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Gastroenterology (Expert Forum)
Gastroparesis, I think?
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Gastroparesis, I think?
by Ilene__0, Aug 25, 1998 12:00AM
After many years of very regular gastrointestinal functioning,
two years ago I experienced a very dramatic change - a cessation
of natural bowel movements. After one week, I finally went to
the doctor and soon found myself in the emergency room being
prepped for surgery for a blockage. The barium enema, quite to
everyone's surprise, showed no blockage. Yet, I continued to
bloat excessively (and painfully) and have no apparent natural
bowel functioning. I underwent a series of tests - endoscopy,
colonoscopy, blood tests for parasites or infections, gastric
emptying, etc. - all of which simply confirmed the symptoms,
but no underlying cause. The term "gastroparesis" was never
used, but I was told I suffered from "autonomic neuropothy."
I am currently on a high dosage of Propulcid (40 mg. 4 times
daily). I only recently learned the word gastroparesis after
seeing a TV spot on "diabetic stomach" and then searching the
web. I am not diabetic. Any suggestions? Would Domperidone
be more helpful than Propulcid? What are the risk factors associated
with such a high dose of Propulcid? What would explain the sudden
onset of this "paralysis," which effects my entire intestinal system,
not just my stomach? Please help!
Dear Ilene,
Gastroparesis implies delayed gastric emptying as an isolated finding. When a more extensive motility disorder is present which involves the small intestine and large intestine in addition to the stomach it implies a generalized muscle or nerve disorder of the gastrointestinal tract called chronic intestinal pseudo-obstruction. Chronic intestinal pseudo-obstruction results from ineffective intestinal propulsion secondary to defects in the either the enteric nervous system (specialized nerves which innervate the gastrointestinal system) or in the smooth muscle found in the intestinal wall. In other words, because the smooth muscle lining the small and large intestinal wall is damaged, food travels slowly down the intestinal tract and causes symptoms. These symptoms mimic an obstruction or blockage even though a mechanical obstruction is not present. Reflux, difficulty swallowing, abdominal fullness and bloating, nausea, vomiting, constipation, diarrhea, abdominal pain and weight loss may occur. In all cases a mechanical obstruction must be excluded with x-rays of the gastrointestinal tract. Sometimes a full thickness biopsy of the intestine must be performed to confirm the diagnosis. This may require surgical exploration. Some centers perform small intestinal manometry (pressure studies) to document poor intestinal propulsion. A family history is present in up to 30 percent of patients with chronic intestinal pseudo-obstruction.
Chronic intestinal pseudo-obstruction may be primary (idiopathic or without secondary cause) or secondary. In secondary pseudo-obstruction an underlying cause may be found. A variety of neurologic diseases, smooth muscle diseases, endocrine and metabolic disorders, anatomic abnormalities, drugs, disorders of the enteric nervous system and other diseases may be present. Parkinson's disease, viral illnesses, brain stem-strokes and tumors, spinal cord trauma, orthostatic hypotension syndromes (diseases where blood pressure decreases with postural changes) and pandysautonomia are the usual neurologic diseases associated with chronic intestinal pseudo-obstruction. If you have not done so already, I would recommend that you consult with a neurologist to rule out a primary neurological disorder.
The treatment for chronic intestinal pseudo-obstruction is generally supportive. In addition to nutritional therapies to maintain weight, prokinetic agents are often used.. Examples of prokinetic agents include: cisapride (Propulsid), metaclopramide (Reglan), erythromycin and soon to become available in the U.S. domperidone (Motilium). These help to more rapidly empty out the stomach. Cisapride at a dose of 40 mg four times daily is an extremely high dose and if you are not getting any benefit with that, you may want to try another prokinetic agent. Some experts find that cisapride and metaclopramide in combination is useful in selected patients who do not respond to single agent therapy. Cisapride is generally well tolerated but can cause diarrhea and drug interactions (especially in patients with underlying heart disease and dysrhythmias). Another consideration is to treat small bowel bacterial overgrowth with antibiotics as needed. Since intestinal contents move slowly down the gastrointestinal tract, the growth and proliferation of bacteria occurs. Small bowel bacterial overgrowth usually presents with diarrhea, poor absorption and weight loss. 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, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: chronic intestinal pseudo-obstruction, causes, symptoms, treatment
two years ago I experienced a very dramatic change - a cessation
of natural bowel movements. After one week, I finally went to
the doctor and soon found myself in the emergency room being
prepped for surgery for a blockage. The barium enema, quite to
everyone's surprise, showed no blockage. Yet, I continued to
bloat excessively (and painfully) and have no apparent natural
bowel functioning. I underwent a series of tests - endoscopy,
colonoscopy, blood tests for parasites or infections, gastric
emptying, etc. - all of which simply confirmed the symptoms,
but no underlying cause. The term "gastroparesis" was never
used, but I was told I suffered from "autonomic neuropothy."
