Severity of gastroparesis on GES.

[cardiactec]

Hi there,

I am 24 years old, have been diagnosed with postural orthostatic tachycardia syndrome (aka POTS) and just recently was diagnosed with gastroparesis via gastric emptying study. I was told that my gastroparesis is most likely due to an autonomic dysfunction because there is evidence already of an autonomic issue effecting cardiac innervation when upright (the POTS) ...

I have two questions.

The first is, at the four hour mark on the gastric emptying study, I still had 40% food remaining in my stomach. If severity of paresis is based on percentages of retained food/tracer, at the four hour mark if i still had 40% remaining in my stomach, what severity classification (mild,moderate, or severe) would that fall under?

Also, second question, do you know of any specific diagnostic testing that can determine the root cause of gastroparesis aside from just a broad category of "autonomic dysfunction" ?

I have tried many medications and none seem to be working. my primary symptom is nausea, no vomiting. I am limited as to what meds i can try because i'm on a beta blocker that is contraindicated with the majority of pro-motility meds since they are known to prolong the QT interval.

Thanks for your time,

Angel-a.

[Kevin Pho, MD]

The gastric residual after 4-hours should be around 0 to 40 percent.  With your reading being around 40 percent, the gastroparesis can be considered more on the mild side.

Further testing can be considered to exclude neuropathic disease.  This can include MRIs to look for central causes, as well as tests to exclude toxic, metabolic or neoplastic causes - such as
lead poisoning, porphyria, or lung cancer respectively.

These options can be discussed with your personal physician.

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.

Kevin, M.D.
kevinmd_

[cardiactec]

I was told by someone that according to mayo clinic criteria, that 10% or less should be in the stomach at a four hour mark for GES....

Does anyone know if the basis for gastroparesis severity is more diagnostic at the T 1/2 level or at four hours?

I have heard both, that the T 1/2 is what docs base severity on (because at 90 minutes more than half food content should have passed into the duodenum) and also that two hour GES arent good enough, that a four hour revealing more than 10% retained food. hmmm, so which is it? my T 1/2 didnt occur until 180 minutes (three hours).

I am just wondering which is true for accuracy because i have heard so many conflicting reports to which is considered significant and what is not. i just know how some docs work, that if a diagnostic test proves a "mild case" of something, symptoms a patient is having unfotunately can be treated the same, as just being mild, even though someone could be suffering greatly - with incapacitating symptoms. i'd rather not waste my time seeing specialists even though my symptoms are severe, if everyone is going to look at a "mild" test result and treat my symptoms as though they were just "mild" as well.