Since removing my gallbladder didn't solve any of my problems, my GI is giving me every test I haven't already had (there aren't many left). I have a gastric emptying scan this week, which watches food pass through the stomach (it's different than the barium test). I wanted to know if anyone has had positive results from this test, and what happens when you do. And yes, I'm already working on being referred to yet another dr. Thanks for your advice.
I had the gastric emptying test about 15 months ago. It consisted of eating two scrambled eggs that had a radioactive substance in them and drinking water (either 12 or 16 ounces, I can't remember which). Then they take a nuclear imaging xray every 15 minutes for two hours to see how effective your stomach is in moving food to your small intestines. The test is completely painless, although the scrambled eggs tasted pretty bad. I recommend a lot of salt and pepper on them! As soon as the test is over, you can return to your regular daily activities. I recommend taking something to read - it is a pretty boring two hours.
In my case, my stomach moved 80% of the eggs out of my stomach and in to my small intestines in 2 hours, which my doctor was very pleased with. I am an esophageal cancer patient who has had a transhiatal esophagectomy and a complete vagotomy, though, so my results probably aren't relevant to your situation.
What is your diagniosis, if you don't mind me asking?
I had a gastric emptying test, because of symptoms that included nausea, bloating, early satiety and chronic gastric irritation. It turned out that my stomach does not digest food properly, meaning it takes longer, and there are some foods that are simply not digestible for someone with poor stomach motility. This disorder is sometimes known as gastroparesis. The stomach is like the heart, it contracts at regular intervals to move the contents through in the digestive process. If your stomach is literally "weak", it doesn't have the necessary function to digest things like fiber, red meat and foods high in fat. That includes foods that are mechanically difficult to digest; raw fruits and veggies, whole grain foods (even oatmeal), beans, etc. This can either be "idiopathic", meaning causation unknown, or due to an underlying disease, such as diabetes.
So, the food just sort of "sits there", and causes you to feel full, nauseated, etc.
Post again after you get the test results. Your stomach should empty by 50% in 90 minutes.
I have had two gastric emptying studies done. One at a local hospital when I was admitted two months post pancreatitis ad gallbladder surgery with what felt like the same pain all over again and another at Shands Hospital in Gaineville, Florida - the nearest specialist to where I live.
What I find extremely interesting is that my first test was very, very different from the second test in every way, shape and form.
The first test took almost four hours. I was given two eggs and two slices of toast and was told to eat them however I wanted. They gave me butter, salt, pepper and jam. I was told that I didn't need to eat the bread so I didn't. I was not given anything to drink. Every 1/2 hour I would get up off my stretcher and stand in front of the "camera" (for lack of a better name to call it) and they would take a short series of "pictures". According to my nuclear medicine report normal emptying is "T60-120" and my result was "normal" at 60.
After six days in the hospital my gastroenterologist told me he didn't know what was wrong with me and referred me to a specialist at Shands for further evaluation/testing. At the time he thought I may have Type 3 Sphinter of Oddi dysfunction.
I went to the specialist on 12/23 and he indicated to me that a diagnosis would probably be a combination and not one specific condition. I had a very broad range of symptoms.
One of the things he suspected was some form of motility problem - be it stomach, small bowel, etc.
I was scheduled for a gastric emptying test at Shand because they do the test differently (according to my doctor). He didn't seem very impressed with my first set of test results so he wanted the test run ASAP. Due to the holidays 1/3 was the first opening. I also live 2 hours away from that hospital so I have to travel.
On 1/3 I had the second test done. NOTHING like the first one. The technician explained a lot to me about the test and the reason the results may vary. I was given one egg which was wrapped in one piece of bread and a small cup of water. I was told to eat all the egg and bread and use however much of the water I needed. I had been fasting since midnight the night before and the test started at 12:00 noon. I then laid down on a table similar to an x-ray table and the technician positioned me under the camera. I was in that position for approximately one hour before he started an IV and injected me with erythromycin. I had been told at the start of the test that if I was boarderline or slow emptying that they would go ahead and inject the erythromycin. Unfortunately it did cause my stomach to cramp quite severely in the dosage it was given, but I had a short time left on the table after the IV was finished. I am not sure how much erythromycin they actually give you, but my understanding is some people don't even know it is going in other than knowing they have the IV hooked up. I was told that erythromycin forces stomach emptying. My test took at total of one hour and 40 minutes.
I talked to my doctor's nurse practitioner today and she said that normal for their test is 40 to 90 and I emptied at 120, therefore the doctor is starting me on liquid erythromycin to be taken four times a day (before each meal and at bedtime). She said they would start me on the lowest dosage and then build from there. I understand that there are four different dosages they can use.
I also have been diagnosed with pancreatic insufficiency and originally was told the doctor would start me on pancreatic enzymes. Today I was told he had decided that he wanted to wait until I get going on the erythromycin before dealing with the pancreatic enzymes so he will have a clear picture of whether or not I have more motility issues or just the stomach. If I do not find relief he will proceed with the "small bowel motility" test where they insert a wire either down your throat or through your nose all the way down to the small bowel and monitor your system.
I am just now beginning to research the condition so I hope to find some good information.
I found your post to be very interesting. It is simply amazing the variety of tests people undergo, with vastly different results.
I had a small bowel follow through, that was done with just drinking the barium liquid, though I have heard of the other test as well. Yuck, is all I can say. The one I had was not bad.
