Questions in the Gastroenterology and Liver Diseases Forum have been answered by Dr. Kevin Pho who is board certified in Internal Medicine and by doctors from Henry Ford Health System.

Subject: Re: gastroparesis
Forum: The Gastroenterology and Liver Diseases Forum
Topic Area: Digestive
Posted by HFHSM.D.-ym on September 02, 1998 at 12:56:43:
In Reply to: gastroparesis posted by RBS on August 31, 1998 at 11:56:23:


I am a 26 year old white female who was diagnosed with idiopathic gastroparesis approximately 6 months ago. My symptoms began in January of this year and consisted of moderate epigastric pain (burning pain), early satiety, nausea, vomiting, weight loss of 10 lbs (I am 5'9" and weighed 120 lbs at that point), and bloating with excessive belching. I had an EGD done after my symptoms failed to improve on omeprazole 20 mg qd X6 weeks. The EGD showed moderate/severe gastritis which was most likely NSAID-induced (H. pylori was negative). I have traumatic arthritis and had a total knee replacement almost 2 years ago, but still have some joint inflammation and pain. I stopped taking th NSAIDS after the EGD and was started on omeprazole 20mg BID, sucralfate 1 gm QID, and cisapride 20mg BID. After 1 month on this new regimen the epigastric pain was somewhat improved, but I continued to have early satiety, nausea, vomiting, and weight loss. I had an abdominal ultrasound which was normal (except for the fact that I have a very small gall bladder, whatever significance that has?). I had a gastric emptying study done (off cisapride) which showed moderately delayed emptying (40% of the meal emptied at 90 minutes). Following this procedure the cisapride was increased to 20mg QID. During this time I had to go to my physician's office periodically for IV fluids and electrolye repletion because I kept getting dehydrated since I was unable to drink enough fluids. My weight continued to decrease and I got down to 108 lbs. I was started on TPN in April of this year and am still on TPN. I have tried erythromycin 80mg QID, but I did not get any relief from my symptoms. I had a severe extrapyramidal reaction to metoclopradmide a few years ago so that agent is not an option for me. I am currently taking domperidone 20 mg QID (I've been taking it for about 5 weeks). Unfortunatley I have not had any improvement with domperidone either. Other diagnostic tests I have had include the following: UGI with SBFT- normal X-ray except for slow emptying time (barium not emptied from stomach until 4 hrs, barium entered right colon at 5 hrs), colonoscopy- normal, small intestinal transit time study- gastric emptying delayed again (20% of the meal emptied at 90 minutes- this was done while taking domperidone), small intestinal transit appeard normal. I have also had 3 episodes of bacteremia from my central line. I am still unable to really eat anything. I try to eat a little each day (jello, bread, sorbet), but I still have this terrible chronic nausea with intermittent bilious vomiting. My weight is fairly stable and currently ranges between 110 and 115 lbs which is still fairly low for me since I am 5'9". I am taking IV ondansetron 10mg every 6 hrs and still require IV prochlorperazine a few times a week. I am not sure what to do from here. My physician has discussed the posibility of getting a j-tube for feedings to replace the TPN, but there was some question about whether or not I have some degree of small bowel dysmotility as well. I have read a lot of literature on this topic and it appears that this condition is quite difficult to treat. Does it ever just go away? Do you have an explanation for the vomiting given the fact that I am not eating? It still bothers me that the etiology has not been identified. I am not diabetic and do not have any systemic neurological disorders. I have hypothyroidism, but have been taking Synthroid for at least 15 years. I had a thyroid panel done a few months ago which showed that I am still euthyroid. I am getting frustrated with this and am afraid the longer I go without eating the worse my stomach will get. Do you have any suggestions for treatement? I am scheduled fo go to a research facility next month and will likely have more diagnostic tests done that time. I would appreciate any help/guidance you could offer.

Dear RBS,

Gastroparesis is unfortunately a difficult problem to treat. Your clinical situation certainly proves that. Most cases of idiopathic
gastroparesis do not remit on their own, but there have been some reports of a viral illness responsible for gastroparesis that
may resolve after several years of symptoms. Although you aren't eating, your stomach is still producing acid, mucus and other
fluids which can give you a sense of stomach fullness and cause you to vomit. Bile can also reflux from the duodenum into the
stomach as well. From your description your small intestinal motility seems to be fairly well preserved. Having a jejunostomy
feeding tube is not without its problems, but it is certainly safer (especially after the tube is placed) than remaining on home TPN
forever. Good luck with your upcoming evaluation.

This response is being provided for general informational purposes only and should not be considered medical advice or
consultation. Always check with your personal physician when you have a question pertaining to your health.

HFHSM.D.-ym
*Keywords: gastroparesis, jejunostomy feeding tube, total parenteral nutrition

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