we do I start?

By the way, my dad has been scheduled for the test to ascertain whether or not he has GP and he has also started to follow the dietary recommendations to control GP while he is waiting for further medical guidance.

Many thanks!

[4gpact]

If he is found to have gastroparesis, or any kind of motility disorder, I would suggest joining the support group that I belong to, it is through Yahoo, for gastroparesis. There are almost 1,000 members, and there is a lot of information and links at the site. Also, others can direct you to the good doctors and specialists. I live in Michigan, so am only familiar with what is near here. In the meantime, you might check with the larger hospitals, especially university or teaching hospitals, and ask if they have a stomach motility specialist. I am not sure if you dad is well enough to travel or not, sometimes that is a necessity to get the best care. Sometimes a combination of the erythrymycin and reglan is more helpful. Unfortunately, sometimes you have to be your own medical detective.
I hope you find some answers soon. In the meantime, keep looking and asking questions. I would agree that your father needs a better trained specialist. It is not a common disorder, though I personally believe it is much more common than thought, simply misdiagnosed.