Why does gastroparesis hurt

Many physicians tend to skip dietary recommendations, although it is the area of most interest to patients. It is important to review the low-fat, low-fiber diet and to discuss nutritional supplements. Rarely, feeding tubes and total parenteral nutrition are necessary. Enteral feeding tubes should be placed in the jejunum, not the stomach. They must be carefully managed to avoid serious complications like infection.

The utility of the prokinetic agents is often limited by their side effects. There is a good bit of anecdotal evidence that medications like amitriptyline can decrease the sensation of nausea. The typical dose is 25—50 mg at bedtime, which is well below the dose that is required to treat depression.

A doctor can check blood levels, and modify the dose accordingly. Side effects, including blurry vision, urinary retention, sleepiness and constipation are uncommon because of the low dose. Bacterial overgrowth SIBO may accompany gastroparesis. The main symptom is bloating.

Judicious use of antibiotics and probiotics may be helpful in the management of these symptoms. It is difficult for patients with nausea and vomiting to tolerate oral medications. Obviously, hospitalized patients should receive intravenous medication. Outpatients may do better with medication that dissolves in the mouth. Reports from highly specialized tertiary medical centers that often see people with severe gastroparesis suggest that bloating is a common symptom.

Bloating impairs quality of life. Bloating severity appears related to intensity of other gastroparesis symptoms but is not affected by gastric emptying rates. Antiemetics, probiotics, and antidepressants with significant norepinephrine reuptake inhibitor activity may help. Abdominal pain may be overlooked in gastroparesis. However, controlling abdominal pain can be the key to success in the management of many patients.

Pain does not correlate with gastric emptying. Low dose tricyclic medications, such as amitriptyline, nortriptyline, and desipramine, have been shown to reduce pain in other functional gastrointestinal GI conditions and may reduce pain associated with gastroparesis. Other drugs found useful in treating neuropathic pain may be tried. Opiates, or narcotics, should be avoided. Not surprisingly, anxiety and depression are very common in people with chronic debilitating illnesses.

The physician and staff need to have compassion and patience. If necessary, psychological consultation should be considered. Low dose tricyclic medications do not treat anxiety or depression. Real emotional disorders require real psychological treatment.

Appropriate treatment can lead to improvement in the GI symptoms. Patients with an eating disorder may be given a diagnosis of gastroparesis.

However, it is probably more common for patients with gastroparesis to be accused of having an eating disorder, rather than actually having one. Patients failing medical therapy should have a thorough evaluation before considering surgical therapy. Surgical procedures all have inherent risks that need to be carefully weighed and understood. Elsevier; Accessed Aug. Cameron AM, et al. Management of motility disorders of the stomach and small bowel. In: Current Surgical Therapy.

Camilleri M. Gastroparesis: Etiology, clinical manifestations, and diagnosis. Treatment of gastroparesis. Parsi MA, et al. Techniques and devices for the endoscopic treatment of Gastroparesis. Gastrointestinal Endoscopy. Hasler WL. Electrical stimulation for gastroparesis. About gastroparesis: Complementary and alternative medicine. International Foundation for Gastrointestinal Disorders.

Brown A. Allscripts EPSi. The goal of the test is to follow this special food as it travels through your system. Unlike diagnostic procedures that require you to fast beforehand, gastric emptying scintigraphy actually requires you to eat this special meal right before the test. This procedure can help diagnose the exact cause of the gastroparesis. Doctors often use it for patients after standard treatments have failed, for surgery candidates and for patients with unexplained nausea.

A wireless motility study evaluates the time it takes for your stomach to empty. This is generally well tolerated and less invasive than other diagnostic studies. The advantage of this method is that you can continue with your normal activities while the capsule gathers the necessary information. The goal in treating gastroparesis is to identify any reversible problems, to correct the underlying disease if possible and to help control symptoms.

Treatment options range from dietary changes to medication or surgery. Health Home Conditions and Diseases. Gastroparesis Symptoms Gastroparesis often causes a number of nonspecific symptoms.

Symptoms of gastroparesis include: An early feeling of fullness Bloating Nausea Anorexia Vomiting Abdominal pain Weight loss Gastroparesis Diagnosis A diagnosis of gastroparesis begins with a comprehensive physical exam during which you describe your symptoms and medical history.

Other tests your doctor may perform include: Endoscopy Upper gastrointestinal barium contrast radiography Gastric emptying scintigraphy Antroduodenal manometry Wireless motility study Upper Endoscopy An endoscope is a thin, flexible tube that your doctor passes through your mouth and into your intestines.

During an upper endoscopy: You receive an anesthetic to help relax your gag reflex. You may also receive pain medication and a sedative. You lie on your left side, referred to as the left lateral position, and the endoscope is inserted through your mouth and pharynx and into the esophagus. The endoscope transmits an image of the esophagus, stomach and duodenum to a monitor that your physician is watching.

During barium contrast radiography: You swallow a contrast solution called barium. The barium coats your esophagus and gastrointestinal tract, making it easier for the doctor to detect abnormalities.

An X-ray is taken. Your doctor can determine if there are delays in the liquid emptying from your stomach. Gastric Emptying Scintigraphy Gastric emptying scintigraphy is the most commonly used test to confirm gastroparesis.

During a gastric emptying scintigraphy: You may be asked to have your blood sugar checked if you are diabetic. Blood sugar values over can interfere with testing.