Expel Common Myths About Gastroparesis
Updated definition of gastroparesis came out in January. Gastroparesis treatment is in transition. A lot of the things I was taught 10 years ago are no longer true, said Ellen Stein, MD, ACP Member, a gastroenterologist and assistant professor of medicine at Johns Hopkins University in Baltimore. Dr. Stein described recent changes in practice, and a number of common myths about gastroparesis, during a session at Hospital Medicine 2013, held in National Harbor, Md., this May. An updated definition of gastroparesis was provided by the American College of Gastroenterology (ACG) in January. The ACG guideline says diagnosis should be based on symptoms of gastroparesis, absence of gastric outlet obstruction or ulceration, and presence of delay in gastric emptying. The last of these should be documented before a therapy is selected. The definitive method for documenting delay is four-hour gastric emptying scintigraphy (GES), which can be a problem to coordinate before discharge from a brief hospitalization, Dr. Stein noted. I'm sure you find it very hard to get that GES done in the four hours before they go to discharge, and it may be better to do once their symptoms settle down for a few days, she said. But a little saved time can actually lead to a lot of wasted time, if patients go home and then return to the emergency department repeatedly because they're still sick. Gastroparesis patients may not show how sick they are after a PO challenge because their stomachs do not empty for more than three or four hours, Dr. Stein explained. Sometimes, this means that the patients appear stable for discharge at two hours, but when they go home, they have symptom recurrence and need to return to the emergency room. Waiting a little longer to be sure symptoms responded to medical ther Continue reading >>
Vomiting And Dysphagia Predict Delayed Gastric Emptying In Diabetic And Nondiabetic Subjects
Journal of Diabetes Research Volume 2014 (2014), Article ID 294032, 7 pages 1Department of Gastroenterology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinski Street 49100, Petach Tikva, Israel 2Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Israel 3Department of Biostatistics, Rabin Medical Center, Beilinson Hospital, Israel 4Epidemiology Unit, Edith Wolfson Medical Center, Holon and the Sackler Faculty of Medicine, Tel Aviv University, Israel Academic Editor: Dimitrios Papazoglou Copyright © 2014 Doron Boltin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background. Gastroparesis is a heterogeneous disorder most often idiopathic, diabetic, or postsurgical in nature. The demographic and clinical predictors of gastroparesis in Israeli patients are poorly defined. Methods. During the study period we identified all adult patients who were referred to gastric emptying scintigraphy (GES) for the evaluation of dyspeptic symptoms. Of those, 193 patients who were referred to GES from our institution were retrospectively identified (76 (39%) males, mean age years). Subjects were grouped according to gastric half-emptying times (gastric ). Demographic and clinical data were extracted from electronic medical records or by a phone interview. Key Results. Gastric emptying half-times were normal (gastric 0–99 min) in 101 patients, abnormal (gastric 100–299 min) in 67 patients, and grossly abnormal (gastric min) in 25 patients. Vomiting and dysphagia, but neither early satiety nor bloating, correlated with delayed gastric emptying. Diabetes was associated with g Continue reading >>
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Gastroparesis
Gastroparesis is a disease of the muscles of the stomach or the nerves controlling the muscles that causes the muscles to stop working. Gastroparesis results in inadequate grinding of food by the stomach, and poor emptying of food from the stomach into the intestine. The primary symptoms of gastroparesis are nausea, vomiting, and abdominal pain. Gastroparesis is best diagnosed by a test called agastric emptying study. Gastroparesis usually is treated with nutritional support, drugs for treating nausea and vomiting, drugs that stimulate the muscle to contract, and, less often, electrical pacing, and surgery. What is gastroparesis? Gastroparesis means weakness of the muscles of the stomach. Gastroparesis results in poor grinding of food in the stomach into small particles and slow emptying of food from the stomach into the small intestine. The stomach is a hollow organ composed primarily of muscle. Solid food that has been swallowed is stored in the stomach while it is ground into tiny pieces by the constant churning generated by rhythmic contractions of the stomach's muscles. Smaller particles are digested better in the small intestine than larger particles, and only food that has been ground into small particles is emptied from the stomach and well digested. Liquid food does not require grinding. The ground solid and liquid food is emptied from the stomach into the small intestine slowly in a metered fashion. The metering process allows the emptied food to be well-mixed with the digestive juices of the small intestine, pancreas, and liver (bile) and to be absorbed well from the intestine. The metering process by which solid and liquid foods are emptied from the stomach is a result of a combination of relaxation of the muscle in parts of the stomach designed to accommoda Continue reading >>
