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Thursday, June 7, 2018

A Collection of Gastroparesis Studies and Research

This article is from 2016, but I still think it's worth sharing. I also want to say that I will keep updating this article for any new studies, research, and new treatments for Gastroparesis. I want it to stay current and it might help someone.




Source: Unknown





According to EMORY:

"Minimally Invasive Procedure for Gastroparesis Shows Promising Results


A minimally invasive procedure at Emory University Hospital is showing promise in patients with gastroparesis, a digestive disorder in which the stomach does not empty food in a normal manner. The results of two small Emory studies were presented recently at the American College of Gastroenterology (ACG) in Las Vegas, where the researchers accepted the 2016 ACG Governor’s Award for Excellence in Clinical Research and the ACG Presidential Poster Award.

Gastroparesis occurs in diabetic patients and other patients with no underlying causes, where the muscles of the stomach and intestines do not properly function. Food then moves slowly or stops moving through the digestive tract.

In one study, Emory researchers performed a retrospective review of data in 10 patients who underwent gastric peroral endoscopic pyloromyotomy or G-POEM for gastroparesis. G-POEM involves guiding a small knife through an endoscope into the submucosal tunnel. Once there, an incision is made in the pyloric ring muscle to release the tightness of that muscle and normalize gastric emptying.

"In these 10 patients, clinical success was defined by improvement of symptoms measured with a decrease in the Gastroparesis Cardinal Score Index (GCSI) and no recurrent hospitalization," says Sunil Dacha, MD, assistant professor of medicine in the Division of Digestive Diseases, Emory University School of Medicine, and a former advanced endoscopic fellow with Qiang Cai, MD, professor of medicine in the Division of Digestive Diseases at Emory, who is an expert in the minimally invasive procedure. "We found G-POEM was clinically successful in eight of the 10 patients (80 percent) with a decrease in mean GCSI from 30.1 prior to the procedure to 12.8 at follow-up."

Gastric emptying studies were obtained on seven of the 10 patients following G-POEM. Results showed gastric emptying had normalized in five patients and improvements were noted in two other patients. Mean four-hour gastric retention decreased from 62.5 percent to 25.4 percent after G-POEM, indicating the stomach emptied much faster at four hours after a meal. A follow-up questionnaire also highlighted significant improvement in quality of life in several areas.

One patient in the study had no response and required hospitalization 15 days after G-POEM and another patient showed no improvement in symptoms.

A second study, presented at the ACG by Abhinav Koul, MD, a former Emory medical resident who worked with Cai, detailed three patients with gastroparesis who had failed gastric electrical stimulation, but showed improvement following G-POEM. Electrical stimulation of the gastric nerves by a small implantable device is one treatment option for patients with gastroparesis. In this retrospective study, Emory researchers determined G-POEM can be performed safely as a salvage therapy for patients with gastroparesis who failed treatment with a gastric stimulator.

The study also found G-POEM improved symptoms (mean GCSI decreased by an average of 64 percent from 27 to 10) as well as gastric emptying (60.6 percent to 18.3 percent mean average) in these patients. However, more data is needed to further define the role of G-POEM in this challenging patient population. Koul is now a clinical assistant professor at the Medical College of Georgia-UGA Medical Partnership at Athens Regional Medical Center.

"G-POEM is showing some positive results as an additional therapeutic modality for patients with gastroparesis who suffer with delayed gastric emptying," says Cai, who also serves as the director of the Advanced Endoscopy Fellowship at Emory. "We are only one of a few centers in the U.S. offering this specialized procedure."

In 2012, Cai started the POEM procedure at Emory University Hospital for patients with achalasia, a disorder of the esophagus that causes swallowing difficulties. He then developed the G-POEM program at the hospital, in hopes of finding alternative treatments for patients with gastroparesis."


Source: The above article



According to THE CLEVELAND CLINIC:


"New Program Offers Multidisciplinary Treatment and Hope to Patients with Gastroparesis


For patients with gastroparesis, long-term relief from nausea, vomiting and bloating may have seemed like an impossible dream. However, medical experts have discovered the secret to conquering this chronic condition. Effective patient care for gastroparesis requires innovative treatment combined with the expertise of physicians from multiple disciplines.


Challenges of traditional treatment

The most common treatments for gastroparesis include pain management, medication and surgery. However, using just one of these treatments is unlikely to relieve the patient’s symptoms. Physicians must consider the patient’s overall health, including diet, psychology and pain levels. When patients receive treatments from physicians in multiple disciplines, the overall treatment plan usually lacks cohesion and focus.

Because gastroparesis is such a rare disorder, few medical centers have had enough exposure to patients with this condition to develop effective treatment plans. Plus, the therapies are evolving so rapidly that many hospitals are struggling to keep up with the changes.

As a result, gastroparesis patients may spend a lot of time and money on various physicians and specialists who are not addressing their condition from a holistic viewpoint. A history of poor, ineffective treatments has left many gastroparesis patients very frustrated.


Convenient, multidisciplinary care

At the Digestive Disease & Surgical Institute, gastroparesis is the number one reason for patient referrals. This influx of patients gives physicians abundant opportunities to gain practical experience diagnosing and treating gastroparesis.

Currently led by Surgical Endoscopist John Rodriguez, MD, and Gastroenterologist Michael Cline, DO, the Gastroparesis Clinic offers a centralized place for patients to consult multiple specialists, including psychologists, gastroenterologists, pain specialists, nutritionists and surgical endoscopists. 'Because they have experience working together to support patients with gastroparesis, they know what works and what doesn’t,' explains Director of Surgical Endoscopy Matthew D. Kroh, MD. 'They also know whom to consult when they’ve hit a roadblock in the process.'

Following the patient’s initial appointments, the multidisciplinary team develops a treatment plan that’s tailored to every aspect of the patient’s condition. Throughout treatment, care team members stay in touch with each other and the patient, making adjustments as needed.The convenience of the Gastroparesis Clinic also contributes to patient ease. 'Our patients can schedule their appointments with multiple doctors over the course of one or two days, making scheduling one less thing that they have to worry about,' says Dr. Kroh. This is especially helpful for patients who must travel a considerable distance to seek treatment at Cleveland Clinic.



POP: Using surgical tools in endoscopic applications

The Digestive Disease & Surgical Institute’s Developmental Endoscopy Group recently used POP to treat several patients with gastroparesis. Led by Dr. Kroh and Medical Director Mansour Parsi, MD, MPH, these experts in gastroenterology, general surgery, colorectal surgery and interventional endoscopy work together to implement and refine POP procedures.

During POP, the physician cuts the pylorus, a muscular valve that empties the stomach, without surgery. Using advanced endoscopic tools, the entire procedure is performed through the mouth without the need for incisions. After the lining of the stomach is opened, only the pylorus is divided under high-definition vision, improving the emptying ability of the stomach.

By using an endoscopic method, the physician decreases the morbidity associated with laparoscopic surgery while delivering the same effectiveness for the patient. Traditional laparoscopic methods for dividing the pylorus muscle can result in pain from the incisions, herniation or leakage from the closure. POP eliminates the access trauma induced by open and laparoscopic surgery.

Many of the new endoscopic instruments and knives used in POP originated in Japan where physicians used them to remove early cancers. These pioneers in minimally invasive technology created a platform that allows Cleveland Clinic physicians to use surgical tools in innovative endoscopic applications.



Promising patient outcomes

The initial patient outcomes for POP procedures performed by the Digestive Disease & Surgical Institute look very promising. Immediately following treatment, physicians have noted symptomatic improvement as well as gastric emptying improvement.

'To finally be able to manage the full spectrum of care for patients who have suffered with gastroparesis for so many years is very rewarding,' says Dr. Kroh. 'Giving these patients the support and treatment they really need — and watching them steadily improve — makes it all worthwhile.'



