From the Guidelines
To determine if gastroparesis is related to diabetes or an eating disorder, consult with a healthcare provider who will evaluate your medical history, symptoms, and conduct specific tests, such as gastric emptying studies and endoscopy, as recommended by the most recent guidelines 1. When evaluating the cause of gastroparesis, it is essential to consider the patient's medical history, symptoms, and diagnostic test results.
- For diabetic gastroparesis, look for long-standing diabetes (especially with poor blood sugar control), other diabetic complications like neuropathy, and symptoms that developed gradually.
- Blood tests showing elevated HbA1c levels may support a diabetes connection.
- For eating disorder-related gastroparesis, healthcare providers will look for a history of disordered eating behaviors, significant weight fluctuations, and psychological factors. Diagnostic tests that help differentiate include:
- Gastric emptying studies, which measure how quickly food leaves your stomach
- Endoscopy to rule out other causes
- Blood glucose monitoring is essential if diabetes is suspected Treatment approaches differ based on the cause, with diabetic gastroparesis focusing on blood sugar control with medications like metformin or insulin, while eating disorder-related gastroparesis requires nutritional rehabilitation and psychological support. Both conditions may benefit from medications like metoclopramide or erythromycin to improve stomach emptying, as suggested by recent studies 1. It is crucial to follow the most recent guidelines and recommendations from reputable sources, such as the American Diabetes Association, to ensure the best possible outcomes for patients with gastroparesis 1.
From the Research
Gastroparesis Diagnosis and Causes
- Gastroparesis is a disorder characterized by delayed gastric emptying of solid food in the absence of a mechanical obstruction of the stomach 2.
- The condition can have idiopathic, diabetic, iatrogenic, post-surgical, or post-viral aetiologies 2, 3.
- Diabetic gastroparesis is a common cause of gastroparesis, and management involves lifestyle modifications, glycemic control, pharmacological drugs, and surgical treatments 4.
Distinguishing between Diabetes-Related and Eating Disorder-Related Gastroparesis
- There is no clear evidence to distinguish between gastroparesis related to diabetes and eating disorders based on symptoms alone, as the symptoms of gastroparesis, such as nausea, vomiting, and early satiety, can be similar to those of eating disorders 5, 2.
- A confirmed diagnosis of gastroparesis requires measurement of delayed gastric emptying via an appropriate test, such as gastric scintigraphy or breath testing 2.
- The management of gastroparesis involves correcting fluid, electrolyte, and nutritional deficiencies, identifying and treating the cause of delayed gastric emptying, and suppressing or eliminating symptoms with pharmacological agents 2, 3.
Diagnostic Evaluation and Management
- Diagnostic evaluation of gastroparesis requires an initial upper endoscopy to rule out mechanical causes, followed by a gastric-emptying scintigraphy for diagnosis 3.
- Management of gastroparesis includes dietary modifications, promotility medications, and antiemetics 3, 6.
- Metoclopramide is the only drug approved by the Food and Drug Administration for diabetic gastroparesis, but it carries a black box warning for use >12 weeks due to the risk of tardive dyskinesia 4.