Non Diabetic Gastroparesis
I am a 36 year old female. I have been diagnosed with gastroparesis. I have had this diagnosis for over a year but I have not been able to find a doctor that will help me find the reason I have it. I am not Diabetic. I cannot take Reaglan and my doctor indicates that I don't have any other options. He has talked about putting a tube in my neck and feeding me that way. I don't want that. I have been throwing up and bad (almost daily) diareaha for over 2 years now. I am at my wits end. I have become very depressed. This is effecting my daily life and ability to work. I live in Lubbock Texas. I need help please. I need to find out why I have this problem instead of treating symptoms that won't go away. I am tired of throwing up and not being able to leave my house for fear of having accidents. Can somebody please help me. I don't know what else to do. I have seen 3 different Gastro doctors in the last 2 years. I have had a colonoscopy that was normal. I have had 2 EGD's. I have a hiatal hernia, and a lot of inflammation in my stomach. I did have H-Pylori, I was treated for it but I don't know if it went away. I have not had another biopsy to find out. I need someone who cares enough to help me find out why. Please, Please help me. My son was wrongly diagnosed with Crohn's disease when he was 14 years old.At the time the doctor put him on a medication called asacol (aa-sa-caul).He remained on the medication for ten years (mainly because the doctor didn't care to check him again and just kept refilling the perscription).In the meantime, the Crohn's mysteriously disappeared.The asacol did help his inflammation and diareaha.He still has the constant nausea and no diagnosis for over a year and a half .All tests, and I mean, all tests came back normal.Even the one for gall ston Continue reading >>
Non-diabetic Gastroparesis
I was just diagnosed, by the gastric emptying study, with Gastroparesis. All my Drs say they have only seen/heard of this happening in diabetics, but I have been extensively tested for diabetes for the past 3 years. Diabetes would explain alot of my health problems( neuropathy, leg ulcers, and now this). Is it possible to have diabetes even if all your blood tests are coming back normal? Is gastroparesis a condition you can have without diabetes? I go in for a stomach scope Thursday morning. Last edited by Nancy741; 02-28-2006 at 08:49 PM. Nancy, years ago I was diagnosed w/slow gastric emptying twice. They could not find a cause and I was not diabetic either. What are your symptoms? Eventualy it went away but now I think I am having a return of some of the symptoms. Do you have symptoms all during the day and night? I have constant stomach pain, but when I eat or drink after the second bite or sip I get real nauseated and I vomit after every meal.It has been going on for 4 months. The gastric emptying study showed no movement of my food after 90 minutes. I had the scope done today. I have no ulcers or blockages but he did biopsy my stomach lining to have it tested. He told me to eat 6 small meals instead of 3 normal meals. I wish he would have told me how much is a small meal. Is it 6 ounces, 8 ounces? I'm trying small meals but I'm not sure how much I'm supposed to be eating. Continue reading >>
Gastroparesis: Etiology, Clinical Manifestations, And Diagnosis
INTRODUCTION Normal gastrointestinal motor function is a complex series of events that requires coordination of the sympathetic and parasympathetic nervous systems, neurons and pacemaker cells (called interstitial cells of Cajal) within the stomach and intestine, and the smooth muscle cells of the gut. Abnormalities of this process can lead to a delay in gastric emptying (gastric stasis) [1]. This topic will review the etiology and diagnosis of gastroparesis. Our recommendations are largely consistent with guidelines by the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) [2,3]. The pathogenesis and treatment of gastroparesis are discussed separately. (See "Pathogenesis of delayed gastric emptying" and "Treatment of gastroparesis".) DEFINITION Gastroparesis is a syndrome of objectively delayed gastric emptying in the absence of a mechanical obstruction and cardinal symptoms of nausea, vomiting, early satiety, bloating, and/or upper abdominal pain [3]. EPIDEMIOLOGY In one of the largest population-based studies that identified 3604 potential cases of gastroparesis of whom 83 fulfilled diagnostic criteria for definite gastroparesis, the age-adjusted incidence of gastroparesis was 2.4 per 100,000 person-years for men and 9.8 per 100,000 person-years for women [4]. The age-adjusted prevalence of definite gastroparesis was 9.6 per 100,000 persons for men and 38 per 100,000 persons for women. Overall survival was significantly lower than for the age- and sex-matched general population. ETIOLOGY Although multiple conditions have been associated with gastroparesis, the majority of cases are idiopathic, diabetic, or postsurgical (figure 1). Continue reading >>
Management Of Gastroparesis