Ongoing training and development

According to Dr. Kroh, the Developmental Endoscopy Group is busy training physicians in digestive disease fellowship programs at Cleveland Clinic to adopt the latest laparoscopic and endoscopic techniques. “When they graduate, these physicians will be fully prepared to help other hospitals implement innovative treatment programs for gastroparesis,” he reveals.

The Gastroparesis Clinic is a valuable resource for digestive disease physicians who lack experience in treating gastroparesis. 'We would love to have administrators or physicians from other hospitals work with us and do case observations through our clinic,' explains Dr. Kroh. 'This training would help them benefit from our expertise and put our technologies and treatments into practice.'

In support of the Gastroparesis Clinic, the Developmental Endoscopy Group will continue to develop laparoscopic and endoscopic procedures to treat patients with gastroparesis and other digestive disorders.



Source: Article above




According to HEALIO (from 2016):

"Latest Gastroparesis News, Research for Health Care Providers


An estimated 5 million Americans have gastroparesis, according to the International Foundation for Functional Gastrointestinal Disorders.

Michael Camilleri, MD, and colleagues detailed the management of gastroparesis in guidelines issued by the American College of Gastroenterology.

'Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying,' they wrote. '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.'

In a statement for the record, Sen. Tammy Baldwin, D-Wis., brought attention to the condition, which can lead to issues in managing blood glucose levels, dehydration and malnutrition.

'While there is no cure for gastroparesis, some treatments, such as dietary measures, medications, procedures to maintain nutrition, and surgery, can help reduce symptoms,' she said. 'Unfortunately, gastroparesis is a poorly understood condition and so patients often suffer from delayed diagnosis, treatment and management of this disorder. As such, further research and education are needed to improve quality of life for this patient population.'

Relamorelin improves diabetic gastroparesis symptoms

Adults with diabetic gastroparesis experienced accelerated gastric emptying and reduced vomiting with 10 µg of subcutaneous relamorelin administered twice daily, according to phase 2 trial data. Read more.

G-POEM promising minimally invasive treatment for refractory gastroparesis

Mouen A. Khashab, MD, associate professor of medicine and director of therapeutic endoscopy at Johns Hopkins Hospital in Baltimore, discusses positive results from a study of gastric peroral endoscopic myotomy.

FDA issues draft guidance on clinical evaluation of gastroparesis drugs

'The purpose of this guidance is to assist sponsors in the clinical development of drugs for the treatment of diabetic and idiopathic gastroparesis,' the FDA wrote in the draft guidance. 'Specifically, this guidance addresses the [FDA’s] current thinking regarding clinical trial designs and clinical endpoint assessments to support development of gastroparesis drugs,' for which there is an “urgent medical need.'

Age, sex, obesity among factors that affect outcomes in gastroparesis

A recent study found that less than a third of patients with gastroparesis had significant symptom relief after treatment, and identified a number of independent predictors of symptom reduction. Read more.

FDA approves breath test for diagnosis of gastroparesis

The FDA today approved the Gastric Emptying Breath Test, or GEBT, a novel noninvasive diagnostic for gastroparesis.


References:

Camilleri M, et al. Am J Gastroenterol. 2013;doi: 10.1038/ajg.2012.373.

Statement in the Record Recognizing Gastroparesis Awareness Month. International Foundation for Functional Gastrointestinal Disorders website. Accessed August 18, 2016. (**Note, you can read more about topics and procedures in the article itself**)



Source: My friend Alley made this image.






Wednesday, June 6, 2018

Abdominal Migraines

I never knew that abdominal migraines even existed until a friend told me she was diagnosed with them. This intrigued me because I wondered if it was due to Gastroparesis or if it just made Gastroparesis worse? Since June is Migraine Awareness Month, I wanted to do some research on abdominal migraines and go from there, in order to understand it better, and to see if there is a connection between them and Gastroparesis.



Source: National Headache Foundation




According to The American Migraine Foundation,

"The Basics

Abdominal migraine is a form of migraine seen mainly in children. It is most common in children ages five to nine years old, but can occur in adults as well. Abdominal migraine consists primarily of abdominal pain, nausea and vomiting.

It is recognized as an episodic syndrome that may be associated with migraine, as links have been made to other family members having migraines and children who have this disorder often grow into adults with migraine. Most children who experience abdominal migraine grow out of it by their teens and eventually develop migraine headaches.

The pain associated with abdominal migraine is generally located in the middle of the abdomen around the belly button. It is often described as dull or “just sore” and may be moderate to severe. In addition to the pain, there can be loss of appetite, nausea, vomiting and pallor. The attacks last between 2-72 hours and in between attacks there should be complete symptom freedom.

Please refer to the International Classification of Headache Disorders 3rd edition (beta version) website for more information on the criteria used to diagnosis abdominal migraine: https://www.ichd-3.org/1-migraine/1-6-episodic-syndromes-that-may-be-associated-with-migraine/1-6-1-recurrent-gastrointestinal-disturbance/1-6-1-2-abdominal-migraine/


Diagnosis

As with any form of migraine, there is no diagnostic test to confirm abdominal migraine. Diagnosis is achieved by reviewing family and patient medical history, physical examination and performing investigations to rule out other causes of the symptoms.

Examples of other conditions that should be ruled out to arrive at a diagnosis of abdominal migraine include: urogenital disorders, kidney disorders, peptic ulcer, cholecystitis (gall bladder), bowel obstruction, gastroesophageal reflux, Crohn’s disease, and irritable bowel syndrome. If there is any alteration in consciousness, seizure disorders should also be ruled out.


Treatment

For acute treatment of abdominal migraine attacks, medications used for other forms of migraine are often employed. These include hydration therapy (particularly if there has been significant vomiting), NSAIDs, antinausea medication and the triptans. The choice of medications is somewhat affected by the age of the patient. When abdominal migraines are frequent, preventive therapies used for other forms of migraines can be explored. These include pizotifen, flunarazine, propranolol, cyproheptadine and topiramate.


Summary

Abdominal migraine is a sub-type of migraine seen mainly in children. It consists of episodes of abdominal pain with nausea, vomiting, loss of appetite or pallor. Between episodes, there should be no symptoms. Children with abdominal migraine generally go on to develop migraine headaches later in life. People suspected of having abdominal migraine should be carefully assessed by their doctor for an underlying cause as certain gastrointestinal, urogenital or metabolic conditions may mimic abdominal migraine.

Resources:
The International Headache Society. https://www.ichd-3.org/1-migraine/1-6-episodic-syndromes-that-may-be-associated-with-migraine/1-6-1-recurrent-gastrointestinal-disturbance/1-6-1-2-abdominal-migraine/

Gelfand AA. Episodic syndromes that may be associated with migraine: A.K.A. “the childhood periodic syndromes”. Headache. 2015;55(10):1358-1364.

Evans RW, Whyte C. Cyclic vomiting syndrome and abdominal migraine in adults and children. Headache. 2013;53(6):984-993."





Source: http://headacheandmigrainenews.com/6-key-stomachgut-terms-related-to-migraine/






It seems to me that it mimics a lot of the same symptoms of Gastroparesis. According to Healthline,

"What is an abdominal migraine?

An abdominal migraine is a type of migraine that affects mostly children. Unlike migraine headaches, the pain is in the belly — not the head.

Abdominal migraines often affect kids between ages 7 and 10, but sometimes adults can get them too. This type of migraine is uncommon, affecting between 1 percent and 4 percent of children.

An abdominal migraine can easily be confused with other, more common causes of stomachaches in children, such as irritable bowel syndrome (IBS) and Crohn’s disease.


Symptoms of this type of migraine

The main symptom of an abdominal migraine is pain around the belly button that feels dull or achy. The intensity of the pain can range from moderate to severe.

