Diagnosing & treating gastroparesis
Diagnosis:
Diagnosis of gastroparesis is notoriously difficult, and test results do not always prove conclusive.
As gastroparesis is relatively rare, many clinicians are unaware of it, and as some of the symptoms mimic other conditions, this can often take some time to obtain a correct diagnosis.
Initially you will need to get a referral to a gastroenterologist, who based on your symptoms may carry out one or a combination of the following tests in order to confirm gastroparesis or eliminate alternative conditions.
• Blood tests. General blood panel. Recent reports have found that those with gastroparesis often have low serum 25-OH vitamin D levels
• Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining.
• Gastric emptying scintigraphy (ges). The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.
• SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract.
• Breath test. With this test, the person eats a meal containing a small amount of radioactive material; then breath samples are taken over a period of several hours to measure the amount of radioactive material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying.
• Esophageal manometry. A test in which a thin tube is passed into the esophagus to measure the degree of pressure exerted by the muscles of the esophageal wall.
• Ultrasound scan. Ultrasound scans are images of the internal organs created from sound waves. The hand held scanner is moved back and forth over the relevant part of the body and it sends sound waves through the skin and muscles. The waves are then turned into an image that appears on a TV screen. The procedure is painless.
• Barium x-ray. An x-ray test of the upper part of the gastrointestinal (GI) tract (including the esophagus, stomach, and a small portion of the small intestine) after the patient is given a white, chalky barium sulfate solution to drink. This substance coats the upper GI and the x rays reveal any abnormality in the lining of the stomach and the upper GI.
Diagnosis of gastroparesis is notoriously difficult, and test results do not always prove conclusive.
As gastroparesis is relatively rare, many clinicians are unaware of it, and as some of the symptoms mimic other conditions, this can often take some time to obtain a correct diagnosis.
Initially you will need to get a referral to a gastroenterologist, who based on your symptoms may carry out one or a combination of the following tests in order to confirm gastroparesis or eliminate alternative conditions.
• Blood tests. General blood panel. Recent reports have found that those with gastroparesis often have low serum 25-OH vitamin D levels
• Upper gastrointestinal (GI) endoscopy. This procedure involves using an endoscope—a small, flexible tube with a light—to see the upper GI tract, which includes the esophagus, stomach, and duodenum—the first part of the small intestine. The test is performed at a hospital or outpatient center by a gastroenterologist—a doctor who specializes in digestive diseases. The endoscope is carefully fed down the esophagus and into the stomach and duodenum. A small camera mounted on the endoscope transmits a video image to a monitor, allowing close examination of the intestinal lining.
• Gastric emptying scintigraphy (ges). The test involves eating a bland meal—such as eggs or an egg substitute—that contains a small amount of radioactive material. The test is performed in a radiology center or hospital by a specially trained technician and interpreted by a radiologist; anesthesia is not needed. An external camera scans the abdomen to show where the radioactive material is located. The radiologist is then able to measure the rate of gastric emptying at 1, 2, 3, and 4 hours after the meal. If more than 10 percent of the meal is still in the stomach at 4 hours, the diagnosis of gastroparesis is confirmed.
• SmartPill. The SmartPill is a small electronic device in capsule form. The SmartPill test is available at specialized outpatient centers. The images are interpreted by a radiologist. The device is swallowed and moves through the entire digestive tract, sending information to a cell-phone-sized receiver worn around the person’s waist or neck. The recorded information provides a detailed record of how quickly food travels through each part of the digestive tract.
• Breath test. With this test, the person eats a meal containing a small amount of radioactive material; then breath samples are taken over a period of several hours to measure the amount of radioactive material in the exhaled breath. The results allow the health care provider to calculate how fast the stomach is emptying.
• Esophageal manometry. A test in which a thin tube is passed into the esophagus to measure the degree of pressure exerted by the muscles of the esophageal wall.
• Ultrasound scan. Ultrasound scans are images of the internal organs created from sound waves. The hand held scanner is moved back and forth over the relevant part of the body and it sends sound waves through the skin and muscles. The waves are then turned into an image that appears on a TV screen. The procedure is painless.
• Barium x-ray. An x-ray test of the upper part of the gastrointestinal (GI) tract (including the esophagus, stomach, and a small portion of the small intestine) after the patient is given a white, chalky barium sulfate solution to drink. This substance coats the upper GI and the x rays reveal any abnormality in the lining of the stomach and the upper GI.