Michael Camilleri, MD1, Henry P. Parkman, MD2, Mehnaz A. Shafi, MD3, Thomas L. Abell, MD4 and Lauren Gerson, MD, MSc5 1Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA; 2Temple University, Philadelphia, Pennsylvania, USA; 3University of Texas, MD Anderson Cancer Center, Houston, Texas, USA; 4University of Mississippi, Jackson, Mississippi, USA; 5Stanford University, Palo Alto, California, USA Am J Gastroenterol2013; 108:1837; doi:10.1038/ajg.2012.373; published online 13 November 2012 Received 24 May 2012; accepted 5 October 2012 Correspondence: Michael Camilleri, Department of Gastroenterology, Mayo Clinic, 200 First Street SW, Charlton 8-110, Rochester, Minnesota 55905, USA. E-mail: [email protected] This guideline presents recommendations for the evaluation and management of patients with gastroparesis. Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying. Symptoms from gastroparesis include nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain. Management of gastroparesis should include assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying and, in diabetics, glycemic control. Patient nutritional state should be managed by oral dietary modifications. If oral intake is not adequate, then enteral nutrition via jejunostomy tube needs to be considered. Parenteral nutrition is rarely required when hydration and nutritional state cannot be maintained. Medical treatment entails use of prokinetic and antiemetic therapies. Current approved treatment options, including metoclopramide and gastric electrical stimulation (GES, approved on a humanitarian device exemption), do no Continue reading >>
Digestive Disorders Health Center
Gastroparesis is a condition in which your stomach cannot empty itself of food in a normal fashion. It can be caused by damage to the vagus nerve, which regulates the digestive system. A damaged vagus nerve prevents the muscles in the stomach and intestine from functioning, preventing food from moving through the digestive system properly. Often, the cause of gastroparesis is unknown. However, the causes of gastroparesis can include: Gastric surgery with injury to the vagus nerve Rare conditions such as: amyloidosis (deposits of protein fibers in tissues and organs) and scleroderma (a connective tissue disorder that affects the skin, blood vessels, skeletal muscles, and internal organs) There are many symptoms of gastroparesis, including: Some of the complications of gastroparesis include: Food that stays in the stomach too long can ferment, which can lead to the growth of bacteria. Food in the stomach can harden into a solid collection, called a bezoar. Bezoars can cause obstructions in the stomach that keep food from passing into the small intestine. People who have both diabetes and gastroparesis may have more difficulty because blood sugar levels rise when food finally leaves the stomach and enters the small intestine, making blood sugar control more of a challenge. Continue reading >>
Gastroparesis
General Discussion Gastroparesis (abbreviated as GP) represents a clinical syndrome characterized by sluggish emptying of solid food (and more rarely, liquid nutrients) from the stomach, which causes persistent digestive symptoms especially nausea and primarily affects young to middle-aged women, but is also known to affect younger children and males. Diagnosis is made based upon a radiographic gastric emptying test. Diabetics and those acquiring gastroparesis for unknown (or, idiopathic) causes represent the two largest groups of gastroparetic patients; however, numerous etiologies (both rare and common) can lead to a gastroparesis syndrome. Gastroparesis is also known as delayed gastric emptying and is an old term that does not adequately describe all the motor impairments that may occur within the gastroparetic stomach. Furthermore, there is no expert agreement on the use of the term, gastroparesis. Some specialists will reserve the term, gastroparesis, for grossly impaired emptying of the stomach while retaining the label of delayed gastric emptying, or functional dyspepsia (non-ulcer dyspepsia), for less pronounced evidence of impaired emptying. These terms are all very subjective. There is no scientific basis by which to separate functional dyspepsia from classical gastroparesis except by symptom intensity. In both conditions, there is significant overlap in treatment, symptomatology and underlying physiological disturbances of stomach function. For the most part, the finding of delayed emptying (gastric stasis) provides a "marker" for a gastric motility problem. Regardless, the symptoms generated by the stomach dysmotility greatly impair quality of life for the vast majority of patients and disable about 1 in 10 patients with the condition. While delayed emptying Continue reading >>
Gastroparesis: Know The Risk Factors For This Mysterious Stomach Condition
