Digestive Disease Treatments
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There are many treatment options for gastroparesis. Most people can be managed with dietary changes. When symptoms cannot be managed through dietary changes, medication may be necessary.
Dietary changes include eating smaller, more frequent meals and avoiding high fiber and high fat foods, as they naturally cause delays in stomach emptying. Your doctor can help tailor your diet to meet your nutritional needs while addressing the symptoms of the disease.
Common medication management for gastroparesis includes prokinetics (drugs that enhance gastrointestinal motility) and insulin changes for those with diabetes. Surgery is also an option in severe cases.
The combined therapies listed above commonly lead a person suffering from gastroparesis back to a more normal body function after treatment. These therapies have been shown to improve and stabilize nutrition, reduce hospitalizations and improve quality of life.
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After you check in for a small bowel enteroscopy—which allows a physician to navigate the entire small bowel from either an oral or rectal approach—a nurse will meet with you to review your medical conditions and medications. An intravenous (IV) line will be placed in a vein in your arm. You will proceed to the procedure room, where your blood pressure, pulse, and oxygen level will be carefully monitored. A sedative will also be administered through your IV, and you may need general anesthesia.
After the procedure, you will rest until the effects of the medicine wear off. You will not be able to drive following the procedure, so plan on having someone with you to take you home. Before leaving, hospital staff will speak with you about the preliminary results of your test and will let you know when you can go back to eating your regular diet.
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Gastroparesis is a condition in which the stomach doesn't empty properly. Says UCLA gastroenterologist Mark Ovsiowitz, MD, "For most people, food empties from the stomach within two to four hours after eating. But for those with gastroparesis, the stomach doesn’t empty properly, which may cause severe nausea, vomiting and other problems."
For people who do not respond well to dietary changes or medication therapy, an implanted neurostimulator may be the best option. UCLA surgeon Darryl Hiyama, MD, explains, "While the neurostimulator does not cure gastroparesis, some studies have demonstrated that the device effectively reduces symptoms in approximately 80% of people."
The neurostimulator is about the size of a pocket watch and may be implanted through an incision in the abdomen during a surgical procedure that takes approximately 30 minutes. Much like a heart pacemaker, the device is programmed to send electric currents to the stomach through a tiny generator and two electrodes, which stimulate the muscle contractions necessary to properly move food through the digestive system. Says Dr. Hiyama, "The device is limited to people who suffer from debilitating symptoms of gastroparesis and who really have no other hope for prolonged symptom relief. The results for the appropriate people are promising, and some people say they feel better almost immediately."
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We treat slow emptying due to a narrow pylorus by dilating the channel with inflatable balloon catheters through our scopes. A gastroparesis diagnosis leads to evaluation for diabetes, low thyroid function, or electrolyte imbalance. If nothing is found, we chalk your problem up to a likely viral infection which affected your stomach nerves and place you on a low-fiber diet and perhaps some medication to enhance the stomach emptying.
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Gastrointestinal specialists are using a new, non-invasive technique called capsule endoscopy to view the entire internal lining of the esophagus and small intestine and help diagnose formerly undetectable abnormalities.
In the small intestine, capsule endoscopy can be used to identify small intestinal polyps or tumors, determine the source of unidentified intestinal bleeding, and evaluate inflammatory changes in patients suspected of having Crohn's disease. In the esophagus, capsule endoscopy is a non-invasive option for detecting varices, esophagitis, and Barrett's esophagus in patients with gastroesophageal reflux disease (GERD).
For this procedure, patients swallow a disposable pill-like device, about the size of a large vitamin, that contains a small camera. The camera transmits images via radiofrequency as the device moves down the esophagus, through the stomach, to the small intestine. The data go to a recorder worn by the individual – usually as a belt around the waist. The procedure is completed within a half hour for an esophageal exam and about eight hours for a small intestinal exam. The capsule is also being studied for use in patients with other GI conditions, such as celiac disease and familial adenomatous polyposis (FAP).
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The dissemination and implementation of the guidelines for endoscope reprocessing (cleaning and disinfecting) have resulted in a remarkable safety record for endoscopy. Based on medical literature, the Technology Committee of the American Society for Gastrointestinal Endoscopy (ASGE) estimates that the chance that a serious infection could be transmitted by endoscopy is only about 1 in 1.8 million.
Given the multiple benefits of endoscopy, it is no wonder that the number of procedures performed grows each year and that endoscopy is a mainstay of digestive disease treatment plans and health maintenance strategies.
Endoscope manufacturers are continually improving the design of endoscopes to ensure patient safety.
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Capsule endoscopy helps your doctor evaluate the small intestine. This part of the bowel cannot be reached by traditional upper endoscopy or by colonoscopy. The most common reason for doing capsule endoscopy is to search for a cause of bleeding from the small intestine. It may also be useful for detecting polyps, inflammatory bowel disease (Crohn's disease), ulcers and tumors of the small intestine. As is the case with most new diagnostic procedures, not all insurance companies are currently reimbursing for this procedure. You may need to check with your own insurance company to ensure that this is a covered benefit.
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Depending on the degree and cause of narrowing of your esophagus, it is common to require repeat esophageal dilations. This allows the dilation to be performed gradually and decreases the risk of complications. Once the stricture, or narrowed esophagus, is completely dilated, repeat dilations may not be required. If the stricture was due to acid reflux, acid-suppressing medicines can decrease the risk of stricture recurrence. Your doctor will advise you on this.
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Five steps to help heal Leaky Gut Syndrome focus on getting rid of anything that might be causing or contributing to increased intestinal permeability:
1) Stop drinking alcohol for at least a month.
2) Stop using aspirin, ibuprofen, naproxen and other non-steroidal anti-inflammatory drugs (NSAIDs).
3) Have a stool test for intestinal parasites. There is extensive medical literature on intestinal parasites causing symptoms like fatigue, joint pain and skin disorders, without causing diarrhea.
4) Adopt an anti-inflammatory dietary pattern. The principles are simple to understand: avoid foods with added sugar and refined starches, made from white flour. Decrease consumption of saturated fat and most vegetable oils, using extra-virgin olive oil instead. Eat at least 9 servings of fruits and vegetables a day and at least 4 servings of fish per week.
5) There are dietary supplements that help the small intestine heal and restore its functional integrity. The most important of these are the amino acid L-glutamine and the amino sugar N-acetyl-glucosamine, which are readily available in health food stores.
These are but a few introductory steps toward an integrated approach to this condition.
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