Along with the pain, kids will have these symptoms:

nausea
vomiting
appetite loss
pale skin

Each migraine attack lasts between one hour and three days. In between attacks, kids are healthy and have no symptoms.

The symptoms of an abdominal migraine are similar to those of many other childhood gastrointestinal (GI) conditions — that is, those involving the digestive system. The difference is that abdominal migraine symptoms come and go with days to months of no symptoms. Also, each episode of abdominal pain is very similar.


Causes and triggers of abdominal migraines

Doctors don’t know exactly what causes abdominal migraines. It could share some of the same risk factors as migraine headaches.

One of the theories is that abdominal migraines stem from a problem in the connection between the brain and GI tract. One very small study also found a link between this condition and slower movement of digested food through the intestines.

Abdominal migraines are more common in children who have close relatives with migraine headaches. One study found that more than 90 percent of kids with this condition had a parent or sibling with migraines.

More girls than boys get abdominal migraines.

Certain factors seem to trigger abdominal migraines, including stress and excitement. Emotional changes might lead to the release of chemicals that set off migraine symptoms.

Other possible triggers include:

nitrates and other chemicals in processed meats, chocolate, and other foods
swallowing excessive amounts of air
exhaustion
motion sickness



Treatment options

Some of the same medicines used to treat migraine headaches also help with abdominal migraines,


including:

nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin IB, Advil)
anti-nausea medicines
triptan migraine drugs, such as sumatriptan (Imitrex) and zolmitriptan (Maxalt), which are the only triptan drugs approved by the U.S. Food and Drug Administration (FDA) for children over 6 years old.
Other medicines used to prevent migraines may prevent abdominal migraines if your child takes them every day.


These include:

cyproheptadine (Periactin)
propranolol (Hemangeol, Inderal XL, InnoPran XL)
topiramate (Topamax, Qudexy XR, Trokendi XR), which is FDA approved for children over 12 years old
Be sure your child is getting enough sleep, eating regular meals throughout the day, and drinking plenty of fluids (without caffeine).

If your child is vomiting, give them extra fluids to prevent dehydration.

Certain foods — such as chocolate and processed foods — may set off abdominal migraines. Keep a diary of your child’s diet and migraine attacks to help you identify their trigger foods and avoid them in the future.

Cognitive behavioral therapy (CBT) can help relieve stress, which is thought to be another cause of abdominal migraines.



How are they diagnosed?

Doctors don’t have a test specifically for abdominal migraines. Your doctor will start by asking about your child’s medical history and your family’s medical history. Children with abdominal migraines often have family members who get migraines.

Then the doctor will ask about your child’s symptoms. Abdominal migraines are diagnosed in children who meet these criteria:

at least five attacks of abdominal pain that each last 1 to 72 hours
dull pain around the belly button that may be of moderate to severe intensity
at least two of these symptoms: appetite loss, nausea, vomiting, pale skin
no evidence of another GI condition or kidney disease
The doctor will also perform a physical exam.

Though usually ruled out by your child’s history and physical exam, tests such as ultrasound or endoscopy can be done to look for conditions that have similar symptoms, such as:

gastroesophageal reflux (GERD)
Crohn’s disease
IBS
bowel blockage
peptic ulcer
kidney disease
cholecystitis


Complications of abdominal migraines

Abdominal migraines can be severe enough to keep children out of school for a few days at a time. Because this condition is easy to mistake for other GI diseases, kids who are misdiagnosed may end up undergoing unnecessary procedures.


Outlook
Kids usually grow out of abdominal migraines within a year or two. However, up to 70 percent of these children will go on to develop migraine headaches when they grow up. Some will also experience abdominal pain in adulthood."


I know that these sources have said that mostly children get abdominal migraines, but adults do too. Here is a study of a thirty-two year old woman with abdominal migraines:

Source:https://www.researchgate.net/publication/236836632_Abdominal_Migraine_in_Adults_A_Review_of_Pharmacotherapeutic_Options_June




It seems like it would be very difficult to diagnose in Gastroparesis Warriors because a lot of us already suffer from the same symptoms that abdominal migraines cause. I have not found a lot in regards on how to tell if you have an abdominal migraine, only that it lasts up to seventy-two hours. I know migraines are different Gastroparesis (vagus nerve damage usually), but the vagus nerve does control your memory. I have written an article about it previously, if you want to see everything that the vagus nerve controls: http://www.emilysstomach.com/2016/07/information-about-vagus-nerve.html




Source: listed on the image




I just wonder if there is a correlation between a damaged vagus nerve and abdominal migraines? I have not found anything in my research that supports that except for what the vagus nerve controls. I will try to keep this article updated and try and find the answers to questions that I have about this condition.


Source: The Daily Mail

This person's story really touched me. I know that mostly children get abdominal migraines than adults do, now that I have read some studies and done some research. The doctors treat them the same way they treat Gastroparesis patients, like it is not real, or that we are faking. There are a million reasons we are not believed but her son's story touched my heart. You can read it here: http://www.dailymail.co.uk/health/article-1053613/Seizures-stomach-pains-If-think-symptom-migraine-headache-think-.html


Above is a chart of Abdominal Migraines but I also included another chart with different kinds of Migraines I have never heard of before. I hope this will help someone out there, struggling with these symptoms.


Source: on the image

Monday, April 9, 2018

Addressing Emails Written to Me



I wanted to thank everyone for their emails. I am so sorry it's taken me so long to get back to you and to answer them. I am currently trying to answer as many as I can tonight, but will spend tomorrow trying to get you answers as well, if you still need them. I have emails going back to August. I want to apologize to all who have sent me emails. I hate making excuses but maybe if you understand what I'm going through, you'll understand.

I had to have several back surgeries. Because I bend repetitively to vomit, which is a reflex I cannot stop, I have slipped a disc, which lead to sciatica. It was very painful and resulted in a series of Facet Injections and then I had an RFA done on both sides of my spine to burn the nerves. It did help, greatly! The sciatica went away and I felt much better but I was having procedure after procedure because the doctor wanted to be safe and not do the RFA at the same time for both sides.

On top of all of that, my Gastroparesis has been really rough. I fell about two weeks ago, because my cat jumped on the bed and clawed my leg really hard and it startled me, so I jumped and hit my head on my nightstand and hurt myself pretty bad. I landed on my lamp and destroyed it, cutting myself on the bulb and glass shards. I also ripped the battery of my Spinal Cord Stimulator out of the pocket my doctor made for it. The battery is supposed to lay flat, but with me, it's protruding out of my back at about a 45 degree angle and is rather painful. So, I am working on getting this fixed.











These images made me laugh and I wanted to share them, especially the Simpson's one. I do feel like I'm under construction, but I'm going to fight through these surgeries and my Gastroparesis, and come out STRONGER!










Even though I have a lot going on - I Promise that I WILL check my email at: emilysstomach@gmail.com at least once a week on Mondays, if not more. I will definitely promise that. I am still catching up on emails and have already written some of you back. Please don't stop emailing me. If you have a question, I will do my best to answer it or refer you to someone who can. I love getting your emails. If I don't reply right away, please just be patient with me.










For those who have sent me their TIMELINES: http://www.emilysstomach.com/2013/05/progressional-timeline-of-gastroparesis.html


I have them and thank you so much for taking the time to do them and send them to me! I have a lot of them to go through but I cannot wait to go through them and let you guys know if I find any patterns or anything interesting. I know it's subjective because it's not medical records, and people's memories can be tricky, but it might spark a conversation or inspire doctors to do a research project like this regarding Gastroparesis.


So, from the bottom of my heart, thank you!


Heidelberg pH Test

What is a Heidelberg pH Test? A friend mentioned he had this test on a comment on one of my pages on Facebook. I had never heard of this test before, so I wanted to do some research into it. As it turns out, this test really does encompass a wide range of things it tests for. It reminds me of the Smart Pill test, in a way, but broadened. So, after reading about it, below is the information I found concerning the test.




