Re: Gastroparesis

Posted By HFHSM.D.-ym on February 20, 1998 at 16:56:08:

In Reply to: Gastroparesis posted by Denise on February 10, 1998 at 13:50:36:







: I have a friend-really-it's not me!  She is diabetic and has been suffering with gastroparesis for many years.  She receives tube feedings as able per J-tube and eats when able but has bile emesis after every meal. She also complains of lower abd cramping during tube feedings. She is a very brittle diabetic. Isn't there some kind of surgery that could help alleviate this problem-even if it means TPN for the rest of her life?                        Thank you!  
_______


Dear Denise,
     Diabetic gastroparesis is one of the more difficult problems a gastroenterologist has to treat. It sounds like your friend is  having a hard time with enteral (tube) feedings.  Usually, feedings vua a J tube are not associated with ememsis if the tube is far enough into the small bowel.  Your friend may consider asking her physician if the J-tube can be movef further into the jejunum.  Sometimes, this can require surgical placement of the tube (as opposed to endoscopic placement).  Other surgical procedures do not have a role in this problem.
     The treatment for gastroparesis has centered around using a variety of medications that improve gastric emptying  and nutritional therapy. I dont know if your friend has 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 medical therapy is to use the intestinal tract for nutrition as often as possible. If your frined is able to maintain adequate caloric intake with jejunal (J-tube) feedings  that is really the way to go. 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) there is cause atrophy (breakdown) of the intestinal lining and an increased risk of infections. 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 your friend  is not tolerating enteral nutrition and cannot adequately meet her 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.
         If your friend is eating some food by mouth it may be helpful for her to eat very small amounts at a time and separate solids from liquids to improve absorption. She could also try some medications to control nausea and vomiting.  These drugs should be prescribed by a physician.  Finally, it is important for her to keep her glucose (sugar) level under good control since that has also been shown to improve her condition.
         I hope your friend finds 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 Nutrition and enteral feedings.
HFHSM.D.-ym
keywords: diabetes mellitus, enteral nutrition, PEG tubes
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