Treatment options:
The type of treatment prescribed will depend on the severity of the case and/or other contributory medical factors.
Gastroparesis is not curable as such, but symptoms, for most, can be managed through an effective care plan - this may sometimes be a matter of 'trial and error' until the best solution is found for your gastroparesis, as each case is unique, and does not necessarily follow a set pattern.
Options include dietary adjustments, oral medications, and in more severe cases Enterra Therapy (Gastric Electrical Neurostimulator - GES), and/or Parenteral nutrition and/or IV antiemetics or pain relief.
Dietary Adjustments:
Small changes to the types, quanitites and regularity of food you eat can sometimes make a big difference to the severity of GP symptoms – please see the ‘nutrition’ page for further guidance and information from other sources.
Diabetes & GP:
You may find that your insulin requirements need adjustment, or the times that you inject, for example some find it easier to inject 1-2 hours after eating to ensure food has begun to be absorbed, thus avoiding hypoglycemic episodes. Some endocrinologists will recommend insulin pump therapy rather than injections.
Adjustment and management plans will differ from person to person, and you will need to work closely with your diabetic nurse and/or diabetic consultant, and dietician and will probably need to monitor your blood sugar levels more closely. You may need to be referred for your diabetic care to a specialist hospital clinic rather than being treated at your local surgery.
Dental Care:
Those with gastroparesis may find that their teeth become damaged through excessive vomiting this is called 'tooth surface loss' (TSL), so you may find it necessary to have more frequent check ups and a tailored treatment plan. Many dentists recommend that you do NOT brush straight after vomiting but use a mouthwash instead and brush at least 30 minutes later.
Hair & Skin:
Those with gastroparesis may also find that they suffer thinning or loss of hair and/or poor quality/dryness of skin - this is usually due to limited nutrient intake. In such cases advice and tailored treatment should be sought from the general practitioner.
Treatments used for gastroparesis:
Below is a list of treatments tried by fellow sufferers to varying degrees of success - remember each case is different and what works for one person may not work as well for another. The list is not exhaustive.
You should always seek professional medical advice before trying an alternative treatment.
The type of treatment prescribed will depend on the severity of the case and/or other contributory medical factors.
Gastroparesis is not curable as such, but symptoms, for most, can be managed through an effective care plan - this may sometimes be a matter of 'trial and error' until the best solution is found for your gastroparesis, as each case is unique, and does not necessarily follow a set pattern.
Options include dietary adjustments, oral medications, and in more severe cases Enterra Therapy (Gastric Electrical Neurostimulator - GES), and/or Parenteral nutrition and/or IV antiemetics or pain relief.
Dietary Adjustments:
Small changes to the types, quanitites and regularity of food you eat can sometimes make a big difference to the severity of GP symptoms – please see the ‘nutrition’ page for further guidance and information from other sources.
Diabetes & GP:
You may find that your insulin requirements need adjustment, or the times that you inject, for example some find it easier to inject 1-2 hours after eating to ensure food has begun to be absorbed, thus avoiding hypoglycemic episodes. Some endocrinologists will recommend insulin pump therapy rather than injections.
Adjustment and management plans will differ from person to person, and you will need to work closely with your diabetic nurse and/or diabetic consultant, and dietician and will probably need to monitor your blood sugar levels more closely. You may need to be referred for your diabetic care to a specialist hospital clinic rather than being treated at your local surgery.
Dental Care:
Those with gastroparesis may find that their teeth become damaged through excessive vomiting this is called 'tooth surface loss' (TSL), so you may find it necessary to have more frequent check ups and a tailored treatment plan. Many dentists recommend that you do NOT brush straight after vomiting but use a mouthwash instead and brush at least 30 minutes later.
Hair & Skin:
Those with gastroparesis may also find that they suffer thinning or loss of hair and/or poor quality/dryness of skin - this is usually due to limited nutrient intake. In such cases advice and tailored treatment should be sought from the general practitioner.
Treatments used for gastroparesis:
Below is a list of treatments tried by fellow sufferers to varying degrees of success - remember each case is different and what works for one person may not work as well for another. The list is not exhaustive.
You should always seek professional medical advice before trying an alternative treatment.