According to Heidelberg Medical,

"What is a Heidelberg pH Test?

The Test will accurately verify the presence of a common Digestive Disorder

The Physician will require a complete Medical History before the Test

There will be a Transceiver that is placed over the Patient’s stomach during the test.

The pre test instructions will help achieve the most accurate results.

There is no discomfort during a Heidelberg pH test. Patients are relaxed and comfortable.

Remember to grab a good old fashioned distraction to pass the time.

Due to wireless interference, cell phones and personal electronic devices may need to be powered off.

The results are immediate so the Physician may have the post test consultation the same day.






Image Source: http://www.phcapsule.com/physicians/system-configurations/





Heidelberg pH Diagnostic Test will accurately verify the presence of low stomach acid production, high stomach acid production, no acid in the stomach, Dumping Syndrome, Acute or sub Acute Gastritis, Heavy Mucus in the stomach, and Pyloric insufficiency.

The Test is accomplished by measuring the time it takes for the acid producing cells (Parietal Cells) in the stomach to produce the required Hydrochloric acid. The strength of the acid (pH) is also measured during the test.

Patients are required to complete a consent form for the Physician’s Office Staff. If you have reservations about having a pH test, please discuss them with the Physician. Mental anguish and stress will only alter the test results.

The Technician will calibrate the pH Capsule to ensure it accurately records the pH values. The Technician will then place a transceiver over the Patient’s stomach. The transceiver receives and transmits the information from the pH Capsule and sends it wirelessly to the computer where the information is displayed. The nurse will rinse the pH Capsule and give it the Patient to swallow with a sip of water.

There is no discomfort during a Heidelberg pH Test. Patients are asked to relax and get comfortable while the test is being done. Remember to grab a good old fashioned distraction to pass the time.

Results are ready for the Physician to review as soon as the Technician ends the Test. Many Physicians opt to have a post test consultation as soon as the test is complete. In many cases the doctor will establish a treatment protocol on the same day. In many instances, after testing and treatment, patients stated that they feel better and healthier in just two or three days.


Unlike other procedures, the Heidelberg pH diagnostic test is an in-office procedure that does not require sedation or the use of a stomach tube.

There is no trauma or discomfort associated with our test, and the results of the Heidelberg test are available to the doctor as soon as the test is complete. Why go through an unpleasant procedure like the nasal-gastric intubation, when you can have a Heidelberg Diagnostic test?




Physicians

As the examining Physician, you will always hear a wide spectrum of complaints from your patients. By adding The Heidelberg pH Diagnostic System to your method of testing, you can be assured of having a comprehensive overview of the patients’ first stage of digestion. We believe you will find that the results of your treatment protocols will be enhanced from the pH data, which this test provides. There is no guess work involved and the test results are reproducible.

When the total digestive system is in pH balance, You can expect higher levels of conversion and absorption of ingested foods and medications. In addition, you can expect an appreciable enhancement of the patient’s immune systems! This is a very encouraging step for all aspects of successful treatment! The digestive system supports the immune system. Without proper conversion and absorption of the foods, medications, and supplements, the immune system cannot function at its optimum level. The Heidelberg pH Diagnostic System can be used to bring the first stage of digestion to its optimum performance level for good conversion and absorption.





Researchers

The Heidelberg Diagnostic technology has been used over the past 39 years by Researchers and Pharmaceutical companies throughout the world.

Some of the recognized Pharmaceutical companies are; Pfizer (Global Research and Development), Boehringer Ingelheim, Tap Pharmaceuticals, Bayer, Merck, Glaxo, SmithKline and Novo Nordisk (Denmark).

When a pharmaceutical company develops a new medication, they use the Heidelberg diagnostic system to perform pharmacokinetic studies to determine the activity of the medication on the human body. This is where, in many cases, the Heidelberg technology becomes a valuable research tool, in assuring the safety of a newly developed medication. These studies are use to determine bodily absorption, distribution, metabolism and excretion of drugs.

Before testing newly developed medications on humans, many pharmaceutical companies test their products on animals. Tests on animals include the use of swine, dogs, monkeys, etc. As part of their approval process, the Food and Drug Administration (FDA) requires testing of many newly developed medications in humans before being approved for use in the open market.

Researchers in many medical teaching colleges and research facilities use the Heidelberg Diagnostic system for testing the side effects of drugs. They also monitor the body pH when testing new vaccines to counter the effect of contagious diseases.

The Pharmaceutical Grade Heidelberg Diagnostic system can be configured to test from 1 to 8 subjects at the same time without interaction. Custom built systems can be configured to test 16 or more subjects at the same time without interaction.

Our current Bibliography of research studies contains over 150 published studies, conducted by researchers, pharmaceutical companies, clinicians, medical teaching colleges and hospitals. A copy of these studies are available upon request.





Image Source: https://sites.google.com/a/wyckoffschools.org/food-lab/digestion-and-ph






Heidelberg pH Diagnostic Systems

The Portable Heidelberg pH Diagnostic System is an innovative system that is ideal for any busy practice, where a stationary desktop computer system would have it’s limitations. It can be transported from one room to another, or from one facility to another. The dedicated laptop computer, and a compact micro-jet printer, is placed on a movable medical grade laboratory cart that has lockable casters, with an Uninterrupted Power Supply (UPS system), with an 8 foot electrical cord. The laboratory cart has a built security feature that allow you to safely store your computer, printer and other equipment in a lockable storage cabinet, when they are not being used. The portable Heidelberg pH Diagnostic System can be used for single, or multiple, patient pH Diagnostic Testing.

The standard clinical grade Heidelberg Diagnostic systems can be configured to test from 1 to 8 patients simultaneously without interaction. Our custom built systems can be configured to test from 1 to 16 patients at the same time without interaction.




Image Source: http://www.phcapsule.com/





Exclusivity

The FDA requires that system operators (nurses or technicians) be training in the use of the system and do testing under the supervision of a licensed physician. Third party reimbursement depends on individual states and individual insurance companies, and the form in which the CPT coding is submitted.

The Heidelberg pH Capsule package insert reads: CAUTION: Federal law restricts this device to sale only by, or on the order of a qualified physician. A patient history and examination are required before administering this diagnostic test.

Example: Crohn’s Disease, or any history of intestinal blockage, adhesions and/or history of bleeding.


We are active with clinical pharmacology and pharmacokinetic research studies with major universities and major American and European pharmaceutical companies.

View our testing software simulation.


Included…

Medical Grade Lab Cart
Dedicated Laptop Computer
Heidelberg Interface Module
Heidelberg Digital Transceiver
Portable Ink Jet Printer
Comprehensive Technical Training Videos
Comprehensive Technical Training Manual
Heidelberg Testing Program CD Package
Capsule Calibration Test Fixture
1 Pint (500 mL) pH 1 Calibration Solution
1 Pint (500 mL) pH 7 Calibration Solution
Uninterrupted Power Supply(UPS System)
Additional Equipment…


pH Capsule Locator

The per test disposables are pH capsules, distilled water and Saline. Everything else necessary, for over a hundred pH tests, is included with the system purchase."






Image Source: http://www.phcapsule.com/patients/faqs/

Gastroparesis and Eating Disorders Part Deux: What is the Difference?

I was watching a documentary about Amy Winehouse, and I had so much going on personally when she was going through her own troubles, that I did not give her a lot of thought. I was really sick, and knew there was something really wrong with me but the doctors who were testing me for different things could not find an answer, until 2012, when I was finally diagnosed with Gastroparesis. I had never heard of Gastroparesis before then and made it my mission to find out more about it, start my blog to keep track of research, and start Facebook pages and groups to help others who may have been diagnosed with the same.

