Gastric emptying study

[UnXmas]

I have another thread here asking whether it's worth having a capsule endoscopy. I have the same dilemma with a gastric emptying study, booked for next month. This test I see more point to - my doctors have assumed I have gastroparesis for a long time. This would be confirmation and, I guess, will quantify it in some way - show how bad it really is. But it's another long trip to the hospital, apparently the test itself may take up to four hours, and I'm not sure whether, if it does show gastroparesis, whether that's actually going to mean anything is done differently in terms of treating the symptoms.

Does this test give a good picture of what is going on? Some days I feel much more full than others; if the symptoms of gastroparesis vary from day to day, is the test going to be representative, i.e. if I have the test on a day my symptoms are very severe, or very mild, is that going to mislead the doctor?

I seem to spend so much of my time in hospital lately, and am so fed up of tests. Is this worth doing?

 

[Cat-a-Tonic]

I haven't had a gastric emptying study so I can't really answer most of your questions. But, I have an anecdote that might help. I had a test for my GERD a couple years ago (pH impedance test). It was essentially, they put an NG tube in me for 24 hours and measured how acidic my reflux was, how high in my throat the refluxate went, etc. They told me to eat my reflux trigger foods and that I should try to make my reflux as bad as it possibly can be for the test. But I just couldn't. I could barely eat with that stupid NG tube in, it was very painful to swallow with it in so I felt like I failed. I couldn't eat enough of my trigger foods to cause a bad episode and I really didn't experience any GERD symptoms that day. Because of that, I didn't think the test results would show anything. But, the results actually showed that my GERD is quite severe - they give you a score from 0 to 100, with 0 being totally normal and no reflux whatsoever, and 100 being the worst reflux ever. I scored a 95! So, long story short, even if you're not having symptoms that day, yes - you can get a worthwhile result from a test like that and you can still be experiencing the issue even if you don't really feel symptoms that day. My GI takes my GERD much more seriously now that he knows how hideous it is even on a day when I'm not feeling symptoms. If it could make a difference in your doctors' attitude and how they treat you, I say go for it. Just my two cents!

 

[UnXmas]

Thanks for sharing - even if it's just anecdotal, it's reassuring. Today I've had one of those days when I woke up feeling so so full, before I'd eaten anything, and it's carried on all day. I think that it's actually my bowel that's full though, like backed up - I've had very little stoma output all day, even by my own standards, though what I did have was watery. That wouldn't be picked up by the gastric emptying study, I don't expect. I get the stomach-fullness that depends on how much I've just eaten as well, but I'm not certain that's the main problem - this bowel-fullness affects my appetite so much too. I can't help it by eating fibre, as I'd risk a blockage, but I'm considering asking my doctors about laxatives. I thought I shouldn't take them with an ileostomy, but mine produces so little output sometimes.

 

[Cat-a-Tonic]

If laxatives aren't a good idea with a stoma, I believe there are things that are gentler than laxatives but have a similar effect. I remember someone in the Undiagnosed Club talking about taking Linzess for constipation & fullness but I don't know much about that med - it may be worth googling at any rate. Perhaps stool softeners could work as well? Although I believe those work by drawing more water into the colon - I have no idea if they'd work for you since you no longer have a colon. I do seem to recall that there is at least one med specifically for gastroparesis, I think it causes the stomach to empty more quickly? I don't remember the name of it though. So yes, there are a few med options you could try to move things along more. I'm not sure how any of them would work with a stoma so probably best to ask your doctor about these things. And if it were me, I'd have the gastric emptying test done before starting on any meds, just so that you know what your "baseline" is so to speak, and any improvements made from medication can be more easily quantified.

 

[UnXmas]

If laxatives aren't a good idea with a stoma, I believe there are things that are gentler than laxatives but have a similar effect. I remember someone in the Undiagnosed Club talking about taking Linzess for constipation & fullness but I don't know much about that med - it may be worth googling at any rate. Perhaps stool softeners could work as well? Although I believe those work by drawing more water into the colon - I have no idea if they'd work for you since you no longer have a colon. I do seem to recall that there is at least one med specifically for gastroparesis, I think it causes the stomach to empty more quickly? I don't remember the name of it though. So yes, there are a few med options you could try to move things along more. I'm not sure how any of them would work with a stoma so probably best to ask your doctor about these things. And if it were me, I'd have the gastric emptying test done before starting on any meds, just so that you know what your "baseline" is so to speak, and any improvements made from medication can be more easily quantified.

I have tried one med that makes your stomach empty faster - domperidone (Motileum) - was that the one you're thinking of? At first it helped a little (this was years ago), but then stopped working, and I tried it again more recently but it still made no difference. I'll ask my doctor about the others, and the laxatives, though I've a feeling my GP will say she doesn't have enough expertise about stomas and I'll have to wait until I see one of my consultants.

All yesterday and overnight I only had about one bag of stoma output in total, and woke up feeling very full. But throughout today my stoma has been more active than usual - it usually only works in the evening, but I've emptied three half-full bags today, and it's still only early evening here. Given that I am eating a normal amount of food, it seems to make sense that long spaces with no output would make me uncomfortable. Though I'm not eating much fibre at all, so perhaps the low volume of output is explained by that.

Thanks for your advice. I see my GP next week so I'll mention the meds then.

 

[Cat-a-Tonic]

Yes, I think that's the gastroparesis med I was thinking of (I seem to recall that it started with "M" so that must be it!). I believe I tried that med myself at one point, I haven't been diagnosed with gastroparesis but I do get a lot of bloating and sometimes fullness, so my GI tried me on a medication and I think it was that one. It didn't really do anything for me, either, so I stopped taking it. If it didn't do much for you then I'm presuming it's probably not worth revisiting, but I'd still ask the doc about other options. Good luck at your GP, hopefully she can be helpful.

 

[littlemissh]

Hi, I had the gastric emptying study and it wasn't too bad as far as some tests go. The hardest part was eating the toast and omelette but they asked me to stop when it looked like i may vomit it back up.
It helped having a diagnosis as there are various meds out there, and now of course I am trialling the gastric pacemaker.
So I would have it if I were you. You have to adapt your diet if you have GP which makes food choices even more difficult- you don't want to do that unless you do have it. It is also helpful in that when I am very sick, they know it could be the crohn's or the GP and have to look at things more carefully to get the right treatment.

In GP you can have anti emetics (ondansetron) and pro kinetics (erythromycin etc). Some anti emetics are also pro kinetics (domeridone, metoclopramide).
Some meds make GP worse e.g. opiates, loperamide.

 

[UnXmas]

Some meds make GP worse e.g. opiates, loperamide.

Interesting you mention that as I used to take huge amounts of loperamide, every day for years (often going over the recommended daily limit). Then I got my ileostomy and didn't need any anymore. But it didn't make the slightest difference to my fullness.

In what way do you have to adapt your diet?

 

[UnXmas]

I had this test done this morning. I don't know the results yet. The meal they gave me didn't make me full. It was a scrambled egg on a slice of toast, with some optional condiments, and a glass of water. The technicians running the test were surprised that I ate it all so easily. I guess either they think that I'm so thin I can't eat as much as I actually do (which is what most people think when they see how thin I am - they think I can't eat), or they are used to dealing with patients with far more severe gastric emptying issues than I have.