Why this burping and regurgitation now ?

[Johnny15]

My wife had a total gastrectomy, partial pancreotomy, splenectomy and a tumor removed from the small bowel on March 28th, 2006. Pathology showed an 8" tumor and all margins clean, including no cancer cells from the partial pancreotomy (at least some good news).She had a rough first two weeks at home starting April 10th with the normal trial and error eating to find what agreed and 'painfully' find out what didn't (4 to 5 hours of cramps like labor pains she said). After that she started to settle into routine of eating as much of what she could tolerate until one day she ate a normal dinner (chicken,carrots) and it went down fine but 30 minutes later it felt like it wanted back up, and she would burp and regurgitate, but not vommit, and it lasted 8 hours. This prevented her from eating again and this still goes on today (June 25th). She has had a recent scan (clean of disease)and xray, barrium swallow and scope. All show mechanically everything is OK. But this doesn't help what's going on now. She has lost significant weight and is now 83 lbs. Tommorrow we will be back in the hospital after a weekend pass and start PICC line TPN on Tuesday. She needs to be sustained while we try and sort this out. Something functionally has changed I'm sure for all of the sudden to have this happen when she was eating without a problem.

Any ideas ??? SOmetimes the burping is bitter, even if she just ate something. She is taking METOCLOPRAMIDE and trying MEGACE now since she has no appetite and body seems in starvation mode.

Any experience trying to ween (SP?) off a DURAGESIC patch (25) without the restlessness she has experienced would be appreciated as well. Thanks.

Espo

[Johnny15]

Now she is home from the hospital, 81 lbs, weak and stressed. Starting eating today small portions every 2 hours, and so far food is settling in 15 to 30 minutes (much better than it has been in the previous 3 or 4 days). Baby food and mashed potatoes, theses items aren't stressing her intestine as much as more whole foods I assume. Need calories in small portions.

Help !
Any suggestions, tips, much appreciated !!

Thanks

[bobelde]

A related discussion, regurgitation was started.

[quiltingnanax3]

A related discussion, anyone been to a nutritionist was started.

[wassupwassabi]

I take metoclopramide myself because I have very severe belching and reflux; I don't find it to be very effective.  I tried zelnorm for a short time and thought it was more effective in keeping stuff down and moving it through, but the flip side is that it all comes out the rear end!  I don't know if you can use zelnorm on someone who has had a gastrectomy but you might ask a doc about that.  Good luck!

[Kevin Pho, MD]

The upper GI series and upper endoscopy would rule out many of the major disorders leading to the symptoms.  This can include strictures or masses.  

You can consider gastroparesis, or delayed gastric emptying, which can lead to some of the symptoms you are describing.  A gastric emptying scan can be ordered to investigate this possibility.  

This option can be discussed with your personal physician, or in conjunction with a GI evaluation.

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_