As diabetes cases skyrocket, another condition called gastroparesisis rapidly becoming a morecommon diagnosis. Itreduces the ability of the stomach to empty its contentsbutdoes not involvea blockage.Nausea, vomiting, loss of appetite, bloating and chronic abdominal pain are the hallmark symptoms, according to gastroenterologist Michael Cline, DO . Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy If you have diabetes , gastroparesis can cause it to be poorly controlled.Severegastroparesis makes it difficult to manage your blood sugar. Primary care physicians and even gastroenterologists frequently overlook and under-diagnose the condition, he says. Sometimes it is initially misdiagnosed as an ulcer, heartburn or an allergic reaction. In non-diabetic patients, the condition may relate to acid reflux. In current data, up to 40 percent of people with acid reflux have some sort of delay in gastric emptying, he says. So thats a fairly large number, when you look at the millions of Americans who have acid reflux, Dr. Cline says. Stomach motility either abnormal or absent Gastroparesis , which means partial paralysis of the stomach,is a serious disease that prevents your stomach from digesting food and emptying properly. Damaged nerves and muscles dont function with their normal strength and coordination. Thatslows the movement of contents throughyour digestive system. Doctors dont yet know how to reverse the damage, but there is a range of treatment options. And, early diagnosis helps, Dr. Clinesays. The primary cause of gastroparesis is damage to or dysfunction of peripheral nerves and muscles. In diabetic patients , Dr. Cline says, it appears asmor Continue reading >>
Treatment Of Gastroparesis In Diabetics & Non-diabetics
Gastroparesis is a pathological condition in which the stomach takes excessive time to eliminate the food inside. This condition is also known by the name of Delayed Gastric Emptying. This condition is caused due to weak muscles in the stomach. At present, there is no definitive cure for Gastroparesis but adequate treatment goes a long way in managing symptoms caused by Gastroparesis. The root cause of Gastroparesis is unknown but researchers believe that it is caused due to some type of disruption in the nerve signals in the stomach. It is opined that the vagus nerve, the function of which is to control movement of food through the digestive tract gets damaged resulting in food to be digested slowly resulting in Gastroparesis. The main cause for damage to the vagus nerve is diabetes. Apart from this, surgical procedures done to the stomach may also cause damage to the vagus nerve. Gastroparesis which is also known by the name of Delayed Gastric Emptying is a pathological condition in which the food is not able to traverse from the stomach to the small intestine The root cause of Gastroparesis is some sort of damage to the vagus nerve as a result of which the muscles of the stomach start to malfunction causing the food to stay in the stomach and not move to the intestine. Majority of the people with Gastroparesis are not able to know as to why they are having this disease even after consulting various physicians or undergoing a battery of tests, although diabetes is thought to be one major cause of gastroparesis since people with diabetes usually have high blood sugar levels which in time causes significant damage to the vagus nerve resulting in gastroparesis An individual with Gastroparesis usually experiences early satiety, frequent vomiting of undigested food, stomac Continue reading >>
Gastroparesis
Gastroparesis (GP also called delayed gastric emptying) is a medical condition consisting of a paresis (partial paralysis) of the stomach, resulting in food remaining in the stomach for an abnormally long time. Normally, the stomach contracts to move food down into the small intestine for additional digestion. The vagus nerve controls these contractions. Gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not properly function. Food then moves slowly or stops moving through the digestive tract. Signs and symptoms[edit] The most common symptoms of gastroparesis are the following:[2] Chronic nausea (93%) Vomiting (especially of undigested food) (68–84%) Abdominal pain (46–90%) A feeling of fullness after eating just a few bites (60–86%) Other symptoms include the following: Abdominal bloating Body aches (myalgia) Erratic blood glucose levels Gastroesophageal reflux (GERD) Heartburn Lack of appetite Morning nausea Muscle weakness Night sweats Palpitations Spasms of the stomach wall Constipation or infrequent bowel movements Weight loss and malnutrition Morning nausea may also indicate gastroparesis. Vomiting may not occur in all cases, as sufferers may adjust their diets to include only small amounts of food.[3] Complications[edit] Primary complications of gastroparesis include: Fluctuations in blood glucose due to unpredictable digestion times (in diabetic patients)[4] General malnutrition due to the symptoms of the disease (which frequently include vomiting and reduced appetite) as well as the dietary changes necessary to manage it Severe fatigue and weight loss due to calorie deficit Intestinal obstruction due to the formation of bezoars (solid masses of undigested food)[4] Bacterial infection due to overgrowth Continue reading >>
Dizziness & Gastroparesis