I have been really sick the past week because of allergies to things growing, so I have a lot of mucus production, plus the nausea that comes with the mucus draining down my throat, and the throwing up of mucus and stomach acid because I have not been able to eat. I watch movies and listen to music to distract myself from the nausea, and I also use it to get me through the vomiting attacks. That sounds weird, I know, but it helps me to have something else to focus on. Because I have been sick for the past week, I've finally gotten to see Amy. I want to say that I have written about Gastroparesis vs Eating Disorders in the past, and you can read it here: http://www.emilysstomach.com/2015/04/gastroparesis-vs-eating-disorders.html.

I loved Amy Winehouse's music and her voice was a welcomed change at the time from the other voices already on the scene. She was not a part of a girl group, she did not look like a carbon copy of anyone, and she maintained her individuality. That is a feat that is hard to do in the entertainment industry when people are trying to market you, and are concerned with sales. I wanted to talk about her because something in her documentary bothered me more than anything else that was mentioned. She went to her mother and father, telling them about a diet she found where she could eat anything, and then vomit it all back up later. Her parents can be heard in the film saying they thought it would pass. However, it would not pass because it was bulimia.

According to National Eating Disorders (NEDA)

"Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.



Image Source: http://www.geronguide.com/gallery/index.php/Bulimia-Nervosa/bulimia-06




DIAGNOSTIC CRITERIA

According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).

Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.




WARNING SIGNS & SYMPTOMS OF BULIMIA NERVOSA

Emotional and behavioral

In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns

Evidence of binge eating, including disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food

Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics

Appears uncomfortable eating around others

Develops food rituals (e.g. eats only a particular food or food group [e.g. condiments], excessive chewing, doesn’t allow foods to touch)

Skips meals or takes small portions of food at regular meals

Disappears after eating, often to the bathroom

Any new practice with food or fad diets, including cutting out entire food groups (no sugar, no carbs, no dairy, vegetarianism/veganism)

Fear of eating in public or with others

Steals or hoards food in strange places

Drinks excessive amounts of water or non-caloric beverages

Uses excessive amounts of mouthwash, mints, and gum

Hides body with baggy clothes

Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury—due to the need to “burn off ” calories

Shows unusual swelling of the cheeks or jaw area

Has calluses on the back of the hands and knuckles from self- induced vomiting

Teeth are discolored, stained

Creates lifestyle schedules or rituals to make time for binge-and-purge sessions

Withdraws from usual friends and activities

Looks bloated from fluid retention

Frequently diets

Shows extreme concern with body weight and shape

Frequent checking in the mirror for perceived flaws in appearance

Has secret recurring episodes of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances); feels lack of control over ability to stop eating

Purges after a binge (e.g. self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting)

Extreme mood swings

Physical

Noticeable fluctuations in weight, both up and down

Body weight is typically within the normal weight range; may be overweight

Stomach cramps, other non-specific gastrointestinal complaints (constipation, acid reflux, etc.)

Difficulties concentrating

Abnormal laboratory findings (anemia, low thyroid and hormone levels, low potassium, low blood cell counts, slow heart rate)

Dizziness

Fainting/syncope

Feeling cold all the time

Sleep problems

Cuts and calluses across the top of finger joints (a result of inducing vomiting)

Dental problems, such as enamel erosion, cavities, and tooth sensitivity

Dry skin

Dry and brittle nails

Swelling around area of salivary glands

Fine hair on body

Thinning of hair on head, dry and brittle hair (lanugo)

Cavities, or discoloration of teeth, from vomiting**

Muscle weakness

Yellow skin (in context of eating large amounts of carrots)

Cold, mottled hands and feet or swelling of feet

Menstrual irregularities — missing periods or only having a period while on hormonal contraceptives (this is not considered a 'true' period)

Poor wound healing


Impaired immune functioning





Image Source: https://anorexianervosaforpharmacists.weebly.com/eating-disorders.html





Many people with bulimia nervosa also struggle with co-occurring conditions, such as:

Self-injury (cutting and other forms of self-harm without suicidal intention)
Substance abuse
Impulsivity (risky sexual behaviors, shoplifting, etc.)
Diabulimia (intentional misuse of insulin for type 1 diabetes)
Learn more about co-occurring conditions





Image Source: https://www.fullcirclehealthcareinc.com/eating-disorders.html





HEALTH CONSEQUENCES OF BULIMIA NERVOSA

The recurrent binge-and-purge cycles of bulimia can affect the entire digestive system and can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.

The body is generally resilient at coping with the stress of eating disordered behaviors, and laboratory tests can generally appear perfect even as someone is at high risk of death. Electrolyte imbalances can kill without warning; so can cardiac arrest. Therefore, it’s incredibly important to understand the many ways that eating disorders affect the body."
**You can get the same dental effects from Gastroparesis, see my article: http://www.emilysstomach.com/2017/12/gastroparesis-effects-on-dental-health.html





Image Source: https://it.123rf.com/photo_71030037_la-bulimia-%C3%A8-un-disturbo-alimentare-binge-eating-e-tentativi-di-sbarazzarsi-del-cibo-consumato-segni-e.html




Image Source: http://gi-north.com/are-you-at-risk-for-gastroparesis/


I found this article while I was doing research on eating disorders and Gastroparesis. I thought it would bring hope to those who have both, or maybe just have an eating disorder. According to Mirror Mirror, Eating Disorder Help,

"GI Symptoms in Eating Disorders

Gastrointestinal (GI) complications are commonly seen with anorexia, bulimia and binge eating disorder. Heartburn, gas, bloating, early fullness, nausea, abdominal distention, rectal pain, constipation or diarrhea might be considered simply 'irritable bowel syndrome' – potentially delaying rapid diagnosis and treatment of an underlying eating disorder. Often referred to as functional gut disorders, there is an impairment in the body’s normal 'functioning,' such as delayed movement of food through the digestive tract, hypersensitivity of intestinal nerve cells, and the way in which a person’s brain responds to these stimuli (1). Re-feeding and in turn, recovery, is difficult physically as well as emotionally.


Anorexia Nervosa, Restricting-Type

gastrointestinal symptoms eating disorders

Prolonged food restriction causes muscular atrophy of the entire digestive tract. This leads to slow stomach emptying (called Gastroparesis) and is a direct cause of the trapped gas, bloating and abdominal distention seen with anorexia. Post-meal pain, pressure and constipation can be quite severe.

Consumption of sugar-free products and high fiber fruits and vegetables to blunt hunger can add to GI discomfort. Sorbitol — found in sugar-free gums and mints, and fructose –found in many fruits — can increase gas production. Psychological factors such as depression and/or anxiety, as well as pelvic floor dysfunction, can lead to heightened awareness of pain sensations in the gut, making the problem feel even worse (2,3).

A rare but documented cause of severe abdominal pain can be seen in extremely malnourished individuals. It is called Superior mesenteric artery (SMA) syndrome and is caused by compression of the artery by the first portion of the intestines called the duodenum (4). This is a medical emergency and therefore is imperative that individuals struggling with overcoming any type of eating disorder work with medical professionals to safely guide and monitor them.



Bulimia Nervosa

Purging can lead to a condition known as acute sialadenosis, in which the parotid glands become swollen and painful. This condition will cause an individual to have a characteristic “chipmunk-like” appearance. Treatment involves warm compresses, tart candies, and anti-inflammatory medication (5). Individuals struggling with bulimia also experience gas, bloating, indigestion and constipation as well as gastritis, an inflammation of the lining of the stomach causing upper abdominal pain.

