February 6, 2014

Gastroparesis – The Good and Bad – Part 1

Part 1 of 3 parts

Gastroparesis is something that has two sides to the issue. Most people do not want this, but others take medications that mimic this. Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from the stomach to the small intestine.

David Mendosa covers the medication that slows the emptying of the stomach – Byetta. Read his blog here from 2006. Bydureon has the same effect. Some people are wanting the slowing of food passing through the stomach, as it is great for prevention of blood glucose spikes.

If you are like me, then gastroparesis is not what you want. Over time, high blood glucose levels can damage the vagus nerve. Other identifiable causes of gastroparesis include intestinal surgery. The most common symptom of gastroparesis is nausea. Other symptoms include:
  1. A feeling of fullness after eating a small amount of food
  2. Vomiting undigested food – often several hours after eating
  3. Pain in the stomach area
  4. Abdominal or stomach bloating
  5. Gastroesophageal reflux (GER), which is also called acid reflux or acid regurgitation and you can add gastroesophageal reflux disease (GERD). These all represent a condition in which the stomach contents flow back into the esophagus.
  6. Lack of appetite

What surprises me is the symptoms that can aggravated by consuming greasy or rich foods, large quantities of foods with fiber, such as raw fruits and vegetables. I am not surprised that drinking beverages high in fat or carbonation and I have been forced to eliminate most of these. Because symptoms vary in intensity over time and may be mild to severe, this often make gastroparesis difficult to diagnose.

I will quote the following, as I want to be sure I get it all. “Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests to rule out blockage or structural problems in the GI tract, and gastric emptying tests. Tests may also identify a nutritional disorder or underlying disease. To rule out any blockage or other structural problems, the health care provider may perform one or more of the following tests:
  • Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining. A person may receive a liquid anesthetic that is gargled or sprayed on the back of the throat. An intravenous (IV) needle is placed in a vein in the arm if general anesthesia is given. The test may show blockage or large bezoars—solid collections of food, mucus, vegetable fiber, hair, or other material that cannot be digested in the stomach—that are sometimes softened, dissolved, or broken up during an upper GI endoscopy.
  • Upper GI series. An upper GI series may be done to look at the small intestine. The test is performed at a hospital or outpatient center by an x-ray technician, and the images are interpreted by a radiologist—a doctor who specializes in medical imaging. Anesthesia is not needed. No eating or drinking is allowed for 8 hours before the procedure, if possible. If the person has diabetes, a health care provider may give different instructions about fasting before the test. During the procedure, the person will stand or sit in front of an x-ray machine and drink barium, a chalky liquid. Barium coats the small intestine, making signs of gastroparesis show up more clearly on x rays. Gastroparesis is likely if the x-ray shows food in the stomach after fasting. A person may experience bloating and nausea for a short time after the test. For several days afterward, barium liquid in the GI tract causes stools to be white or light colored. A health care provider will give the person specific instructions about eating and drinking after the test.
  • Ultrasound. Ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off organs to create an image of their structure. The procedure is performed in a health care provider’s office, outpatient center, or hospital by a specially trained technician, and the images are interpreted by a radiologist; anesthesia is not needed. The images can show whether gallbladder disease and pancreatitis could be the cause of a person’s digestive symptoms, rather than gastroparesis.
  • Gastric emptying scintigraphy. The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.
  • SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract.
  • Breath test. With this test, the person eats a meal containing a small amount of radioactive material; then breath samples are taken over a period of several hours to measure the amount of radioactive material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying.

Treatment of gastroparesis depends on the severity of the person’s symptoms. In most cases, treatment does not cure gastroparesis, which is usually a chronic, or long-lasting, condition. Gastroparesis is also a relapsing condition—the symptoms can come and go for periods of time. Treatment helps people manage the condition so they can be as comfortable and active as possible.”

I have been tested using the first three above and even they are not fun. I felt after the doctor and I discussed the tests, that the tests were beneficial. The doctor could not rule out gastroparesis, but did discover that I had gastroesophageal reflux disease (GERD).

Continued in part 2 of 3 parts.

2 comments:

Jane said...

I hadn't heard of this condition. Looking forward to the other parts of this story. I have some of these symptoms for awhile and I'm wondering if I have this condition. My doctor has never brought it up even though I've told her my digestion doesn't seem right.

Thanks for the topic. But it's kind of scary too.

Bob Fenton said...

Jane, This can be scary. I was a nervous wreck until the doctor discussed the three tests with me. He felt that I did not nave gastroparesis, but that GERD was the culprit and what was aggravating my stomach and esophagus. I also had my gall bladder removed because that was causing my vomiting and stomach pain. This was discovered with an ultra-sound scan.

What you do is important and needs to be discussed carefully with your doctor.