Effects of Osteopathic Manipulative Treatment on Diabetic Gastroparesis

Participants

• Number: 1
• Description: a 49-year-old white man with a diagnosis of type 1 diabetes mellitus and gastroparesis (diagnosed 3 years before the visit). Nausea, worse in the morning and lasting 5 to 7 days a week for the past several years. Intermittent decrease in appetite and headache once a week, managed with ibuprofen. Pain in the right shoulder. The patient denied having had fever, chills, night sweat, syncope, chest pain, palpitations, exertional dyspnea, cough, shortness of breath, hematemesis, changes in bowel or bladder habits, sleeping habits, vision and weight.

The patient also presented other complications of diabetes (coronary artery disease, retinopathy and hypertension) and his medical history included depression, anxiety, migraines, hypo-thyrodism and hypercholesterolemia. At the time he was taking amlodipine, aspirin, atorvastatin, insulin aspart (subcutaneous), levothyroxine, losartan, metoprolol succinate and sertraline.

He had received a cardiac stent placemat one year earlier; due to gastrointestinal bleeding he had undergone colonoscopy and upper endoscopy but with no results; he had undergone 4 surgeries for retinopathy and 10 years earlier he had experienced a head injury together with fractures of the lower ribs. He was an occasional marijuana user and, until 5 years before the study, he used to smoke a lot. He received disability payments and was in a long-term relationship. He had tried everything to cure the gastroparesis (including metoclopramide) but without any success.

Interventions and evaluations

• The patient continued to take metoclopramide
• 6 30-minutes OMT sessions every 2-4 weeks (except for the first one which lasted 1 hour)
• Assessment of the gastroparesis status using GCSI before the first appointment, 2 weeks after the third and after the sixth one.

• Given his medical history, a structural assessment of all body regions, but treatment restricted to the four diaphragms in order to promote the free flow of fluids
  • main techniques used: ligamentous articular release to the thoracic inlet, to the abdominal diaphragm and pelvic diaphragm, to the legs, spine, pelvis and arms, suboccipital release, rib raising, Becker’s sacropelvic technique, facilitated positional release applied to the lower extremities.

Results

• 2 weeks after the first session, his nausea had resolved and after 4 weeks it was at a minimum level. The shoulder pain decreased and the appetite increased. However, he struggled to eat as he had recently undergone various surgical interventions of dental extraction. For two weeks after the second session the patient felt fine without nausea and vomiting. Nevertheless, he was subsequently admitted to hospital for an acute episode of nausea and vomiting that had induced dehydration. However, before the treatment, he had been used to being hospitalized for similar problems every 6 to 8 weeks, at this stage it had been four months since his last admission. After the third session, the patient reported feeling very well, more vigorous and with more appetite. He woke up feeling nauseous only twice. After the fourth session, the patient said he felt really well: he even played baseball for the first time in 3 years, although he felt he had overdone it. However, he still struggled to eat because of the new dental implants. After the fifth session, the patient reported not having had any nausea for at least a month. Likewise, he had had no migraines for three months (while before the OMT sessions he used to have migraines a few times a week).
• After the sixth session, the patient expressed the desire to continue OMT because it was the only treatment able to improve his condition, also without producing adverse effects.
• The GCSI score went from 12 at the beginning of the study to 4 after 12 weeks and to 8 after 19 weeks. Nevertheless, the scores related to nausea and vomiting went from 4 (very severe) to 2 (moderate) and from 4 (very severe) to 0 (none) respectively. Therefore, he went from a situation with a few very severe symptoms to a situation with various lighter symptoms.

Discussion

• The positive effects that OMT produced in this case may depend on several reasons. Acting at the level of the occipital and abdominal diaphragms allows the vagus nerve to regulate digestion without hindrance. In addition, an abdominal diaphragm in good condition allows a good lymphatic circulation and a good stomach motility. On the contrary, an inefficient diaphragm can encourage the accumulation of metabolic waste at the tissue level, reducing tissue oxygenation and nourishment. In addition to acting on the detected somatic dysfunctions, acting on the consequences of the head injury (sphenobasilar compression) and rib fracture has most likely helped to release vagal and diaphragmatic activity. The OMT could therefore be an effective and safe treatment in case of diabetic gastroparesis, both as an adjuvant treatment and, potentially, as the only treatment.