EGD today and gastritus and gastroparesis revealed - Questions

[silverstanger]

Well after having a globus sensation and referred pain in my back and a Barium Swallow test that was negative.. they scoped me.

My GastroEnt. is a very vague and not talkative. I was completely awake for the test as I am allergic to Versed and Demerol, and even benadryl. They gave me some ben. (and i realized today what I thought all along that i was indeed allergic to benadryl because when i would have a reaction to another drug, ben. would make my pulse shoot up upon injection - but we thought it was left overs from whatever made me allergic)
They also gave me some other kind of relaxer.. bentadine? or something with a dine (dEEn) in it.

**** My doc. said I had gastritis and gastroparesis. He couldn't say whether it was severe or not and since i am NOT diabetic, couldn't say why either. He DID say that the food was putrified, which I don't know what that means. Finally I asked how much food was in there and he said "does that matter??" I then asked "did you see my stomach okay with the food in there" and he said "yes, sure"****

My questions are:

-- What are some other causes of (besides diabetes) GParesis? This explains why sometimes I have no appetite despite not eating for a while.

-- Could the doctor be mistaken.. || I have no nausea or vomiting but once in a great while.. more on the nausea side if anything || I took the test at 7am and ate last the night before at 10pm.. so that is 9 hours.. My stomach should have been empty I think right?

-- Is there any treatment without medication since I seem to be allergic to almost everything?

[Kevin Pho, MD]

To answer your questions:
1) In addition to diabetes, there are several other causes of gastroparesis.  This would include scleroderma, previous gastric surgery, and various neurological diseases - such as multiple sclerosis, brain stem stroke or tumor, diabetic or amyloid neuropathy.

2) Confirmatory tests can be considered to further confirm the diagnosis.  One option would be a gastric emptying scan.  Another option would be gastroduodenal manometry which is normally considered if there is no clear cause fo gastroparesis on emptying scan.  

3) There are various medications that can treat gastroparesis.  Intravenous erythromycin is the treatment of choice for patients who cannot take oral medications, while cisapride is the drug of choice for those who can ingest oral liquids, although its availability is severely restricted in the United States.  Other considerations would be reglan or domperidone (which is not available in the United States).  There are investigational studies examining the injection of botulinum toxin into the pylorus.  

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.  Treatment of delayed gastric emptying.  UptoDate, 2003.

[TJV]

   In the vast majority of cases-- the cause of gastroparesis is unknown.
  Disorder involving nerves - typically vagi-- and muscles of the stomach

  Possible other causes -- various muscular and neurological disorders .  --stomach surgery  anticholinergic drugs, electrolyte abnormalities , thyroid disease--viral infections i think- don't quote me on that one

Somewhat, sort of-  perhaps--associated with GERD  Taking any PPIS for the globus? perhaps you need a ph test

Gastroparesis can be confirmed with gastric emptying study

  Variety of symptoms---some of them besides vomiting--... nausea-- bloating,-- decreased appetite-- weight loss

   Things you can do besides meds
  
   Eat small meals --

  eat solids and liquids seperately

  cut down on fatty foods

   Besides food residue,  the doctor may have seen that the muscular contractions of the stomach were weak

[TJV]

   Forgot one of your questions  

   putrified--advanced state of decomposition and having a foul odor

[silverstanger]

do you think drinking alot of liquids will help.. wash it down??

And i did hear him say something right after the test about part of the stomach looking weak or something to that effect.

Do you think my case is moderate being that I dont get nausea and vomiting alot??

[TJV]

    Is the severity of gastroparesis measured by the severity of symptoms ? good question, i assume so. You still should be assessed in my humble opinion.

   When you do vomit is your food still in tact?

   Yes , it's best to take liquids seperately.The stomach muscles that are used to empty solid food are different from the stomach muscles which empty liquids. Some people have problems with one or the other --- or both.

[silverstanger]

I had an MRI of my brain in April of 2002. So I don't think it is a tumor..

Although lately I have had lots of headaches in and/or around my right eye, temple, and the back of my head. For a few weeks they would start in the morning and not change in intensity during the day, then go away only to come back later OR last all day. Right now they have started to let up and my eyes are still kind of bloodshot, more so in the right eye. AND they aren't starting when I wake up, they are starting around the same time in the evening but NOT everyday now.

A few days the left eye has felt the same instead of the right, and it all started with the left, but moved to the right then left 20 percent, but right 80 and way more chronic and severe when they occur.

Should I get an MRI again, or do you think I am safe with having it last year in April??

The Doc. who answered kind of scared me with those possibilities.. is it possible that there is NO cause..
-- And I DO NOT vomit on the regular basis.. occasionly I feel stomach pain and nausea but nothing that would be attributed to GERD --

** Also keep in mind I had this test (EGD) last year when I had the MRI and the doc never seen ANY food in my stomach at all, and it looked fine. **

In one year my stomach is doing this, and I have had alot of IBS problems this year and last too.. but that has cleared up.

Any suggestions would be helpful. My doctor said fancy tests when I asked to see the severity.. and acted like it was unnecessary, that he just wanted to give me Reglan and let's see how I do attitude.

[silverstanger]

is it also possible the diagnosis of gastroparesis was wrong?

I ate at 10pm, and has the test at 7am..

When I asked how much food, I was trying to determine if there was alot of food left.. meaning a sure thing of what the doc. seen, and diagnosis -  or if there was something really small.. maybe it was a fluke.

-- I guess I have to seek another doctor to find out the cause and double check the diagnosis --

[Gastro_interest]

Well, don't worry about there being no cause for your gastroparesis, if that's what you have.  About one third of all cases are idiopathic, meaning there is no cause.  If the feelings of nausea and not wanting to eat are really decreasing your quality of life, then you should look into this further and try to treat.  If not, I wouldn't worry about it.  If you want to find out more, you should do a gastric emptying scan, as the doc recommended, to find out for sure if that's what's wrong.  If it is, there are many treatment options.  I know many people who have had the botox injections, and that works for some.  Unfortunately, the majority of the rest of the treatments invlolve medicine, which I know you're not fond of.  I personally like orally disolving Zofran for nausea, it works great for my Gastroparesis.
Good luck and feel better!

[silverstanger]

Ok, well there was only once or twice periods where I was nauseated.. but it doesn't bother me other than that.

My stomach hurts with pain more than anything when I have probs. and in my back also. And the throat tightening (globus sensation) feeling gets bothersome sometimes.

Actually right now, I have more head pains than anything.

[jc175]

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