Radiographic tests, endoscopy, and motility tests are useful to diagnose obstruction, view the stomach lining, and examine muscle contraction patterns.

Gastroparesis diagnosis tests

• Upper Endoscopy usually requires 10-15 minutes to complete. Upper endoscopy is performed after giving sedative medicine administered intravenously immediately before the test to make the patient drowsy. The doctor will insert a thin flexible tube through the mouth into your stomach. This tube has a camera, which allows the evaluation of upper gastrointestinal tract for ulcers, inflammation, cancers, hernias, or other abnormalities. These conditions can cause symptoms similar to gastroparesis.
• Perform Ultrasound test to view the shape of gallbladder & pancreas to rule out any gallbladder disease and pancreatitis as sources of the problem.
• Barium x-ray is carryout after 12 hours of fasting and drinking thick a liquid contains barium, which coats the stomach, making it more visible on the x-ray. In the case of diabetic, doctor may give special instructions for safe fasting. Normally, the stomach should be empty of all food before 12 hours of fasting. However, if the test shows the presence of food, then there are more chances for gastroparesis.

Your doctor once ruled out the other causes then asks for gastric emptying tests to confirm a diagnosis of gastroparesis.

Gastric emptying tests

• Gastric emptying scintigraphy test involves eating eggs or egg substitute who contains a small amount of a radioactive substance, called a radioisotope that shows up on scans. The scan measures the rate of gastric emptying at one, two, three, and four hours. Gastroparesis is confirmed when more than 10 percent of the meal is still in the stomach at four hours.
• Gastro duodenal manometry is by inserting a pressure sensitive plastic tube through the throat and into the stomach and small intestine. This pressure-sensitive tube is connecting with a computer that measures the strength, frequency, and coordination of muscle contractions before and after having food. Gastro duodenal manometry can distinguish among different motility disorders.
• Electrogastrogram monitors and records the electrical signals of the stomach before and after eating that control the muscle contractions in the stomach. In a normal stomach, the electrical rhythm is regular and increases after a food. However, in the case of gastroparesis, the rhythm is irregular and do not increases or become nonexistent after eating.
• Magnetic resonance imaging (MRI) is an imaging technique uses powerful magnet waves to view cross-sectional picture of the body. MRI is useful to diagnose a broad range of conditions, including various cancers. Researchers are studying the use of real-time MRI to help diagnose stomach motility. Unlike other gastroparesis tests, MRI is not invasive and does not expose to the radiation.
• SmartPill - Swallow a small device in capsule form, approved by the U.S. FDA. The device then moves through the digestive tract and collects information about its progress that is sending information to a receiver worn around your waist or neck. When the capsule leaves the body with the stool in a couple of days, you take the receiver back to the doctor, who enters the information into a computer.

Most common symptoms of gastroparesis are nausea, vomit, and early fullness of the stomach while eating food.\

Sign & symptoms of Gastroparesis

The most common symptoms of gastroparesis are:

• Nausea
• Vomiting
• Early fullness while eating food

Vomiting usually occurs several hours after eaten when your stomach is still full of undigested food and even with normal stomach secretions. Sometimes, accumulated stomach enzymes and acids can cause vomiting even if you do not eat.

In addition to nausea, vomiting and premature fullness during eating, gastroparesis often has other symptoms:

• Heartburns or gastro esophageal reflux (GER)
• Upper abdomen pain
• Poor absorption of food, thus feel most of the time weak and have some weight loss
• Abdominal bloating
• Abnormal blood-glucose level, high and low
• Loss of appetite
• Stomach spasms

Eating solid foods, high-fiber foods, fatty foods, carbonation drinks increase these symptoms.
The symptoms of gastroparesis may be mild or severe, happen frequently or rarely depending on the person. Sometimes it is difficult for the physician to diagnose.

The most common cause or risk factor for gastroparesis is diabetes. Other causes may be medication and treatment for some other diseases.

Gastroparesis risk factors

The most common cause of gastroparesis is diabetes. People with diabetes have been high blood-glucose than normal, causes damage to the blood vessels that carry oxygen and nutrients to the nerves. Over time, high glucose level can damage the vagus nerve in the stomach, which signals the smooth muscles in the stomach to contract in peristaltic waves at the rate of about three contractions a minute. If these contractions are slow down or stopped, food cannot move out of the stomach into the duodenum, as it should.

Gastroparesis other causes

• Post viral syndromes - viral infections, post viral gastroparesis is uncommon.
• Endocrine disorders (endocrine system is composed of a network of organs and glands responsible for producing, storing, and secreting hormones that help to maintain and control vital functions such as growth, reproduction, and energy levels.). Most common endocrine disorders are diabetes, hypothyroidism, and hyperthyroidism.
• People with eating disorders such as anorexia nervosa (has an intense fear of gaining weight – thus limit food, even if they are low in weight) or bulimia (psychological eating disorder - eating followed by inappropriate methods of weight control. That may include vomiting, fasting, enemas, excessive use of laxatives and diuretics, or compulsive exercising.) may also develop delayed gastric.
• Gastroesophageal reflux disease (GERD) - is a condition in which the liquid content of the stomach backs up or refluxes into the esophagus. The liquid can inflame and damage the lining of the esophagus.
• Connective tissue disorders like scleroderma (hardening of skin or other organ),
• Nervous system diseases - abdominal migraine (Abdominal Migraine consists primarily of abdominal pain, nausea, and vomiting.) and Parkinson’s disease (motor system disorders - trembling in hands, arms, legs, jaw, and face).
• Metabolic disorders – hypothyroidism (abnormally low thyroid hormone production).
• Autoimmune conditions (body produces abnormal cells, which attack the body, itself.),
• Neuromuscular diseases (affect the nerves that control voluntary muscles),
• Idiopathic (unknown) causes, is present in many patients with functional dyspepsia, and in some cases occur after a viral infection.
• Cancer,
• Radiation treatment applied over the chest or abdomen,
• Some forms of chemotherapy (cancer treating drug therapy that can stop these cells from multiplying),
• Surgery of the upper intestinal tract
• Surgery on the esophagus, stomach, or duodenum may result in injury to the vagus nerve, which is responsible for many sensory and motor (muscle) responses of the intestine.
• Medications may cause delayed gastric emptying, mimicking the symptoms of gastroparesis. Some common medications are Narcotic, Tricyclic antidepressants, Calcium channel blockers, Clonidine, Dopamine agonists, Lithium, Nicotine, Progesterone.