Upper GI symptoms of acid reflux occur due to repeated bouts of self-induced vomiting. The valve (called a sphincter) that controls the connection between the stomach and esophagus becomes floppy, allowing stomach acids and partially digested foods to back up through the esophagus and into the throat. This is involuntary and may cause erosion of the mucosa of the esophagus, leading to a condition known as Barrett’s esophagus, a pre-cursor to esophageal cancer (3). Repeated bouts of self-induced vomiting can ultimately cause tears in the esophagus, referred to as a Mallory Weiss Tears. Vomiting blood is a very frightening experience and requires emergency medical care. Daily vomiting can put tremendous strain on the heart muscle resulting in arrhythmias, palpitations and death (4).

Bloodwork may show characteristic abnormalities more commonly seen when purging becomes frequent and habitual. The pancreas and liver enzymes may be elevated without other symptoms and electrolyte levels may be abnormal (5,6)

Difficulty swallowing is another problem commonly seen in anorexia and bulimia and may be related to the loss of muscle tone in the esophagus. It is important to see a physician when a patient complains of difficulty swallowing while increasing nutrition.




Image Source: http://www.eatingdisorderpro.com/2013/02/28/diabulimia/





Other purging disorders – Laxatives, Diuretics and Exercise

Laxative abuse has been reported in more than 1/3 of patients with eating disorders. Patients believe they are purging calories to stay thin, when in fact, most absorption of calories occurs in the small intestine. Most commonly (though not exclusively) seen in patients with bulimia, laxative abuse causes the bowel to become dependent on laxative stimulation to pass a bowel movement. Individuals who use laxatives, diuretics or both (to purge calories) become severely and chronically dehydrated. Kidney function can then suffer impairment from chronic depletion of blood flow due to dehydration. Stimulant laxatives work by irritating the nerves that stimulate the colon to cause frequent watery stools, while bulk-forming laxatives work by increasing stool mass to the point the bowels force it out.

This chronic overstimulation can cause complete bowel shutdown which is referred to as cathartic colon. Once a patient’s colon becomes incapable of transporting fecal material, they may require partial or complete colon resection, or even require a colostomy bag (7,8). Additionally, stopping these behaviors ‘cold turkey’ can cause extreme fluid shifts, renal shutdown and life threatening electrolyte imbalance. This is referred to as Pseudo-Bartters syndrome. (5,6) Medical practitioners need to carefully monitor patients as they wean off laxatives and diuretics for this reason. Over exercise is another form of purging behavior.



Rectal Prolapse

Rectal prolapse occurs when the rectum protrudes outside the opening of the anus. Although not a common feature, rectal prolapse has been seen in patients who binge and purge, and in patients suffering from severe constipation and/or laxative abuse.

Increased intraabdominal pressure from vomiting, among other factors such as medication, poor diet and low fiber intake contribute to this condition. Surgical treatment is the definitive treatment for recurring prolapse but steps to prevent further constipation are essential. (5,6)




Binge Eating Disorder

Individuals who binge-eat tend to have erratic and irregular eating patterns around all meals, in turn causing a host of GI symptoms including constipation, gas, bloating and diarrhea.

Patients with anorexia who binge eat are at risk for acute gastric dilatation. This is due to slow gastric emptying and overeating large volumes in the face of weakened stomach musculature. The large quantity of food exceeds the stomach’s ability to empty which obstructs of blood flow to the stomach and intestines. The result is potential rupture of the stomach (4). Symptoms include vomiting, severe abdominal distention and pain.




Practical Suggestions to Reduce GI Discomfort While Recovering

It is advisable to see a physician to evaluate the many causes of gastrointestinal distress. Although many symptoms mentioned resolve with normal eating, it is important to rule out the potentially serious GI issues we see commonly with eating disorders.

The best long term relief for the discomfort accompanying normalized eating at the start of recovery is to schedule meals, snacks and fluids at regular intervals, and to sit calmly and mindfully while eating. Often referred to as “the rule of threes” (7,8) it is advisable to consume three meals and three snacks, at least three hours apart. Re-introducing foods as well as any type of nutritional supplementation should be done under the proper care and guidance of a physician and the dietitian to collaboratively treat these problems in a multidisciplinary approach.



GI Symptoms in Eating Disorders



Constipation Relief

For people with eating disorders, adequate fluids and fiber are the first line treatment for chronic constipation. It is advisable to increase fiber intake slowly to avoid additional gas and bloating. Examples of fiber-rich foods include whole grain breads and cereals, bran, nuts and seeds, lentils, beans and some fruits and vegetables.

Patients who are continuing to struggle with constipation should consult with their physicians for any potential medication needs. The fact remains that with continued good eating over time, many of these GI complains will resolve.



Gas, Bloating and Cramping

Physicians will recommend simethicone (Gas-X) to help with gas pain, and recent clinical guidelines by the American College of Gastroenterology suggest the use of metoclopramide (Reglan) to help with slow gastric emptying (9). Metoclopramide increases muscle contractions in the upper digestive tract and speeds up the rate at which the stomach empties into the intestines. This medication must be given with caution, however, as it can affect the heart rate of someone with anorexia.

One of the main goals in treating the GI symptoms of bulimia is to reduce and eliminate purging behavior. In cases where associated heartburn is frequent doctors will recommend a protein-pump inhibitor, a medication that protects the esophageal wall by reducing the stomach’s production of gastric acid.

In some cases, therapies to calm the gut including meditation or anti-anxiety meds, can be quite helpful. It is important to note that 'special' diets, or eliminating certain foods in an attempt to alleviate symptoms is not wise to try while in recovery. Dietitians need to individualize meal plans for the specific needs of each client.




Final Words

If you are in recovery or caring for someone in recovery, the abdominal discomfort with eating is very real. The body has gotten used to eating smaller amounts of food and the additional anxiety of increasing intake is truly distressing. As long as you’ve consulted a medical professional, the best treatment for GI upset is to continue following a plan of regular meals and snacks. Some patients have found heat pads or hot water bottles placed directly on the belly after meals to be helpful when pain is severe.





New Research Ahead – The Role of the Intestinal Microbiota

New research on the role of the intestinal microbiota in anorexia and other eating disorders is exciting. This research looks at the enteric nervous system, comprised of more than 100 million nerve cells lining your entire GI tract. This neural complex is thought to be equivalent to “a second brain” affecting digestion, weight regulation and even mood. Entirely new treatments are on the horizon as we begin to understand the interactive regulation that now clearly exists between the gut and the brain (10). Hopefully, we will continue to find new treatments for the gastric distress that eating disorder sufferers encounter as they work towards meaningful recovery.




Image Source: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/psychiatry-psychology/eating-disorders/




About The Author:

Erica Leon, MS, RDN, CDN, CEDRD is the founder of Erica Leon Nutrition. She specializes in nutrition counseling for eating disorders and unhealthy eating patterns, as well as intuitive eating coaching.

Thank you so much to the following clinicians who kindly (and generously) reviewed this paper for accuracy of content:

Marcia Herrin, EdD, MPH, RDN, LD, FAED
Fellow, Academy of Eating Disorders
Author: The Parent’s Guide to Eating Disorders (Gurze Press, 2007) & Nutrition Counseling in the Treatment of Eating Disorders (Brunner-Routledge, 2013)

Patsy Catsos, MS, RDN, LD
Digestive Health Expert
Author: IBS—Free at Last! (2012)
Nutrition Works

References:

1) Janssen, P. Viewpoint, Can eating disorders cause functional gastrointestinal disorders? Neurogastroenterol Motil 2010; 22:1267-1269.

2) Wang, X, Luscombe, G, Boyd, C et al, Functional gastrointestinal disorders in eating disorder patients: Altered distribution and predictors using Rome III compared to Rome II criteria, World J Gastroenterol 2014; Nov 21; 20 (43): 16293 – 16299.

3) Sato, Y, and Fukudo, S, Gastrointestinal Symptoms and disorders in patients with eating disorders, Clin J Gastroenterol 2015; 8:255-263.

