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Re: [IP] gastroparesis

Pumpers and Friends,
  I seen this post and someone said I may beable to give more info on it. As
I'm not feeling the best tonight, I going to post a copy of a file I got off
the web some time ago.
On Fri, 23 Aug 2002 13:21:12 -0700 (PDT) Heidi Vogan <email @ redacted> wrote:

> Any of you folks who know anything about
> diabetic
> gastroparesis,I need your opinion.(don't
> worry,I'll
> consult my physician )The past couple of days,I
> have
> been afflicted with some bg whacko stomach
> ailment,it
> appears to have a great deal to do with
> eating.

What is gastroparesis?
Gastroparesis means paralysis of the stomach. The stomach is a hollow organ
composed primarily of muscle that serves as a storage container for food. Food
in the stomach is ground into tiny pieces by the constant churning which is
generated by the regular contractions of the stomach muscles. Once the food
has been adequately ground, it slowly is emptied from the stomach into the
intestine in a metered fashion. This process allows the emptied food to be
well-mixed with the digestive juices of the intestine, pancreas, and liver
(bile) and to be digested and absorbed well. When the stomach muscles are
paralyzed, food is not thoroughly ground and does not empty into the intestine
What causes gastroparesis?
Gastroparesis can be caused by either diseases of the stomach muscles or the
nerves that control these muscles. Often there is no specific cause
identified.The most common cause of gastroparesis is diabetes mellitus, which
damages the nerves controlling the stomach muscles. Gastroparesis can also
result from the intentional nerve cutting (vagotomy) during surgery for peptic
ulcer disease.  Occasionally, gastroparesis is caused by nervous reflexes, for
example, when the pancreas is inflamed (pancreatitis). In such cases, neither
the nerves nor the muscles are diseased, but messages are sent through the
nerves of the stomach which prevent the muscles from working normally. Other
causes of gastroparesis include potassium, calcium or magnesium imbalance,
medications (such as narcotic pain-relievers), scleroderma, and thyroid
disease.  Gastroparesis can occur as an isolated problem or the condition can
be associated with paralysis of other parts of the intestine, including the
esophagus, small intestine, and colon. """IN MY CASE I had a problem from
birth once I got DM the gastroparesis got harder and harder to control"""
What are the symptoms of gastroparesis?
The primary symptoms of gastroparesis are nausea and vomiting. The vomiting
usually occurs after meals; however, with severe gastroparesis, vomiting may
occur without eating due simply to the accumulation of secretions in the
 """I have had morning sickness for the last 24 years"""
The characteristic vomiting of gastroparesis happens several hours after a
meal when the stomach is maximally distended by the presence of food and
post-meal secretions. Since the grinding action of the stomach is absent, the
vomited food remains intact and is easily recognized. (Contrast this with the
more common type of vomiting in which the food appears as small, uniform,
unidentifiable particles.) The stomach muscles that are used to empty ground,
solid food are different from the stomach muscles which empty liquids. Thus,
with gastroparesis, there may be deficient emptying of solid food (most
common), solid and liquid food (less common), or liquid food alone (least
common). Bloating and pain in the abdomen can result.  Other, less frequent
effects of gastroparesis are the promotion of gastroesophageal reflux disease
(GERD) and malnutrition caused by poor digestion and absorption of food.
"""Yes it can be very painfull, and I must take a lot of meds to help with the
malnutrition and absortion"""