In general, the severe depressive illness, particularly that is a recurrent, will require antidepressant medications along with psychotherapy for the best result.

Who can help in depression treatment?

Mental health professionals, such as a psychiatrist, psychologist, or clinical social worker who is in close communication with the physician providing diabetes treatment, should manage treatment for depression for diabetics. If you need antidepressant medication, then it is very much important to avoid potential harmful drug interactions.

Treatment options for depression

• Psychotherapy (talk therapy),
• Antidepressant medication,
• Electroconvulsive therapy (ECT),
• Transcranial magnetic stimulation (TMS)

Medical study shows that depression leads to drop in physical and mental functioning, so a person is less likely to follow a required meal or medication plan. Treating depression with psychotherapy (“talk” therapy), antidepressant medications, or a combination can improve a patient’s mood, well-being, and their ability to manage diabetes.

Psychotherapy for depression

Psychotherapy is often the first treatment option recommended for depression. Simple called as "talk therapy,” the word psychotherapy actually involves a variety of treatment techniques.

During psychotherapy, a person with depression talks to a licensed and trained mental healthcare professional who helps him or her identify and work through the factors that may be causing their depression. In addition, the healthcare profession works to re-mould you to overcome depression by his convincing talk.

Antidepressant, Medication drugs for depression

Prescription antidepressant medications are generally well tolerated and safe for people with diabetes. However, recovery from depression takes time; medications can take several weeks to work and may need to combine with psychotherapy.

• Tricyclic antidepressants (TCAs); TCAs primarily affect the levels of two chemical messengers in the brain, norepinephrine and serotonin. They can have more side effects than other drugs, so they typically are not the first drugs used.
• Monoamine oxidase inhibitors (MAOIs); MAOIs are most effective for people with depression who not respond to other treatments. Substances in certain foods like cheese, beverages like wine, and medications can interact with an MAOI. So when taking this medication must adhere to strict dietary restrictions. Therefore, this too typically is not the first drug choice.
• Selective serotonin reuptake inhibitors (SSRIs); SSRIs are a newer form of antidepressant; it works by altering the amount of chemicals in the brain called serotonin.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs); SNRIs are a newer form of antidepressant, works by increasing the brain chemicals serotonin and norepinephrine.

Electroconvulsive therapy (ECT)

It can also be known as; electroshock therapy is mostly preferred to treat severe depression. During ECT, a skilled doctor applies a brief electric current through the scalp to the brain. This current induces a seizure. ECT is very effective at treating depression.

ECT is generally preferred, when severe depression and not responsive to other forms of therapies. Alternatively, used when patients pose a severe threat to themselves or others, and it is dangerous to wait until medications take effect.

Transcranial magnetic stimulation (TMS)

TMS creates a magnetic field to induce a very small electric current in a specific part of the brain without seizure or loss of consciousness.

Use TMS to treat milder depression and works best for patients who have failed to benefit other antidepressant treatments. In addition, unlike ECT, administer TMS does not require sedation and on an outpatient basis. Patients undergoing TMS must treat four or five times a week for four weeks.

There is some scientific evidence that St. John's wort is helpful in treating mild to moderate depression. You should discuss with your physician before you try to use any of herbal supplements. Recent study shows St. John’s wort may interact with some other medications taken for diabetes.

Accurate diagnosis, which requires a complete physical and psychological evaluation to determine whether the person may have a depressive illness, and if so, what type.

Who can help, if depression?

Many health care providers may help in diagnose depression: family physicians, or other primary-care providers, licensed mental-health therapists, psychiatrists, psychologists, psychiatric nurses, and social workers.

No diagnosing blood test for depression

We are accustomed to doctors using specialized blood tests or other expensive laboratory tests to help them make a conclusive diagnosis. However, most laboratory tests are not very helpful when it comes to diagnosing depression. In fact, talking with the patient may be the most important diagnostic tool the doctor has for diagnosing depression.

Diagnosing depression

For effective diagnosis of depression, the doctor may ask about specific signs and symptoms of depression. While a physical examination will reveal a patient's overall state of health, by talking with a patient, a doctor can learn about other things that are relevant to making a depression diagnosis. A patient, for example, can report on such things as daily moods, behaviors, and lifestyle habits.

Good psychological diagnostic evaluation

• A complete history of your symptoms, i.e.,
• o    when they started,
• o    how long they have lasted,
• o    how severe they are,
• o    whether you've had them before and if so,
• o    Whether you get treatment and what treatment, you are receiving. In addition, which treatment is effective?
• Psychologist should ask about alcohol and drug use,
• If have had thoughts about death or suicide.
• Whether other family members have had depression and if treated, what treatments they may have received and, which were effective.

Doctor will ask series of questions about the way you feel, including whether have any symptoms of depression such as the one in the above discussion.

After reviewing the information including the signs and symptoms, patient history, family history, and physician exam, doctor may ask for some lab tests to rule out other serious diseases. For example, hypothyroidism could cause symptoms of depression. Doctor may ask you to list all drugs you are taking and may ask for a urine specimen.