I especially wanted to comment on the subject of medication. I was first given reglan (horrible stuff, in my opinion), and I quit taking it almost immediately. Erythromycin can be effective, but it is tricky to get the dose right, and it doesn't work for everyone, and can lose effectiveness. The drug I take is called domperidone. I think it is prescribed by nearly every, if not all, of the specialists in gastric motility disorders. Many have motility disorders throughout the digestive tract. I have seen a specialist at Cleveland Clinic, and now see a specialist at U of M, one of the top in his field. The domperidone is a pro-kinetic, and helps stimulate digestion. It works much differently than reglan or erythromycin. By the way, there is a new drug study going on for a drug that is like erythro, but without the antibiotic part. Now, some doctors get all freaky, because domperidone is not sold here in the US, I get mine from a very good, reliable, safe and legal pharmacy in New Zealand. It is the original brand name (Motilium). This drug has been on the market for about 40 years, and is very safe, with a minimum of side effects. So, when they say, oh, it is not FDA approved, it's only because the company (which is one of the major drug manufacturers) had decided the demand in the US is not sufficient to warrant the headaches that the FDA require. Although that may change. This drug helped change my life from not being able to eat much of anything to have a much greater variety in my choices, and reducing my nausea significantly.
Look for more information on the internet. I belong to an online support group through Yahoo for gastroparesis. You will see it listed if you do a search. There are almost 900 members, and I have learned a LOT from them.
You should be on a low fat, low fiber diet; no raw fruits or veggies, nothing with a skin, no whole grains, no red meat, no high fat foods. These are all very difficult for the stomach to process, especially with limited motility.
You are right, tests can vary greatly even day to day on the same person using the same test.
You are learning a lot. I hope you have a really good GI doc, one that knows about stomach motility disorders. Ask about the domperidone, and let me know if you have any questions. I was diagnosed last year after years of problems and no answers. Since then I have learned a great deal. Hope this helps.
Just to update... I had my scan done today, one scrambled egg with the radioactive stuff sprinkled on it. Every 15 minutes I went in and had a picture made. I emptied 50% in 92 minutes, which is average. So I've pretty much ruled out everything now. I'm working on getting an appointment with a new GI in a different group, although I'm not sure if he'll have any new ideas. What's the next step? Thanks for your responses.
I have posted before. I had my gallblader out 8/01 and have had severe ruq pain and nauseau. My doctor ordered all sorts of tests and put me on meds for reflux. He said he wanted to try it even though all the tests showed I did not have reflux. I took advice from some of you and went to Boston to a Pancreatic specialist. He examed me and LISTENED to my complaints for 2 hours and said he thought it was a motility problem. He called xray and had a gastric empting study done right then. After 2hours of pictures nothing had moved in my stomach! He has tried two meds. I had trouble with reglan so I only take 5mg of that before every meal and now I tak 20mg of Donnatal with it before meals. I feel much better. If i forget my meds I am miserable and have even had severe(13 hr)vommitting without meds. I'm glad somebody finally figured this out. Now I can eat small amounts and not feel awful.
Ask your doctor about domperidone (Motilium is the brand name) If they know anything at all about stomach motility disorders, they will recognize it. Reglan has MANY risks, and this works the same way, without all the side effects. Some doctors get scared away because it is not sold in the US, but that is really a meaningless fear. It is manufactured by one of the top drug companies, and has been on the market world wide for about 40 years. Bureaucratic red tape is the only reason they don't sell it here. I order mine from a pharmacy in New Zealand, they are safe, legal and reliable. You do not need a prescription to order it. In England it is sold over the counter. I see one of the top specialists in the country, and it is the drug of choice for gastroparesis. Also ask about Zelnorm, many people have motility problems throughout the digestive tract, and end up suffering from constipation as well. Zelnorm is used to treat constipation, in combination with the other meds, it helps keep things moving more normally. There are some very good nausea meds, such as Zofran and Kytril, they are used for chemo patients, so are very effective (though costly, shouldn't be a problem if you have insurance, just might need some help from your Dr. because of the cost factor) and do not have the drowsy side effect that many of the others have. Good luck.
My husban recently had the gastric emptying study. The eggs meal with radioactive stuff. His results...after 70 min. no emptying at all. Physician say he has slow motility and called it CHRONIC INTESTINAL PSEUDO OBSTRUCTION. Anyone else heard of this? The treatment was Zelnorm but this has been fruitless. His symptoms are Bloating diarrhea burning sensation in abdomen and severe pain. After beginning the Zelnorm, the diarrhea discontinued and now has constipation problems. The only way to move things is with Citrate of Mag. This takes 12 hrs for his body to create enough pressure to move things out. He has lost 35 pounds since September when the symptoms began. Our physician cannot find a way to get his body to act normal again and we do not know what to do next. He has been out of work for almost 3 months! Could use some information from anyone else with these symptoms.
Thanks for the info. I still am waiting to hear back from my doctor. He was going to set up a consult with a motility specialist since his specialty is pancrease. Hopefully they will find the right med for me. I have been miserable again this week.
My mom has a motility problem and was on reglan but it caused Parkinson Symptoms so we tried erythromycin and stomach problems were severe. Next choice domperidone but I am concerned about heart rhythm problems. Anyone been there? Thanks.
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