Chronic vomiting accompanied by bradycardia of small intestine

[iswecrazy]

My friend, female, early 40's has been told she has "bradycardia of the small intestine." Instead of a series of small peristatlic waves which move her food along, she experiences just 1 or 2 HUGE waves, then a flat line. Those huge waves are what causes her to vomit several times ea. time she eats anything - about 10-12 times per day - every day - for the past 2 yrs.
She has been to too many specialists to keep count of. They all write out prescriptions and send her to someone else. They've tried inject. of Botox to temp. paralyze the intestine (didn't work), and even feeding her via a tube in her abdomen, but as soon as the liquid food hits her sm. intestine, it comes right back up and out. She 5'5", and has gone from around 180 or so lbs. to 85 lbs. She's slowly starving to death, and yes, she looks like a survivor of the Holocaust. Now she's been told that she needs a pacemaker to regulate the peristaltic waves. Of course, when she visited the doctor to whom she was referred for this procedure, she was told she had been referred to the WRONG doctor. OOPS! Now she's waiting again to be referred to yet another. I can't find any information on this disorder, and my friend is beginning to worry that she may not live to find any relief. Isn't there something she can do? Has anyone else heard of this, or a doctor that treats it? I am desperate to find a way to help her. Any info would be appreciated. Thanks.

[Kevin Pho, MD]

What is being described is intestinal dysmotility - or pseudo-obstruction.  Pseudo-obstruction is usually secondary to an underlying disorder affecting neuromuscular function, although rare familial cases have been described. The neuropathic disorders include amyloidosis, diabetes mellitus, and paraneoplastic syndromes; scleroderma is an example of a myopathic process.

The following are the most common symptoms associated with this:
Nausea and vomiting — 83 percent (of patients)
Abdominal pain — 74 percent
Distension — 57 percent
Constipation — 36 percent
Diarrhea — 29 percent
Urinary symptoms —17 percent
Other symptoms that can occur include easy satiety, anorexia, and weight loss. These symptoms may be acute, recurrent, or chronic.

Treaetment is determined by the cause.  Small bacterial overgrowth can be treated with course of rotating antibiotics.  

Prokinetic agents, particularly erythromycin and cisapride, may be useful for acute and chronic therapy of intestinal pseudo-obstruction.  Cisapride can only be obtained if there is a documented reason to use it.  Other medications to consider would include reglan, octreotide or neostigmine.  You may want to discuss if these medications would be considered.  

If medications are not an options, then surgery should be considered.  Options would include procedures to resect or bypass localized disease of the small bowel.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Camilleri.  Chronic intestinal pseudo-obstruction.  UptoDate, 2003.

[Ciao]

Three years ago I started vomiting four hours after eating and when I ate I was quickly full, nothing seemed to be digesting so I would throw up and eat and of course throw up again.  This went on until I became so dehydrated that I had to start going to emerg to be re-hydrated. An upper GI gastroscopy revealed Crohn's ulcers and duodenitis, there was also some scar tissue that created a narrowing in the duodenum.  Other than vomiting I had no other symptons except dizziness from time to time.  I started a treatment of Prednizone (full treatment was three months)and Prevacid.  The Prednizone made me feel a whole lot better and gave me a life however the Prevacid didn't cooperate with my large intestine.  Within a few days of treatment I had stopped vomiting. When I stopped taking the Prevacid I felt even better and by then the Crohn's had gone into remission.

Recently I started vomiting again and an upper GI gastroscopy showed no active Crohn's but duodenitis.  I started to take Pantoloc which seems to have work very quickly as the vomiting stopped within a day and I felt much better, no nausea, no fist in the middle of my stomach feeling.  

If your friend can handle Carnation Instant Breakfast please recommend it to her as it has kept me hydrated and provided some nourishment during the worst of times when solid food wasn't an option.  For fluids, l gallon of water with three tablespoons of sugar, 1/4 to 1/2 tsp salt and the juice of a lemon.

My advice is to have your friend examined by a Gastroenterologist as soon as possible.

[iswecrazy]

Thanks for the advice.  Unfortunately, since this has been ongoing EVERY DAY, EVERY TIME SHE EATS, for two years now, she's already seen just about every gastroentologist (and numerous other doctors in other specialized fields) in this part of the country. No one seems to have any idea what brought this on, and they haven't been able to find any drug for nausea (my friend is never nauseated anyway, just throws up due to the seizures in her intestine) or other drug that has any effect on the vomiting. She's been tested for Crohn's and just about every other disease and disorder anyone can come up with. They've all been negative. They've tried her on Ensure, even feeding it to her through an abdominal tube, but as soon as it hits the sm. intestine, the seizures begin and it all comes right back up. The ONLY thing she can keep in her system is water and sometimes Pepsi, which she drinks continuously all day, and even some of that comes back up. That, and the TINY bits of food that she doesn't manage to vomit up. She has a bowel movement about once every 6 wks. or so, which she refers to as "rabbit pellets." Like I said, there's no nausea involved, just some pressure and pain from the seizuring intestine. She's been put on different diets, tested for food allergies, even humiliated once at the onset of the malady, by one doctor that insisted all she needed was sedatives and a good psychiatrist. Her specialists know that's not true now, but they still haven't come up with a cause or any cure. Her potasium level has to be monitored, and when it drops too low, she has to get to the hospital fast and have that taken care of. She's beginning to feel desperate, as you can well imagine. But hey - thanks anyway for your interest. I truly appreciate your concern and your willingness to share your thoughts and comments.