4) Norris, et al. Gastrointestinal Complications Associated with Anorexia Nervosa: A Systematic Review. Int J Eat Disord 2016; 49:3 216-237.

5) Mehler, S & Walsh, K, Electrolyte and Acid-Base Abnormalities Associated with Purging Behaviors. Int J Eat Disord 2016; 49:3 311-318.

6) Forney, J, Buchman-Schmitt, J et al, The Medical Complications Associated with Purging. Int J Eat Disord 2016; 49:3 249-259.

7) Herrin, M & Larkin, M, Nutrition Counseling in the Treatment of Eating Disorders, 2nd ed. Publ. Taylor & Francis, 2012.

8) Herrin, M & Matsumoto, N, The Parent’s Guide to Eating Disorders, 2nd Ed. Publ. Gurze Books, 2007.

9) Camilleri, M et al. Clinical Guideline: Management of Gastroparesis. Am J Gastroenterol, 2013; 108: 18-37.

10) Kleiman, S, Carroll, I, et al. Gut Feeling: A Role for the Intestinal Microbiota in Anorexia Nervosa? Int J Eat Disord 2015; 48 (5):449-451."


There is a wonderful documentary that looks into recovery of people who are facing an eating disorder. Even if you have Gastroparesis and no eating disorder, I would recommend this video highly. It brought me to tears. It's a really well done documentary:

https://youtu.be/mU6MT6Bzyw0



Eating disorders like Bulimia can lead to motility disorders like Gastroparesis. A lot of people have trouble understanding the difference between an eating disorder like Bulimia and a motility disorder like Gastroparesis, because both include vomiting and with Gastroparesis, there is the ability to get full easily because you retain food in your stomach because the stomach does not function normally.

People with Gastroparesis can gain weight instead of losing weight, but that does not mean they are not malnourished or vitamin deficient. A lot of people with Gastroparesis lose weight, and they do not want to lose the weight because they get down to scary levels of weight loss. Most people end up with a feeding tube at that point or TPN, because there is not much in the way of treatment for Gastroparesis. Bulimics can develop Gastroparesis and motility disorders because of the vomiting and weight loss. They can damage their vagus nerve, which controls so much in your body. if you do have an eating disorder and have been diagnosed with Gastroparesis, I do have a support group that you can join to talk to others and get support from others in the same position at: https://www.facebook.com/groups/GPandEDSupport/. You are NOT alone.

Gastroparesis, according to the Mayo Clinic, is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach's motility is slowed down or doesn't work at all, preventing your stomach from emptying properly. Gastroparesis can interfere with normal digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition. The cause of gastroparesis is usually unknown. Sometimes it's a complication of diabetes, and some people develop gastroparesis after surgery. There is no cure for Gastroparesis.

The Medscape Journal of Medicine has a really detailed, in depth look into Gastroparesis and what causes it. You can read the article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2258461/, but I will post an excerpt here,

"Gastroparesis presents with symptoms of gastric retention and nongastrointestinal manifestations, with objective evidence of delayed gastric emptying in the absence of mechanical obstruction. Diabetic, idiopathic, and postsurgical gastroparesis are the most common forms, although many other conditions are associated with symptomatic delayed gastric emptying (Table 1). Gastroparesis is estimated to affect up to 4% of the US population[1] and may produce either mild, intermittent symptoms of nausea, early satiety, and postprandial fullness with little impairment of daily function, or relentless vomiting with total disability and frequent hospitalizations. A recent report estimated that inpatient costs for patients with severe gastroparesis approach $7000/month.[2]

Gastroparesis presents with a constellation of symptoms. In one study, nausea was reported by 93% of patients whereas early satiety and vomiting were noted by 86% and 68%, respectively.[3] In another series, nausea, vomiting, bloating, and early satiety were reported by 92%, 84%, 75%, and 60% of patients, respectively.[4] Many patients in both case series (89% and 46%) also reported abdominal pain (Table 2). Others experience heartburn from acid reflux into the esophagus that is facilitated by fundic distention which increases the rate of transient lower esophageal sphincter relaxations.[5] Although some gastroparetics with frequent vomiting lose weight and develop malnutrition, most patients were overweight or obese in one series, indicating that the disorder does not necessarily restrict food intake.[6] Phytobezoars are organized concretions of indigestible food residue that are retained within the stomach. These may increase gastroparesis symptoms or produce a palpable epigastric mass, gastric ulceration, small intestinal obstruction, or gastric perforation.[7] Bezoars are eliminated by endoscopic disruption and lavage, enzymatic digestion (papain, cellulose, or N-acetylcysteine), and dietary exclusion of high-residue foods. Variably delayed gastric emptying may cause unpredictable food delivery in diabetics with gastroparesis, affecting glycemic control and increasing risks of both severe hypo- and hyperglycemia.[8]

Gastroparesis has many causes. In a case series of 146 gastroparesis patients seen at a large US tertiary medical center, 29% had underlying diabetes, 13% developed symptoms after gastric surgery, and 36% were idiopathic.[4] The mean age of onset for gastroparesis is 34 years. Eighty-two percent of cases occur in women.[4]"



Image Source: http://studylib.net/doc/7356614/super-cereal-recipes



If you do have an eating disorder, and you want to get help - there are several ways you can do so. You can make an appointment with your primary doctor, who can refer you to a doctor who can help you. There are several numbers you can call for help and links below (click on the bold words):

Shoreline Eating Disorders.

Eating Disorder Hope.

National Eating Disorders.

Help Guide - Helping Someone with an Eating Disorder.

Selah House.

Magnolia Creek - Bulimia Help for Women.

National Eating Disorders Collaboration.

Bulimia.com - for 24/7 hour advisors to help you, call 1-866-578-1604.






Image Source: https://www.eatingrecoverycenter.com/blog/2016/04/30/eating-recovery-day-why-we-celebrate





I am not a doctor, I am a researcher. Please call your doctor if you have any questions or concerns so that they may decide the best care for you. Everyone is different. Everyone with Gastroparesis is different. I just wanted to distinguish between eating disorders and Gastroparesis, and to make sure people know that eating disorders can lead to Gastroparesis as well. Like I said before, if you have any questions or concerns, please consult your doctor.

Sunday, April 8, 2018

Gastroparesis: The Different Ways it Effects the Body

This idea and article dedicated to: Laurie Jayne

Her story, "After 14 years of being diagnosed with gastroparesis, a nurse practitioner told me this morning, that I don't have gastroparesis because I am not thin enough and don't vomit."

There are many kinds of Gastroparesis, many faces of Gastroparesis, and because everyone is different, it is hard to diagnose and treat. I, myself, have had Gastroparesis since about 2000 after an appendix surgery but was officially diagnosed in 2012. I do vomit, but that doesn't make my Gastroparesis more than someone who does not vomit, or my Gastroparesis less than someone who may have a feeding tube. There are also people who gain weight with Gastroparesis. However, Gastroparesis is Gastroparesis. It does not matter how much you weigh, because that does not mean that you are not malnourished or that you are not vitamin deficient. The Vagus Nerve is still damaged.

First of all, let's go into what Gastroparesis actually is and what causes it before we go into the different types of Gastroparesis.



Sources from GPACT and Imgur from years ago for the above images.


According to Gastroparesis Clinic,

"What is gastroparesis?

Gastroparesis is a gastric motility disorder in which the function of the stomach is impaired. The stomach is an important organ in our digestive system, which uses a series of muscular contractions to store meals after they have been eaten, grind up any solid food and pump this liquid into our small intestine at the right rate, so that the next steps in the digestive process can take place. In the case of gastroparesis, the muscular contractions of the stomach are defective, and as a result the contents of the stomach are emptied too slowly leading to symptoms.



Source from Imgur.



