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Forum Name: Gastroenterology Topics

Question: Marked delay in gastric emptying study, vagus neuropathy?


 syralia - Wed Sep 16, 2009 6:08 am

Greetings and than you for your time.

I just recently got the answer to my gastric emptying test and was told that there was a 'marked delay in gastric emptying' by my primary physician, but he did not really have much more information for me and I am awaiting approval to go to a tertiary treatment center for a ?possible gastric pacemaker?

My question are-

What exactly does 'marked gastric emptying' mean other than my stomach takes too long to empty?

I have other unexplained neuropathies (woke one morning in 2003 unable to use either hand, arms weak and with bells palsey on the left side of my face... I have regained use of my hands, though there is marked weakness and my hands are often numb and my face has regained mobility though there is still loss of sensation. The thought is possible MS, but no plaques are present so that is up for debate) and with the advent of this I wonder if there is a connection?

My gastric symptoms are- abdominal discomfort at all times, sometimes severe, diareah alternating with constipation but usually multiple loose stools a day, constant nausea and weight loss. I cannot stand anything touching my stomach so my pants are always loose but even the slight pressure of loose pants causes increased pain.

I have been limiting my diet more and more over the years, fried foods and fatty foods are a thing of the distant past. Red meats must be very lean and I usually try to eat only buffalo and deer meat since it is low in saturated fat, chicken breasts and baked plain fish. I avoid spices, raw veggies, salt, raw fruits and whole grains because I have learned they only make me feel worse and now I learn that my body was already craving and wanting the things that I could and should eat with this problem, but I really don't understand what 'marked delay' means in relation to severity and the information is almost impossible to find online. With a possible long wait for approval from insurance and perhaps having to go through many appeals to be able to see a specialist in this condition I would like to know more about it so that I can be forewarned and prepared for my appointment.

I am not diabetic, do not have insulin resistance and am not hyperthyroid and the only things I can find relate to these conditions.

Any information and suggestions would be greatly appreciated.
 Dr.M.Aroon kamath - Fri Nov 27, 2009 1:19 am

User avatar Hi,
Gastric emptying is a highly complex and as yet not fully understood phenomenon.The rate of gastric emptying is strongly influenced by both volume and composition of gastric contents

The gastric contractions are generally of two types.
- contractions following a meal and
- contractions that go on in between meals.

Some studies indicate that gastric contractions are generated by slow waves in the smooth muscle, which occur in the absence of neural activity and are thus believed to be myogenic. This myogenic activity in the digestive tract is believed to originate in the interstitial cells of Cajal (ICC), which act as pacemakers, generating slow waves in the smooth muscle, which then travel all the way down to the large gut in between meals.The autonomic system perhaps modulates the gastric peristaltic activity.

There is considerable normal variability among healthy people in transit times through different sections of the gatrointestinal tract. Secondly, the time required for material to move through the digestive tube is significantly affected by the composition of the meal. Finally, transit time is believed to be influenced by such factors as psychological stress, gender and reproductive status.

Transit times are studied by the following ways...
- Radiography following a barium-labelled meal.
- Breath hydrogen analysis
- Scintigraphic Gastric Accommodation etc.

I hope the tertiary center would confirm if inded you really have gastroparesis.Your large bowel symptoms are unlike those of gastroparesis.There are certain drugs which can cause gastroparesis, such as...
Lithium,
Nicotine,Narcotics,
Calcium channel blockers
Clonidine,
Dopamine agonists,
Tricyclic antidepressants,
Progesterone etc.

To this list, i should add one more...ie, calcium. Calcium has been and being extensively studied in connection with gastroparesis.You seem to be on 'TUMS Ultra 1000 mg'. I hope this fact was taken into consideration while interpreting the results of gastric transit time studies.

Media are replete with the supposed links between Ehlers-Danlos syndrome and gastroparesis. There does not seem to be solid scientific evidence to back up these reports.
Best wishes!

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