[iswecrazy]

Dr. Kevin, thanks for your insights.  I showed the message to my friend. She said she'd never heard any of her specialists mention ANY of the medical terms you had listed, even tho I think they're right on the money! I checked out all of them on the 'net at various sites, and it certainly sounds like a darn good diagnosis! So why haven't any of the dozen or so specialists to which she's been referred ever mentioned them? The only drug that you listed that she's been prescribed was reglan, which even I'M familiar with, for nausea. I've suggested she "arm" herself with the new information you provided when she visits her newest "specialist." (This latest dr. has AGAIN suggested an "all liquid" diet. She's tried that several times with NO luck, but he wants to do it again, so.....)Anyway, maybe she can at least ask some better questions of her condition, thanks to the info you provided! You've been a big help! I'm continuing in my search for as much info I can find to help my friend, because I don't want to lose her to this. Thanks again.

[Gastro_interest]

Dear iswecrazy,
I suffer from Chronic Intestinal Pseudo-Obstruction as well as Gastroparesis.  A woman in my support group with the same conditions also vomits frequently.  She is considering having up to 3/4th of her colon removed to try to bypass the "bad" part of the colon.  This is a serious procedure, but if dying from malnutrition is your only other option, a necessary one.  Your friend may want to discuss that with her doctors.  Also, she should consider TPN feedings if her weight is too low (nutrients through an IV).
Nicole

[ktor240]

I am writing this on behalf of my girl freind and hopeing she is better by the time my concern reaches your eyes.
  She is 19 years old and this whole mess started about 2 months ago with a spinal fusion surgery -for scholiosis.  after the surgery she was fine but wasnt eating like she should have been because of the pain medications she was on. when she returned to the hospital for a checkup, they readmited her because shed lost so much weight and did an upper GI (with the barium). they concluded that she had a minor obstruction they called SMA syndrome and they put her on a feeding tube.  she was in the hospital for about a week and went home with the feeding tube doing better.  about 4 days after going home she started getting natious and vomitting all the time.  she went to another hospital, closer to our home town than the original one. they did an xray and saw that the tube had come out and was coiled in her stomach, so they admited her and took it out.  a few days after they took it out, her nausea was going away, and she was starting to eat some solids. they did another upper GI test and they said there was still a "minor obstruction" so they performed a surgery, it was like a bypass surgery called a jujunostomy if i remember correctly...ever since the surgery she has been vomiting almost whenever she eats.  she usually vomits 2 to 4 hours after she eats, though, there isnt and obstruction anymore because they did another GI after the surgery. after two weeks at the hospital they kicked her out saying they no longer thought she needed to be there. I am very concerned about her and would like to know what might have caused this. sometimes it seems like shes not even digesting the food, just today she ate some rice and threw it up five hours later and it basically looked like chewed up rice. please reply with any ideas of what might be wrong with her....she is currently on TPN (total parental nutrition) through a pic line IV.  although, tonight she is going without it on the hunch that it might be causeing some of the nausea.  she went without it ounce a couple of days ago and she acctually ate quite a bit and kept it all down no problem.  she even had a bowel movement which appeared normal today, and she thinks it was the food she kept down a couple days ago. please post anything you can....
                     thank you    Kamron

you can also eamil me at ***@****

[Rupe]

A close friend after years of abdominal pain and distress finally had her gall bladder out and also diagnose with a condition linke to oddy's sphincter dysfunction. not always recognised the op bypassed this damaged area, previous hospital told her she needed supository and cup of tea. gall bladder a mess, told it was fine. usualy arrogance ignorance and insularity. egos wont accept opinion of another surgeon from different discipline, just where do these people get it from. operation very good, removed dreadful pain. a month or so after began vomiting. no one wanted to get involved usual buck passing and denial. since then weight down hill, vomiting now every week. PEJ not PEG fitted as she vomited up any tube even the one that is supposed to coil up and be fixed. Dietician worse than useless, number crumcher, never followed up totally inadequate grasp of needs. perhaps thought it was bulimia, so how can food be brought up many hours after eating undigested, that serious Yogi trick.Now i get her to squirt complex carbohydrate polymers with vits mins and amino acids directy into tube, adapted 60 ml syringe as 20  useless to stop her dehydrating even. again medics not on top of what happening. also added Fructo oligo sacharides, acidophilus and mycelised oils. on this she is doing better and can think and function. slurred speech and emotional distress is eased. vomiting gross, injectections, supositories they have tried it all to no avail. no one wants to get a proper team in though, each seems to think they have the answer. no doubt thought without the combination of supplements, big syringe and PEJ bypassing the reversed bit we would have lost her,. any comments on better anti nausea or vomiting suppression welcome. there are NO patterns or foods that link that we have been able to establish. even water if its that way out makes her bring back the lot for hours.

[Roar]

WOW, sometimes you think you are alone, then you find a message board like this. My symptoms are almost identical to all those posted here. My symptoms include vomiting 99% of everything I eat or drink. The vomiting is almost immediate at times, I cant even finish a plate of food before I have to run to the bathroom. I have lost over 20 lbs so far and thats just the first few months. I have no energy and can barely work. All my doctor's that I have seen also say the same thing. They can't find anything wrong with me, x-rays show nothing, CT scans show nothing, blood work shows nothing. So they just say to me, come back in a month for a follow up. In the mean time I slowly starve to death. I have tried every combo of diet, I have tried the Ensure stuff as well. Nothing seems to help. I am affraid that soon my employer won't believe me or the dr's will stop believing me. I don't know what to do anymore, the depression that's starting to build is getting very hard to cope with. Anyone with any advice please feel free to reply to this email. Thanks in advance,
Rick.