To those who were asking about gastroparesis, here is some info I found on the U of L website (University of Louisville). The direct link is:
http://www.uoflhealthcare.org/digestivehealth/gastroparesis.html
And here is the info in case I didn't put the link in correctly:
What is Gastroparesis?
"Gastro-Paresis" means "Stomach-Paralysis". It is a disorder in which the stomach takes too long to empty its contents. It is an abnormal function of the stomach without any physical evidence of obstruction. The most common symptoms are nausea and vomiting especially after eating. Other symptoms include bloating, feeling full after small meals, and regurgitation. In some patients, symptoms can be quite non-specific, such as persistent heartburn, abdominal pain, or poor glucose control in patients with diabetes.
What are the Causes of Gastroparesis?
Gastroparesis is a disorder of the nerves and muscles in the stomach. Unfortunately, the exact cause can not be found in approximately 60% of patients. The most common known cause of gastroparesis is diabetes. At least 20 percent of people with type I diabetes develop gastroparesis. It can also occur in people with type 2 diabetes, although less often. Other causes of gastroparesis include a prolonged post-viral syndrome, complications from stomach or ulcer surgery, certain medications, immune diseases like Lupus or Scleroderma, and other muscular and neurological disorders in the body.
Gastroparesis happens when nerves to the stomach are damaged or stop working. The vagus nerve controls the motor function in the upper part of the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.
Diabetes can damage the vagus nerve if blood glucose (sugar) levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to the nerves.
Furthermore, there is a "pacemaker" in the stomach which regulates the stomach to contract 3 times per minute. When this pacemaker malfunctions, symptoms of gastroparesis can occur.
What are the Symptoms of Gastroparesis?
Symptoms of gastroparesis are the following:
• Nausea, especially after meals. Some patients may have nausea when they get up in the morning.
• Vomiting
• Sensation of feeling full easily when eating
• Persisting heartburn and regurgitation despite treatment
• Abdominal bloating
• Abdominal pain
These symptoms may be mild or severe, depending on the person. They can be persistent or intermittent. In patients with diabetes, symptoms of gastroparesis get worse when the glucose control is poor.
What are the Complications of Gastroparesis?
Gastroparesis can make diabetes worse by adding to the difficulty of controlling blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person's blood glucose levels can be erratic and difficult to control.
If food lingers too long in the stomach, it can cause uncommon problems like bacterial over-growth from the fermentation of food. Also, the food can harden into solid masses called bezoars that may cause nausea, vomiting, and physical obstruction in the stomach. Bezoars are rare but can be dangerous in severe cases if they block the passage of food into the small intestine.
How to Make a Diagnosis of Gastroparesis?
Since gastroparesis is an abnormality of stomach function without any obstruction, x-ray and endoscopy are usually normal. "Functional" tests are usually needed to make a diagnosis. The diagnosis of gastroparesis can be confirmed through one or more of the following tests:
Gastric emptying scan: A test you eat foods that contain a very safe radioisotope, a slightly radioactive substance that will show up on the scan. The dose of radiation from the radio-isotope is small and not dangerous. After eating, you will lie under a machine that detects the radioisotope. It shows an image of the food in the stomach and how quickly it leaves the stomach. Gastroparesis is diagnosed if more than half of the food remains in the stomach after 60 to 90 minutes. However, this test can miss the diagnosis, depending if the stomach is working well on that particular day. Sometimes, it requires more than one gastric emptying scan to detect gastroparesis.
Upper Endoscopy: In the more severe cases of gastroparesis, food can be seen in the stomach during endoscopy despite fasting overnight. However, endoscopies are usually normal in most patients with gastroparesis.
What are the Treatments of Gastroparesis?
Treatment of gastroparesis usually includes diet changes and medications. "PRO-KINETIC" medications are drugs that will improve the pumping or pacing function of the stomach.
Diet Recommendations for Gastroparesis
Eat smaller meals more frequently. Liquids emptying the stomach much faster than solid foods. Some patients may require a liquid diet when the symptoms of gastroparesis become severe. Avoid fatty foods. Fat slows down the stomach and small intestines. Even when the patient is feeling well, one needs to avoid fatty foods to prevent gastroparesis from coming back!!
In patients with diabetes, tight control of diabetes is essential. Since low sugar levels can occur in diabetic patients with gastroparesis, careful monitoring under physician's care is very important.
Medications for Nausea and Vomiting
There are many medications for treating nausea. The ones that are usually tried first include Compazine, Phenergan, and Tigan. These medications are available in many forms: tablets, liquids, suppository, intramuscularly injections and intravenous injections. Several medications are reserved for those with severe nausea and vomiting despite initial treatment. These medications include Zofran and Kytril.
Prokinetic Medications for Gastroparesis
Reglan (Metochropropamide): can relieve nausea and vomiting by working in the brain as well as improving the stomach by working on the stomach directly. However, it can cause side effects of tremors, agitations, twitching, or stiffness in up to 30% of patients who take Reglan. If these symptoms occur, stop the reglan and contact your doctor. Reglan is available in tablet, liquids, and injection formulations.
Propulsid (Cisapride): can improve the stomach function and relieve symptoms. However, Propulsid must be used carefully with close physician supervision. It can cause serous cardiac rhythm problem and even death has been reported recently. Propulsid must not to be used with many drugs, and you must check closely with your pharmacist or your physician. Furthermore, Propulsid should not be used in patients with heart rhythm problems, significant heart disease, kidney and liver diseases, any condition causing electrolyte problems. Ask your doctor for the complete information on Propulsid.
Erythromycin: a well known antibiotic. In smaller doses, erythromycin can be effective for gastroparesis. Erythromycin is available in tablet and liquid formulation. The liquid forms have to be stored in the refrigerator.
Domperidone: a drug similar to metochropropamide (Reglan) but without the common side effects. It can be very effect for gastroparesis, especially for patients with gastroparesis from diabetes. Unfortunately, domperidone is not available in the United States. However, it is available in Canada and Europe. Certain pharmacies in Canada can fill prescriptions of domperidone and mail to the US.
Surgery for Gastroparesis: In most cases, surgery is not helpful for gastroparesis. Some physicians believe surgery to remove part or all of the residual stomach may be useful in patients who developed severe gastroparesis from complication of previous surgery. In most patients, surgery is not recommended.
Placement of Stomach and Small Intestine Tubes: In the few patients with severe vomiting requiring repeat hospitalizations for dehydration, placement of stomach tube and/or small intestine tube can be helpful. The stomach "venting tube" is used to vent the stomach when nausea and vomiting become severe. The small intestine "feeding tube" is used to maintain nutrition by bypassing the non-functioning stomach. Furthermore, liquid medications can be given through the small intestine tube to ensure proper absorption.
Electrical Stimulation of the Stomach
Electrical stimulation (Enterra) of the stomach is an option for patients with gastroparesis who are losing weight. FDA has approved the Enterra device under Humanitarian Device Exemption (HDE) status. Significant improvement in nausea, vomiting, quality of life and weight gain have been shown in patients 1 year after placing the Enterra device. The indications for Enterra therapy are chronic nausea, vomiting and weight loss despite medical therapy in patients with diabetic and idiopathic gastroparesis. At this time, patients with gastroparesis from surgery do not qualify for the Enterra device.
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Gastroparisis Information