I am currently on a high dosage of Propulcid (40 mg. 4 times
daily). I only recently learned the word gastroparesis after
seeing a TV spot on "diabetic stomach" and then searching the
web. I am not diabetic. Any suggestions? Would Domperidone
be more helpful than Propulcid? What are the risk factors associated
with such a high dose of Propulcid? What would explain the sudden
onset of this "paralysis," which effects my entire intestinal system,
not just my stomach? Please help!
Dear Ilene,
Gastroparesis implies delayed gastric emptying as an isolated finding. When a more extensive motility disorder is present which involves the small intestine and large intestine in addition to the stomach it implies a generalized muscle or nerve disorder of the gastrointestinal tract called chronic intestinal pseudo-obstruction. Chronic intestinal pseudo-obstruction results from ineffective intestinal propulsion secondary to defects in the either the enteric nervous system (specialized nerves which innervate the gastrointestinal system) or in the smooth muscle found in the intestinal wall. In other words, because the smooth muscle lining the small and large intestinal wall is damaged, food travels slowly down the intestinal tract and causes symptoms. These symptoms mimic an obstruction or blockage even though a mechanical obstruction is not present. Reflux, difficulty swallowing, abdominal fullness and bloating, nausea, vomiting, constipation, diarrhea, abdominal pain and weight loss may occur. In all cases a mechanical obstruction must be excluded with x-rays of the gastrointestinal tract. Sometimes a full thickness biopsy of the intestine must be performed to confirm the diagnosis. This may require surgical exploration. Some centers perform small intestinal manometry (pressure studies) to document poor intestinal propulsion. A family history is present in up to 30 percent of patients with chronic intestinal pseudo-obstruction.
Chronic intestinal pseudo-obstruction may be primary (idiopathic or without secondary cause) or secondary. In secondary pseudo-obstruction an underlying cause may be found. A variety of neurologic diseases, smooth muscle diseases, endocrine and metabolic disorders, anatomic abnormalities, drugs, disorders of the enteric nervous system and other diseases may be present. Parkinson's disease, viral illnesses, brain stem-strokes and tumors, spinal cord trauma, orthostatic hypotension syndromes (diseases where blood pressure decreases with postural changes) and pandysautonomia are the usual neurologic diseases associated with chronic intestinal pseudo-obstruction. If you have not done so already, I would recommend that you consult with a neurologist to rule out a primary neurological disorder.
The treatment for chronic intestinal pseudo-obstruction is generally supportive. In addition to nutritional therapies to maintain weight, prokinetic agents are often used.. Examples of prokinetic agents include: cisapride (Propulsid), metaclopramide (Reglan), erythromycin and soon to become available in the U.S. domperidone (Motilium). These help to more rapidly empty out the stomach. Cisapride at a dose of 40 mg four times daily is an extremely high dose and if you are not getting any benefit with that, you may want to try another prokinetic agent. Some experts find that cisapride and metaclopramide in combination is useful in selected patients who do not respond to single agent therapy. Cisapride is generally well tolerated but can cause diarrhea and drug interactions (especially in patients with underlying heart disease and dysrhythmias). Another consideration is to treat small bowel bacterial overgrowth with antibiotics as needed. Since intestinal contents move slowly down the gastrointestinal tract, the growth and proliferation of bacteria occurs. Small bowel bacterial overgrowth usually presents with diarrhea, poor absorption and weight loss. 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, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: chronic intestinal pseudo-obstruction, causes, symptoms, treatment