Medication:
Antiemetics/Anti sickness:
• Metoclopramide
• Zofran
• Motilium/Domperidone
• Prochlorperazine
• Ondansetran
• Cyclizine
• Ordroleptan
• Levomepromazine/Nozinan - this is a pallative care/anti psychotic med with an anti emetic effect.
. Transdermal patch
. Mirtazapine (Zispin) - an anti depressant with antiemetic side effects
Antacids:
• Mosapride
• Esomeprazole/Nexium
• Gaviscon
• PrilosecOTC
• Protonix
• Lansoprazole
• Buccal (mouth ulcers due to acidity)
• Mebeverine
Prokinetics/Gastric Motility:
• Colpermin
• Erythromycin
• Flucloxacillin
• Ondansetron
• Maxalon
Antiemetics/Anti sickness:
• Metoclopramide
• Zofran
• Motilium/Domperidone
• Prochlorperazine
• Ondansetran
• Cyclizine
• Ordroleptan
• Levomepromazine/Nozinan - this is a pallative care/anti psychotic med with an anti emetic effect.
. Transdermal patch
. Mirtazapine (Zispin) - an anti depressant with antiemetic side effects
Antacids:
• Mosapride
• Esomeprazole/Nexium
• Gaviscon
• PrilosecOTC
• Protonix
• Lansoprazole
• Buccal (mouth ulcers due to acidity)
• Mebeverine
Prokinetics/Gastric Motility:
• Colpermin
• Erythromycin
• Flucloxacillin
• Ondansetron
• Maxalon
- Creon
Pain relief:
• Sandomigran
• Tramadol
• Co-codemol
• Naproxen
• Buscopan
• Morphine patches
• Fentanyl patches
• Oramorph
• Colpermin
• Lignocain
• Spinal cord neurostimulator – manufactured by Medtronic (see ‘specialist contacts’ page)
Emotional/Stress:
• Imipramine (Depression)
• Propranolol (Hyper tension)
Mineral deficiences
- leg cramps due to salt deficiencies - quinine
- Store bought iron a multivitamin products
Parenteral nutrition/tube feeds:
• Osmolite
• Ensure
• Peptamen AF
• Nutricia
• Nutrison energy
• Jevity
• Perative
• Servimed opd
• Paedia
• Nepro
• Pulmocare
• Similac
• Suplena
• Two cal
• Vital
• Oxepa
Enterra Therapy:
Gastric Electrical Neurostimulator device used to encourage stomach muscles to work.
Procedures:
• Botox into the Pyloric Sphincter (via endoscope)
• Parenteral nutritional support via Feeding Tube inserted direct into stomach/intestine
• Enterra Therapy Implant
• Gastric Sleeve Surgery
• Osmolite
• Ensure
• Peptamen AF
• Nutricia
• Nutrison energy
• Jevity
• Perative
• Servimed opd
• Paedia
• Nepro
• Pulmocare
• Similac
• Suplena
• Two cal
• Vital
• Oxepa
Enterra Therapy:
Gastric Electrical Neurostimulator device used to encourage stomach muscles to work.
Procedures:
• Botox into the Pyloric Sphincter (via endoscope)
• Parenteral nutritional support via Feeding Tube inserted direct into stomach/intestine
• Enterra Therapy Implant
• Gastric Sleeve Surgery
- Transpyloric stent
Alternative therapies:
• Acupuncture
• Reflexology
• CD with Sound waves/ Relaxation
• Stomach breathing CD
• PSI band (pronounced sigh) - an anti nausea wrist band, currently only available for purchase in the US
Homeopathic medicine:
• Nux Vom
• Phosperhous
• Ipeca
• Tahitian Noni
• Centurion
• Silver shield homeopathic immune system builder
• Gaia herbs
• Digestzen
Exercises for stomach:
• Hula Hooping
• Swimming
• Walking
• Acupuncture
• Reflexology
• CD with Sound waves/ Relaxation
• Stomach breathing CD
• PSI band (pronounced sigh) - an anti nausea wrist band, currently only available for purchase in the US
Homeopathic medicine:
• Nux Vom
• Phosperhous
• Ipeca
• Tahitian Noni
• Centurion
• Silver shield homeopathic immune system builder
• Gaia herbs
• Digestzen
Exercises for stomach:
• Hula Hooping
• Swimming
• Walking