gastroparesis, gastric bypass, acid reflux

[rushbaby]

Hi Dr. Steve,

I am a 33 year old woman. I have mild epilepsy that is controlled by medication (right now I take Lyrica for it, because it also treats my trigeminal neuralgia). I also take Effexor for mild anxiety, and Baclofen to help keep me from getting headaches (associated with the seizure disorder).

About a year ago I was diagnosed with gastroparesis (the doc had me do the test where I eat food that is tagged with nuclear stuff, and then sit there as they watch it go through my system - it said I had delayed emptying indicative of gastroparesis). I've had various tests to find the cause of it. I was tested by a rheumatologist, and found out that I don't have any auto immune disorders. And I'm not diabetic.

I can't take Reglan for this because I have a seizure disorder. The other medicine they use for it has been taken off the market by the FDA, but is available in Canada. Right now I'm taking Aciphex in the morning and Zegerid at night to deal with the associated reflux, and that's basically all I can do. Unfortunately, I'm still experiencing a lot of nausea and some pain.

My gastroenterologist told me that the only real cure for gastroparesis is gastric bypass surgery. As I am also about 80 lbs overweight (not heavy enough to qualify for surgery by itself, but I'm pretty sure the gastroparesis will lead the insurance company to approve the surgery), I'm not against having this surgery. I just want to find out if my doctor is correct about this. I guess my question is . . .

Does gastric bypass surgery cure gastroparesis?

This is such a big step. I'd be lying if I didn't say that it makes me nervous. But my uncle, who's in his 60's, just had to have his whole stomach and esophagus rebuilt because of years of untreated/poorly treated reflux and other problems and unfortunately the surgery did not help. He will have to be tube fed for the rest of his life.

I don't want to let this get that bad and I'm guessing I'm in danger of having that happen if I just let me go.

Any information you can give me will be greatly appreciated.

Thank you SO much,

rushbaby

[Dr Steve]

Hi Dr. Steve,

I am a 33 year old woman. I have mild epilepsy that is controlled by medication (right now I take Lyrica for it, because it also treats my trigeminal neuralgia). I also take Effexor for mild anxiety, and Baclofen to help keep me from getting headaches (associated with the seizure disorder).

About a year ago I was diagnosed with gastroparesis (the doc had me do the test where I eat food that is tagged with nuclear stuff, and then sit there as they watch it go through my system - it said I had delayed emptying indicative of gastroparesis). I've had various tests to find the cause of it. I was tested by a rheumatologist, and found out that I don't have any auto immune disorders. And I'm not diabetic.

I can't take Reglan for this because I have a seizure disorder. The other medicine they use for it has been taken off the market by the FDA, but is available in Canada. Right now I'm taking Aciphex in the morning and Zegerid at night to deal with the associated reflux, and that's basically all I can do. Unfortunately, I'm still experiencing a lot of nausea and some pain.

My gastroenterologist told me that the only real cure for gastroparesis is gastric bypass surgery. As I am also about 80 lbs overweight (not heavy enough to qualify for surgery by itself, but I'm pretty sure the gastroparesis will lead the insurance company to approve the surgery), I'm not against having this surgery. I just want to find out if my doctor is correct about this. I guess my question is . . .

Does gastric bypass surgery cure gastroparesis?

This is such a big step. I'd be lying if I didn't say that it makes me nervous. But my uncle, who's in his 60's, just had to have his whole stomach and esophagus rebuilt because of years of untreated/poorly treated reflux and other problems and unfortunately the surgery did not help. He will have to be tube fed for the rest of his life.

I don't want to let this get that bad and I'm guessing I'm in danger of having that happen if I just let me go.

Any information you can give me will be greatly appreciated.

Thank you SO much,

rushbaby



Rushbaby:

sorry you're having so much trouble with your stomach. Let me see what I can do to help.

First, gastroparesis (gas-trow-puh-REE-sis) refers to chronically delayed stomach emptying. this can cause reflux of stomach contents into the esophagus (because the stomach doesn't empty in a timely fashion and there's no where else for it to go), nausea, vomiting, and over all just crappy feeling. Usually it's diabetes that causes it, but it can be caused by a ton of medications and other conditions. Sounds like you had a complete workup.

The three good drugs for gastroparesis include Reglan, Erythromycin, and Cisapride. Reglan is contraindicated (i.e., don't prescribe it) in people with seizure disorders. Cisapride can't be obtained easily in this country (though it works well, it has a host of badass adverse effects). This leaves Erythromycin, which is an antibiotic that causes nausea in some people but IS "prokinetic" and is a godsend for some people with gastroparesis. it's cheap, too.

Surgery is indeed a solution for gastroparesis...they just open up your stomach and let the contents fall into the intestines by gravity. It solves the problem of delayed stomach emptying, but can cause a new problem called "dumping syndrome". I'll let you google that one yourself.

There are some new things on the horizon...I cribbed these from the mayo clinic website:

* Botulinum toxin (Botox). Once used exclusively to treat migraines and wrinkles, botulinum toxin is now being tried for a variety of problems, including gastroparesis. In trials, researchers have found that Botox relaxes the pyloric muscle in some people, thereby allowing the stomach to release more food. The benefits are temporary, however, and more studies are needed to determine the overall usefulness of this treatment.
* Electrical gastric stimulation. Another new treatment for gastroparesis uses an electric current to stimulate stomach contractions. Working much like a heart pacemaker, a stomach pacemaker, consisting of a tiny generator and two electrodes, is placed in a pocket that surgeons create on the stomach's outer edge. Stomach pacemakers have been shown to improve stomach emptying and reduce nausea and vomiting. It takes time for the pacemaker to produce these effects, however, and the procedure isn't widely available.


You may want to look around and see if anyone is doing the less-invasive stuff first; it never hurts to talk to someone. I agree with you, that changing your anatomy should be the absolute last-resort.

Now, with regard to your reflux:

1) see if your doctor can get you some Kapidex. The manufacturer SWEARS that once a day will fix anyone's acid-related symptoms. If you still have symptoms after taking it, it ain't acid (according to them)

2) put a brick under both floorposts under your bed at the head of the bed. This small elevation of the head of the bed will keep your stomach contents where they need to be while you're sleeping...in your stomach.

3) don't eat past 6pm at night...give your stomach plenty of time to empty before going to bed. And go easy on the sweets and carbohydrates at nighttime...they really make the reflux worse.

let me know what you decide, and if any of this helps.


your pal,



steve

[Billy Staples]

Dumping is your new digestive systems plumbing reaction to certain foods, most regularly sugar. I been with people who have it with cheese, tuna fish and others

It is for the most part sugar. You are not to have any sugar when you have the full gastric BP. It makes you feel horrible. dizziness, sweating, shaking, like a bad hangover just laying in bed, headaches, genital warts, nausea and assorted other symptoms. all are not the same as everyone else. some people I've known don't get it at all. although few and far between.

the good news is it doesn't last forever. More good news is that overtime, like years, it tends to diminish little bit each year or so. So you have got to e careful.

Either way, good luck and I know nothing regarding your other issue, but it is available by some doctors laproscopically. You don't get the benefit of a large scar down the middle of your stomach, makes you look like a gutted marlin. I hated mine until the tummy tuck and made it almost disappear.



BS

[led37zep]

It is for the most part sugar. You are not to have any sugar when you have the full gastric BP. It makes you feel horrible. dizziness, sweating, shaking, like a bad hangover just laying in bed, headaches, genital warts, nausea and assorted other symptoms. all are not the same as everyone else. some people I've known don't get it at all. although few and far between.

BS

If I had them I'd use this excuse too.

[spoon]

Taggot!