Trying to undrstand Gastroparesis

[Elliemae]

I am 67 yrs old.  I have recently been diagnosed with Gastroparesis While in Fl this past winter I saw a Gastroenterologist.for symptoms of epigastric pain sometimes across the whole upper abdomen with frequent bouts of nausea and frequent belching for two to three months.   I had pain on swallowing, as the food hit my stomach I felt a sharp pain, not severe but definitely there..

He ordered an ultasound of the abdomen which was negative.
The EGD showed the stomach to be “full” after 12 hours fasting.
Gastric Emptying study was normal.
Thyroid studies were normal. I am not a Diabetic
Abdominal CT was negative except for a large amount of stool in the colon.

After the testing the doctor pronunced  my diagnosis of Gastroparesis and handed me a prescription for Reglan.  I asked how long to take it and he said “the rest of your life”
If it works we will know that is what you have and if it doesn’t we will have to look further.
No other discussion how to manage the problem or what was involved.

Being a nurse I am familiar with the drug and know that it isn’t the greatest for side effects, and very often does not work.  I decided not to take the drug as my symptoms were much better.  
My medical HX consists of:
Heartburn x many years.
Have been on Prevacid since it came out 15-30 mg.

Hysterectomy –1984
Took premarin until blood clots
1994 Two blood clots in lungs, no source was found.

Paroxsysimal Atrial Fib for several years.
On Tambocour 50mg bid..
I had a cardiac cath one year ago which was negative

Hypertension about 20 years.  
Hyzaar 100 1xd
Atenolol 25 mg 2xd
Norvasc 2.5 mg started one year ago to tweak my BP
Factor  five Leiden Mutation found 2003
Started on Coumadin 4 mg daily since this diagnosis.
Diverticulosis-Must take daily Metamucil for it.
Arthritis Various areas -no drugs.  Was taking Celebrex but quit with the Vioox scare.
Glaucoma- very stable -Zalatan both eyes nightly

I have several questions for you.
#1 Have seen in the PDR that Prevacid significantly delays the emptying time of the stomach.
How much could this be possibly adding to, or possibly causing the problem? I discontinued the drug nine days ago.  Have not noticed much change. How much time woud it take for the effect to “wear” off?
My family Dr.  Gave me some Zelnorm at the same time I stopped the Prevacid. He told me if I did not notice a change in 2 weeks to stop the Zelnorn and start Aciphex.

#2Could Tambocour affect the pacemaker of the stomach as it does the heart?
A. How about Norvasc?
#3 Is Gastroparesis progressive?

#4 Will taking Gastric enzymes help the situation?

#5 When taking drugs when does the effect kick in.  If the stomach is emptying so poorly are the drugs not utilized for hours after taking them.  How could I maximize their absorption.  Will food inhibit their absorption?  

#6 I must take Metamucil for my diverticulosis and I know the fiber slows the emptying.  When would I best take that?  If the emptying time is so slow everything will be all mixed up anyway.

Thanks so much for any information you can give me.  I read your archives and enjoyed the reading.  Again thank you!  There are so many people out there that are suffering from this problem, not knowing what to eat, what to take and so on.  A website just dealing with this problem would be so helpful

Again-Thank you–Elinor

[Kevin Pho, MD]

To answer your questions:
1) I'm not sure how the diagnosis of gastroparesis is made in light of the normal gastric emptying study.  Although possible, Prevacid uncommonly increases the gastric emptying time.  Repeating the gastric emptying scan off the medication can be considered.

2) I am not aware of Tambocor (flecainide) or Norvasc leading to gastroparesis of the stomach.

3) Depending on the cause, it may be possible for gastroparesis to spread to the rest of the digestive tract.  This can be seen specifically in various neurological diseases.

4) Taking gastric enzymes has not shown to be effective in the treatment of gastroparesis.

5) Medications like erythromycin or Reglan normally start working within 4 weeks of taking the medication - sometimes sooner.

6) It is difficult to give specific recommendations regarding this without reviewing your studies.  Again, I question the diagnosis of gastroparesis in light of the normal gastric emptying scan.

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_b

[Duchess47]

I feel your pain!  I too have recently been diagnosed with Gastroparesis and have been told almost exactly the same as you.  I have not started the Reglan for the same reason and my Gastroenterologist is not happy about that.  He feels that the Gastroparesis may be casued by something else or is in addition to something else such as Sphincter of Oddi Dysfunction, (as I have no gallbladder).  So, it's trial and error.  If the Reglan helps then so be it.  But if not, then we need to try other things. I had the gastric emptying scan which confirmed gastroparesis.  The doctor told me to eat small meals, not drink  a lot of liquids all at once, stay away from fiber (which is confusing because I also have IBS), no sugar or fat.  I have to use laxatives and suppositories to get me going so to speak.  The information on the websites can be scary.  I will be interested in seeing the answer to your post, which will answer some of my questions also.

[yoshi]

fiber from raw fruit and vegetable is hard to digest for the stomach.
Have you tried not sitting so much,especially after a meal?
Also standing and moving around seem to help moving the food from stomach to duodenum,I found out doing aerobic sure help my case!!

[alana miller]

Just to let you know, I experience the same problems the upper abdominal pains, chest pains, freq belching and air in stomach, nasea, sometimes I even feel the pain in my chest and shoulder blade area. The doc's told me basically the same as you, I still take fiber though, and I do take digestive enzymes, Try the enzymes and let me know if it helps you, It has made some improvement in me, although I still have some trouble, certainly not as severe. Take care!

[yoshi]

After age 40,our stomach produces less acid,so taking prevacid is not going to help your digestion.
If food is not well digested and medication such as Reglan moves the partially digested food from the stomach to the small intestines,it would just create other problems.

[Niki156]

A related discussion, Confused was started.