How is gastroparesis diagnosed?
The most common method for diagnosing gastroparesis is a nuclear medicine test
called a gastric emptying study which measures the emptying of food from the
stomach. For this study, a patient eats a meal in which the solid food, liquid
food, or both contain a small amount of radioactive material. A scanner
(acting like a Geiger counter) is placed over the stomach for several hours to
monitor the amount of radioactivity in the stomach. In patients with
gastroparesis, the food takes longer than normal (usually more than several
hours) to empty into the intestine. """This test is easy to do, it takes over
22 to 23 hours for my stomach to empty"""
An upper gastrointestinal (GI) endoscopy test usually is performed to exclude
the possibility of an obstruction as the cause of the patient!&s symptoms.
(Upper GI endoscopy involves the swallowing of a tube with a camera on the end
and can be used to visually examine the stomach and duodenum.) An obstruction,
which can be caused, for instance, by scarring from an ulcer near the exit
from the stomach, can block the outflow of food and secretions from the
stomach and cause symptoms which are similar to those of gastroparesis.
Therefore, it always is necessary to exclude the presence of such an
obstruction.  The antro-duodenal motility study is a study that can be
considered experimental that may be used in patients with gastroparesis. It
measures the pressure that is generated by the contractions of the stomach and
intestinal muscles. This study is conducted by passing a thin tube through the
nose, down the esophagus, through the stomach and into the small intestine.
With this tube, the contractions of the muscles of the stomach and small
intestine can be measured at rest and following a meal. """" This is the one
that I hate the most, but they did find that my stomach and small intestine do
not contract very well and sometimes push things back up in to my stomach and
esohagus""" In most patients with gastroparesis, food (which normally causes
the stomach to contract vigorously) causes either infrequent contractions (if
the nerves are diseased) or only very weak contractions (if the muscle is
diseased)."""I can have no contractions for a week/  month then so hard that I
can't move off the floor to stand up""  An electrogastrogram, another
experimental study that sometimes is done in patients with suspected
gastroparesis, is similar to an electrocardiogram (EKG) of the heart. This
test is a recording of the electrical signals that travel through the stomach
muscles and control the muscles!& contractions. An electrogastrogram is
performed by taping several electrodes onto the patient!&s abdomen over the
stomach area in the same manner as electrodes are placed on the chest for the
EKG. The electrical signals are recorded at rest and after a meal. In normal
individuals, there is a regular electrical rhythm just as in the heart and the
power (voltage) of the electrical current increases after the meal. In most
patients with gastroparesis, the rhythm is either irregular or there is no
post- meal increase in electrical power. Although the electrogastrogram does
not measure gastric emptying (a key indicator for this disease), it is an
attractive first test for suspected gastroparesis because it is easy to
perform. However, there are patients with gastroparesis who have a normal
electrogastrogram and abnormal gastric emptying and vice-versa. 
How is gastroparesis treated?
Gastroparesis usually is treated with medications that stimulate contractions
of the stomach muscles. The goal of treatment is to stimulate stomach
contractions so that food is properly ground in the stomach and emptied into
the intestine so that digestion can occur. There are two important guidelines
in treating gastroparesis with medications. First, the drugs must be given at
the right times, and second, the drugs must get into the blood stream to be
The muscular activity of the stomach (like the intestine) is not continuous.
There are fluctuations in activity throughout the day. The periods generally
can be categorized as fasting (little or no muscular contractions), digestive
(frequent contractions for up to two hours after meals), and a third period
occurring in the middle of the fasting periods which produces a short burst of
strong contractions that quickly sweeps remaining, undigested food into the
colon. Stimulating muscular contractions during and immediately after a meal
(the digestive period) is the goal in treating gastroparesis. For this reason,
drugs that stimulate contractions are given before meals.  Most drugs must be
absorbed from the intestine into the blood stream to be active. A frequent
problem that occurs in treating gastroparesis is transporting the drugs out of
the stomach and into the intestines where they can be absorbed into the
bloodstream, reach the muscle of the stomach, and stimulate contractions. The
majority of patients with gastroparesis have inadequate emptying of solid
food. Since pills and capsules behave like solid food, they have a tendency to
remain in the stomach after they are swallowed and not be absorbed. Most
patients with gastroparesis have at least some emptying of liquids from the
stomach, and, therefore, liquid medications usually are more effective than
pills or capsules because they empty from the stomach and then are absorbed
from the intestine. Occasionally, patients have such poor emptying of both
liquid and solid food that only drugs given intravenously are effective.
"""Back in 1998 my stomach stopped working for over 6 months, it didn't matter
if it was liquid or solid food. It was not going to stay in or move thru my
gut. I was on TPN 'IV FOOD' , I lost 138lbs, had 17 low blood sugar seizures
...BS below 20ml , heart stopped, and 7 infections, I had j-tube that did not
work and had to be removed."""
 Three drugs that are used to stimulate contractions are cisapride
(Propulsid), metoclopramide (Reglan), and domperidone (not approved in the
US). (Editor's note: Cisapride has been removed from the general market
because it can cause irregular heart rhythms.If taken with the wrong drugs) A
fourth drug, erythromycin (E-Mycin, Ilosone, etc.), stimulates short bursts of
strong contractions that are more like the contractions that sweep undigested
food into the colon than regular digestive contractions Octreotide
(Sandostatin) is a hormone-like drug that can be injected beneath the skin.
Like erythromycin, this medication stimulates short bursts of strong
contractions.  Surgery occasionally is used to treat gastroparesis. The goal
of surgery is to create a larger opening between the stomach and the intestine
in order to aid the process of emptying the stomach!&s contents.
Alternatively, the entire stomach may be removed. These procedures should only
be considered when all other measures have failed because of significant
potential problems associated with them.""" I was going to have mine removed
but once they found out how my small intestine work they said NO""" These
surgeries should be done only by surgeons in consultation with
gastroenterologists who are knowledgeable and experienced in caring for
patients with gastrointestinal motility disorders (disorders of the nerves or
muscles of the gastrointestinal tract that affect digestion and transport of

Electrical pacing of the stomach is a new  treatment for gastroparesis.
Electrical pacing of the stomach is analogous to cardiac pacing with a
pacemaker for the treatment of an abnormally slow heartbeat. This treatment
appears to be effective in short-term studies, but the long-term effectiveness
and safety are unknown. 
What is the prognosis (long-term outcome) for patients with gastroparesis?
"""Once they can get my blood and infections cleared up , I'm going to have a
gastric pacer placed"""
If gastroparesis is caused by a reversible problem, for example pancreatitis,
the condition will subside when the underlying problem resolves. If there is
no reversible cause, gastroparesis rarely resolves. In fact, it may become
worse with time. Gastroparesis is particularly difficult to treat when there
are accompanying motility disorders of the muscles of the small intestine and
Gastroparesis At A Glance
h Gastroparesis is a disease of the muscles of the stomach or the nerves
controlling the muscles that causes the muscles to stop working. 
h Gastroparesis results in inadequate grinding of food by the stomach and
poor emptying of food from the stomach into the intestine. 
h The primary symptoms of gastroparesis are nausea and vomiting. 
h Gastroparesis is diagnosed by a test called a gastric emptying study. 
h Gastroparesis usually is treated with medications that stimulate the muscle
to contract. 

There are many ways to try to handle gastroparesis, eat small meals..... watch
your fat,.. raw foods,.. take the meds.. But the biggest thing for me was/is
learning how to use my pump to control my blood sugars, I have a plan of
action for what to do if this happens or that. I may not take a bolus for
something I ate until 2 or 3 hours after.... I may have to let my BS be over
150 all day because my gut is not working right. I may need to check my BS
every hour ""AVE for me is 15 test aday"" I must remember that any day I get
out of bed is a good day because I'm still alive.


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