My head is spinning today. Or rather, the room is spinning. Either way, I’ve been feeling quite dizzy since yesterday afternoon. About every other month or so I’ll have a day or two (or sometimes longer) where I’m really dizzy for no apparent reason. I’ve seen my primary care doc about it. I’ve even been to an ENT specialist. Nobody has any solid answers, but personally I think it has something to do with living with gastroparesis (not necessarily a result of the gastroparesis itself). Two reasons. First, I think it’s improbable that random things keep happening within my body with no connection whatsoever to each other. I find it much more likely that seemingly unrelated symptoms that have appeared since I was diagnosed with gastroparesis have something to do with the GP — whether it’s a result of dietary choices, nutritional deficiencies, stress, the dysfunction of the enteric nervous system, or the delayed gastric emptying itself. Second, I know that recurrent dizziness is something that a lot of other GPers also experience. A lot of people email me about it, a lot of one-on-one clients have ask about it, and the topic came up in one of my group programs just last week. Here are some of my thoughts as to what might contribute to dizziness among GPers (just like most other things, it’s not likely to be the same for everyone):* Dehydration Whether it’s a result of vomiting or not drinking enough due to fullness or other symptoms, some GPers are chronically dehydrated. Even mild dehydration can cause dizziness, as well as other symptoms like headaches, constipation, fatigue, and moodiness. If you’re experiencing the symptoms of even mild dehydration, make an effort to sip on water throughout the whole day (I always have a water bottle with me) and Continue reading >>
Diabetic And Nondiabetic Gastroparesis.
University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas 66160. Nutritional support is essential in treating patients with gastroparesis. Initially, dietary changes should be instituted to reduce extra fat and bulk, and patients should be encouraged to eat frequent small meals with liquid supplementation. Enteral feeding should be introduced in the event of weight loss or persistent vomiting. Medical therapy is usually necessary early in treatment. Cisapride is the initial agent of choice and may be combined with an antiemetic agent, such as promethazine or chlorpromazine or, if side effects occur, ondansetron and granesitron. If cisapride is ineffective or contraindicated, metoclopramide is a reasonable option, though limited by side effects. Erythromycin is useful in the acute treatment of postoperative ileus and hospitalized gastroparetic patients, but its role is limited based on concerns about poor long-term effectiveness and antimicrobial resistance. Once domperidone becomes available in the United States, it will be useful for its promotility and antiemetic qualities. Combination therapy should be considered if monotherapy with cisapride or metoclopramide alone is ineffective. While not yet well studied, combination therapy has the potential to offer dramatic benefit for patients with refractory gastroparesis. Metoclopramide may be added to cisapride for patients with breakthrough symptoms or refractory chronic symptoms. Other combinations include metoclopramide with erythromycin, domperidone with cisapride, and domperidone with erythromycin. In the future, gastric pacing may become an effective option for patients not responding to medical therapy. Total gastrectomy should be performed only for end-stage gastroparesis when all other ther Continue reading >>
Diabetic And Nondiabetic Gastroparesis
Nutritional support is essential in treating patients with gastroparesis. Initially, dietary changes should be instituted to reduce extra fat and bulk, and patients should be encouraged to eat frequent small meals with liquid supplementation. Enteral feeding should be introduced in the event of weight loss or persistent vomiting. Medical therapy is usually necessary early in treatment. Cisapride is the initial agent of choice and may be combined with an antiemetic agent, such as promethazine or chlorpromazine or, if side effects occur, ondansetron and granesitron. If cisapride is ineffective or contraindicated, metoclopramide is a reasonable option, though limited by side effects. Erythromycin is useful in the acute treatment of postoperative ileus and hospitalized gastroparetic patients, but its role is limited based on concerns about poor long-term effectiveness and antimicrobial resistance. Once domperidone becomes available in the United States, it will be useful for its promotility and antiemetic qualities. Combination therapy should be considered if monotherapy with cisapride or metoclopramide alone is ineffective. While not yet well studied, combination therapy has the potential to offer dramatic benefit for patients with refractory gastroparesis. Metoclopramide may be added to cisapride for patients with breakthrough symptoms or refractory chronic symptoms. Other combinations include metoclopramide with erythromycin, domperidone with cisapride, and domperidone with erythromycin. In the future, gastric pacing may become an effective option for patients not responding to medical therapy. Total gastrectomy should be performed only for end-stage gastroparesis when all other therapy has failed. Both procedures should be reserved for centers that specialize in severe Continue reading >>
