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abdominal pain, and
even throwing up
what was eaten the day before.
These symptoms may be easily
dismissed as gastric problems
like indigestion and stomach
ulcers — and indeed, these
indications are often diagnosed
and treated as such.
But they can also describe a
little known condition known as
gastroparesis, a chronic illness
often associated with diabetes,
especially type 1. Gastroparesis
is linked to damaged nerves and
muscles that control how food
in the stomach empties into
“By definition, someone has
gastroparesis when the stomach
takes a long time to empty
itself into the intestine,”
said Dr Andrew Ong, Senior
of Gastroenterology and
Hepatology, Singapore General
When food is not emptied but
accumulates in the stomach, the
person then develops nausea
and vomiting as a result. “That
is what gastroparetic patients
experience because the food
basically has not left the stomach.
It has been there since the day
before,” he added.
Though not widely known, this
disease is fairly common. “Data
from the US and Europe suggests
that 20 per cent of diabetic
patients suffer from it. While we
do not have Asian data, it is fair
to say that conservatively, 10 per
cent of diabetic patients in Asia
have some form of gastroparesis,”
said Dr Ong.
Patients with persistent
symptoms referred to hospital
specialists usually undergo an
endoscopy first to rule out stomach
obstructions, before taking a
gastric emptying test to determine
if they have gastroparesis.
Patients often suffer from
gastroparesis for years before
receiving an accurate diagnosis.
If undiagnosed and untreated,
gastroparesis can affect patients’
quality of life. Besides daily
discomfort, persistent retching
and vomiting can lead to tears
and bleeding in their food
pipes. Some experience so much
discomfort that they avoid
eating, losing weight and
Besides patients with diabetes,
those with Parkinson’s disease,
post-viral illnesses, and postsurgery
complications can also
develop the condition.
Type 1 diabetes usually occurs
in childhood, so if gastroparesis
occurs, it does so at a younger age
for these patients — in their 30s
— as it takes years for diabetes
to affect their nerves. For
patients with type 2 diabetes and
Parkinson’s disease, gastroparesis
may occur only later in life.
“For diabetics, the biggest
problem is their sugar control,
which can go all over the place,”
said Dr Ong.
A patient who does not know
that he has gastroparesis will
continue taking insulin even when
food has not been absorbed. He
effectively overdoses on insulin,
pushing sugar levels down. Hours
later, his sugar levels rise as
the food empties into the small
intestines. “This makes it very
confusing for both the patient and
the healthcare provider trying to
control his sugar,” Dr Ong said.
Apart from short-term
medication to help empty the
stomach and longer-term pain
relief medication for stomach
discomfort, patients will be
advised to make dietary and
lifestyle changes. A low-calorie,
low-fat, and low-fibre liquid diet
that empties from the stomach
faster ensures patients’ calorie
and nutritional needs are met.
Eating smaller and more frequent
meals also helps, while smokers
should quit the habit as smoking
can irritate stomach nerves.
Surgery to dilate a narrow
passage between the stomach
and small intestines can improve
gastroparesis caused by a
“Many patients will have this
condition for a long time so they
need to be empowered. Once they
know what they can eat and what
triggers their symptoms, they can
be creative in making adjustments
and take control of their lives,”
said Dr Ong.