While gastroparesis is a relatively uncommon disorder, it can be very debilitating for those who suffer from it. Gastroparesis can have a significant impact on quality of life including the physical, emotional, and financial aspects of life. Sufferers may find that the nausea, discomfort, and pain associated with gastroparesis interfere with their ability to work, socialise, and maintain normal eating patterns. In severe cases, the inability to properly digest food can result in hospitalisation for fluid and nutrition supplementation, or sometimes the need for extra nutritional supplementation by a tube.

Gastroparesis is considered to be a motility disorder because there is no evidence of physical obstruction of the stomach, meaning that the primary issue is in the movement of the stomach. Impaired movement of the musculature of the stomach can be related to many underlying health problems, including diabetes, infection, neurological disorders, side-effects of medication, and following gastric surgery. However, in a large percentage of cases, gastroparesis is idiopathic – there is no known cause. In addition to the abnormalities of movement, there are also abnormalities of sensory function, so that the stomach becomes oversensitive and the sensations arising from the stomach are perceived as different or abnormally intense.

There are a variety of treatment options available to help gastroparesis sufferers manage their symptoms, though there is currently no cure. Health professionals are likely to recommend dietary changes, medications to minimise symptoms, psychological support, or hospital-based interventions depending on the severity of the symptoms and their response to treatment.







How many people are affected?

There are very few statistics on the prevalence of gastroparesis. It has been estimated that up to 4% of the population may experience gastroparesis-like symptoms, but it is uncertain how many of these people have the actual condition, as the sympotms and abnormalities of gastroparesis can be similar to other chronic functional gastrointestinal diseases such as functional dyspepsia or chronic idiopathic nausea. The lack of clarity around the incidence of gastroparesis is partially due to variation in the recognition of the condition by health professionals, as well as variation in the interpretation of test results.

As gastroparesis may be caused by diabetes, estimates about how many people are affected by gastroparesis are sometimes made based on diabetes statistics. These statistics suggest that more than 1.5 million Americans suffer from severe gastroparesis, and one estimate suggests that approximately 120,000 Australians are affected by the disorder. Women are more commonly affected than men, with approximately 80% of gastroparesis sufferers being female. The reason for this difference is not fully understood.









When does gastroparesis start?

Gastroparesis can begin at any age, although the average age of onset is 34 years.


Types of gastroparesis

In some cases, gastroparesis may be categorised as one of the following:

Idiopathic gastroparesis – there is no detectable abnormality responsible for the symptoms experienced, although sometimes the symptoms began following an infectious episode (gastroenteriltis with vomiting, nausea and diarrhea) – postinfectious gastroparesis

Diabetic gastroparesis – diabetes mellitus is the most common disease associated with gastroparesis, with 20-50% of longstanding diabetics experiencing gastroparesis, mostly in association with other complications of diabetes.

Post surgical gastroparesis – symptoms began following surgery to the upper gastrointestinal tract – the esophagus (gullet) or stomach.






Source from Imgur years ago.




Symptoms of gastroparesis

The symptoms associated with gastroparesis range in severity, but can be very debilitating. Common symptoms include: nausea, vomiting, bloating, early satiety, postprandial fullness, and abdominal pain. In extreme cases, the inability to digest foods and liquids properly can also lead to malnutrition, weight loss, and dehydration.



Source included in the image.



These symptoms can mimic a number of other health conditions (e.g., functional dyspepsia), and a medical history, physical examination and testing will help to discern if gastroparesis is the most likely explanation for the patient’s symptoms. Imaging tests and physiological measurements are used to determine the functioning of the stomach and the rate of gastric emptying. Some patients have severely delayed emptying but little in the way of symptoms, whereas other patients may have severe symptoms with only minor delays in emptying. In other words the severity of symptoms and the rate of emptying may not be closely correlated, which is why the abnormalities of sensation (which cannot be as easily measured) are likely to be important.










Further details about specific gastroparesis symptoms

Nausea: One of the main symptoms of gastroparesis is a feeling of nausea that may be accompanied by vomiting. Whilst dietary modification and prescribed medications can be helpful in addressing this symptom, there are also some other approaches that can lessen nausea. Using ginger to make a tea, as an ingredient in recipes, or taking ginger capsules, is known to ease nausea and speed up gastric emptying in some people. There is also evidence that stimulation of acupoints PC-6 and ST-36 can help relieve nausea and improve gastric emptying.

Bloating: Abdominal bloating is commonly associated with gastroparesis. Dietary modification may decrease abdominal bloating and discomfort. A discussion with your doctor can guide you in the necessary direction however, a specialised dietician’s advice is usually required in more severe cases

Abdominal pain: Many people with gastroparesis experience abdominal pain and discomfort. Gastroparesis generally does not cause sharp stabbing pains, but instead pain that is vague and crampy in nature. It is commonly made worse by eating, and may disrupt sleep at night.

Pain relief in the form of applying a hot pack to the abdomen for short periods may be helpful. The frequency and severity of pain episodes may also be reduced by treating gastroparesis with dietary modification, as well as natural, over the counter, and prescribed medications. Opiate based medications (eg morphine) are best avoided as they can lead to an increase in symptoms in the long term and are highly addictive.

Pain in gastroparesis can have a significant impact on quality of life. Learning techniques to cope with the symptoms is an effective strategy to make living with gastroparesis easier. Techniques that can be helpful in managing pain include those used by psychologists, for example cognitive behavioural therapy.

Depression and anxiety: It is common for gastroparesis sufferers to experience anxiety or depression. This may be due to the symptoms themselves, or to other issues such as family, relationships, financial stresses, or even to significant life changing events from the past.

The symptoms of gastroparesis may interfere with the normal activities of day-to-day life. This can lead to tiredness, low mood, low energy levels, and feelings of being out of control, tense, or anxious. This in itself will make the experience of living with gastroparesis more difficult and can create a vicious cycle of increasing symptoms leading to more anxiety and a further increase in symptoms, impacting on the overall condition of the person’s health and quality of life.

If any of the above feelings or events is pertinent to your care, then this should be discussed with your doctor, and if there are previously unresolved psychological issues then it would be the right time to address these as part of the treatment plan. Treating these issues can improve the ability of the mind and body to cope with gastroparesis. If your doctor feels that depression and/or anxiety is contributing to your symptoms, your doctor may suggest medication. It can often take some time to work out the right medication and dosage before it has a favourable outcome. Alternatively, a referral to a psychologist for further assessment and treatment may be appropriate."



Source: A friend made these images.


Just because people have Gastroparesis, does not mean that they vomit or have all of the symptoms listed. Everyone has different body chemistry and not everyone may have developed Gastroparesis from diabetes. I am here to talk about the different kinds of Gastroparesis people have because:

1. Gastroparesis is misunderstood.
2. Everyone is different (and that is why it is so hard to treat and find a cure).
3. Not everyone has the same symptoms (for instance, I vomit but my friend Kenny does not).
4. Not everyone with Gastroparesis is on a feeding tube.
5. Gastroparesis can range from mild to severe.
6. Just because people have a "mild" form of Gastroparesis, that does NOT make their Gastroparesis any less than someone who vomits or has a feeding tube with it. Vagus nerve damage is vagus nerve damage.





I wanted to upload this PDF from John Hopkin's because it explains everything regarding Gastroparesis, the different types and how a person could get them, as well as other useful information. This source comes from, which you can click on to make the images bigger if you have a hard time reading them below: https://www.hopkinsmedicine.org/gastroenterology_hepatology/_pdfs/esophagus_stomach/gastroparesis.pdf



In conclusion, Gastroparesis can effect each person who has it differently. It does not mean that the person is less sick if they have a milder form of Gastroparesis. In the end, it is a motility issue that will be with that person for the rest of their life. It is not fair to compare someone on a feeding tube with Gastroparesis to someone who vomits daily with Gastroparesis. That serves no purpose because those people are both very sick with a motility disorder and they deserve respect and understanding.