Friday, 30 December 2016

Gastro-Intestinal Problems With Neuropathy

Today's post from (see link below) looks at another underrated and more frequent than you think form of neuropathy - stomach and bowel problems as a result of autonomic neuropathy (affecting the many involuntary functions we take for granted). It's another form of autonomic neuropathy that can be very difficult to pin down for doctors because stomach and bowel problems can have many causes. However, if you have been diagnosed with autonomic neuropathy and you suffer from these problems, you need to take into consideration that these may well be a result of your nerve damage. The article gives some helpful explanations and tips but it's important to mention here that you have to be certain you have autonomic neuropathy, before committing to long term stomach and digestion treatments. This is especially true if you're taking medications for both neuropathy and other conditions. Taking many of these stomach and bowel pills may affect the absorption of other necessary medications, with potentially serious consequences. Try all the 'change of diet' and 'patterns of eating' options first and then discuss any drugs for digestion problems with your doctor. The problem is that many of these drugs can be bought over the counter, so it's important to tell your doctor what you're taking. Also, for those who are wondering, gastrointestinal neuropathy is not confined to neuropathy caused by diabetes. Many of these articles refer to diabetic neuropathy but you can safely take the content of these articles and apply it to most other forms of neuropathy - you're neuropathy is relevant here too.

by Dr. Leonel Porta

When we speak about Diabetic Neuropathy we immediately think of very intense chronic pain in our lower limbs that characterizes Polyneuropathy.

In DiabeTV we’ve talked about the different types of Diabetic Neuropathy and the available treatment possibilities to the dreaded and frequent polyneuropathy.

Today we will focus on the treatment of one of the main components of Autonomic Neuropathy. This is  Gastrointestinal Neuropathy. The variety of symptoms that can occur when this condition is present are many and they deserve equal recognition as tools for diagnosis, treatment, and prevention of neuropathy.

The most common symptom in this type of Neuropathy is constipation. This can be caused by a delayed gastric emptying (Gastroparesis) caused by reduced contractions of the stomach muscles.

The treatment options for Neuropathy varies and depends on the judgment of your doctor. Generally, several drugs are used and while they do not cure the disease, they will help relieve the symptoms so that the patients improve their quality of life.

Nonetheless, before even considering any treatment, it should be noted that good eating habits can help control Gastroparesis and other gastrointestinal disturbances such as neuropathic diarrhea and stool leaks.

Some of the nutritional measures that can be recommended are the following:

Eat less at each meal. It is preferable to increase the meal frequency than to increase the amount of food consumed.
Eat more slowly.
Sit upright while eating.
Take a walk after meals.
Avoid foods high in fat because they slow down digestion.
Avoid high fiber foods because they can be difficult to digest and can form obstructions inside the intestines.

The most commonly used drugs to improve digestion and improve Gastrointestinal Neuropathy are: 

Metoclopramide: (Primperan®) acts on dopamine receptors in the stomach, intestine and brain, stimulating contractions in the stomach to facilitate the emptying of it. It also controls the vomiting reflex in the brain to reduce nausea. Long-term use is not recommended as it can cause agitation, facial spasms and breast pain.
Domperidona (Motilium®): it also acts on dopamine receptors favoring gastric emptying and reducing nausea and vomiting. It must be used under strict medical supervision as it has significant adverse effects on the heart.
Loperamide (Loperam®, Lomotil®, Fortasec®): This is an anti-diarrheic compound which acts on the muscles of the digestive tract diminishing intestinal motility, secretion of fluids and electrolytes, and increases the absorption of water, thus increasing stool consistency .
Antibiotics can be useful to treat some Gastroparesis complications. However, remember that a reduction of the intestinal movement favors bacterial overgrowth.

In severe cases, particularly when other methods fail, there is a surgical procedure called Jejunostomy, and this may be an option. It consists of inserting a tube through the abdominal skin into the small intestine for the administering of nutrients and drugs directly into the intestinal lumen.

As we mentioned before, in most cases, treatment is not a cure for Gastroparesis. Treatment only allows control of the symptoms allowing patients to be as healthy and comfortable as possible. A Jejunostomy will not be necessary if you can keep your glycemia levels under control, follow your medical treatment and the dietary recommendations of your Doctor. Don’t worry about Gastroparesis, just prevent it!

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