Question Title: Gastroparesis after drug withdrawl

I was on a strong doses of rivitril(20m) and zyprexa(20m)daily for over three years. In Aug this year I was taken off all drugs over a period of two weeks. At the end of the two weeks I started experiencing what I though was the flue-nausa and bloating without vomiting. This did not clear up. I was sent to a specialist in Oct. I had a endoscopy which showed my stomach was inflammed and had relux of bile. I was put on pantaloc and prevasid.These did not help.In Nov I had a gastric motility test that showed decreased motility.The pantaloc was increased and prepulsid was added.Presently I am taking 40mg pantaloc twice daily and 20mg prepulsid 4 times daily.The prevasid was stopped. These are not working there has been no improvement. I am constantly bloated and nausiated. Sometimes the pain from the bloating is so bad that I am in tears.I can not sleep at night because of the bloating and nausa. When I stand up the nausa becomes increased.Can you offer another opinion so that I might be able to have a more productive discussion with my specialist.
Sincerly,
Brenda

Dear Brenda,

Gastroparesis is one of the more difficult problems a gastroenterologist has to treat. It sounds like you are having a difficult time. Delayed gastric emptying can be caused by mechanical obstruction, impairment of gastric motility secondary to drugs, inflammation, viral infection, diabetes, electrolyte disturbances, smooth muscle disorders or neurological disorders. I am not familiar with the medications you referred to in your posting. Are these medicines used in Europe or Canada?

Nevertheless, the treatment for gastroparesis has centered around using a variety of medications that improve gastric emptying and nutritional therapy. If medications are causing your problem it would be reasonable to assume that discontinuing these drugs should improve gastric emptying and your symptoms. I don’t know if you have tried medications such as metoclopramide, cisapride, erythromycin . A newer medication called domperidone is not currently available in the United States but it will soon be marketed as “Motilium”. This medication, available in Canada, has helped some patients with gastroparesis.

The goal of nutritional therapy is to use the intestinal tract for nutrition as often as possible. If you are continuously losing weight and unable to maintain adequate caloric intake orally, jejunal (J-tube) feedings may be necessary. Enteral feeding is relatively inexpensive and utilizes the cells lining the intestinal tract to enhance absorption of nutrients. If the cells lining the intestinal tract are not used such as in the case of total parenteral nutrition (TPN) then atrophy (breakdown) of the intestinal lining and an increased risk of infections can occur. The developed intestinal tract functions as a barrier to prevent infectious organisms from crossing into the bloodstream. It also has an active immune system. The absence of intestinal nutrients causes the immune system to function less effectively. However, if enteral nutrition is not tolerated and not enough to meet your caloric needs ( as assessed by a stable and appropriate weight), then TPN can be used. However, it must be understood that TPN is associated with risks of serious infection due to the long term placement of a central line. Lots of blood tests and frequent physician visits are needed to monitor the patient.

Dietary measures found to be helpful include: eating very small amounts at a time more frequently and separating solids from liquids to improve absorption. You could also try some medications to control nausea and vomiting. These drugs should be prescribed by a physician. Finally, it is important for you to keep your glucose (sugar) level under good control since that has also been shown to improve gastroparesis (especially if gastroparesis is secondary to diabetes).
I hope you find this information helpful.

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.

If you would like to be seen at our institution please call 1-800-653-6568, our Referring Physicians' Office and make an appointment to see Dr, Muszkat our expert in Gastroenterology.

HFHSM.D.-ym
*Keywords: gastroparesis, medical treatment, enteral nutrition, jejunostomy tubes, total parenteral nutrition

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