Gastroparesis

A discussion of the symptoms, causes, diagnosis, and treatment of gastroparesis - part of Strong Medicine's series on underappreciated diseases.

Image of scintigraphy scanner courtesy of user Arturo1299, provided under CC BY-SA 2.5 Poland, downloaded from Wikimedia Commons April 2021.

[Dulcimerist]

I have gastroparesis which is caused by hypermobile type Ehlers Danlos syndrome. The prokinetic medication Mestinon (Pyridostigmine) has been a miracle for me. It works by stimulating the vagus nerve and parasympathetic nervous system, which are in charge of digestion. As a bonus, the Mestinon also effectively treats my POTS/dysautonomia and fatigue. Since Mestinon was developed in 1945, it's highly affordable and has a long track record for safety.

[lauriejordan]

I have no idea how anyone is obese with this horrible disease. I am in pain and nauseous 90% of my day. The last thing I can ever think about is eating. I’m actually scared this is going to wind up killing me because I just can’t eat.

[musiqal]

I never knew of any such condition as rumination syndrome. In medicine, we really learn something new every day! Thank you Dr. Strong.

[AyyeeItsAyden]

I thought your lecture was very good. The only thing I would like to say is that what you have said about most patients being able to treat it and get back to normal lives is not the experience I have had. I’m every GP Facebook group you’ll find most people have had to permanently change their life in some way because of the condition, even in mild cases. For a lot of us it greatly impacts our everyday lives. I wouldn’t say that is true of just a small number of very severe cases. It’s definitely more than that. But I do appreciate you educating people about this illness. It’s not something many people have heard of.

[sherrielane]

Your lecture & All. The. Comments, each were enlightening. Thank you.

[ElizabethMillerTX]

I have gastroparesis, secondary to Hypermobile Ehlers Danlos, although not nearly as badly as many others. I have seen benefit from focusing on a whole foods mostly ANIMAL-based diet, especially avoiding seed and veg oils, gluten, grains, nuts, seeds and excessive fiber. I think sunshine has helped my inner and outer skin, and thereby helped my GI issues, but my autoimmune stuff has improved a lot, too.

[-Mlem-]

I have gastroparesis, I’ve had it for over a year now and I’m only a teen. It is really hard for me to deal with but I am much better now. I used to have to go to the hospital 2 times a week for testing and malnutrition. I don’t know my cause.

[ILoveMyselPH-D]

Question. Is using a glp-1 1 week before a GES enough to register a grade 4 of 4 on the test?

[ILoveMyselPH-D]

Question for you guys. Does the fact that food doesn't empty into the small intestine within a "normal" time frame cause malabsorption? Like i know our nutrients are absorbed thru the small intestine so does the fos rotting in the large intestines before eventually going into the small intestines cause less nutrients to be absorbed due to the "rotting" of food?

[FullTimePatient]

I'm going to have the gastric emptying scan, colonoscopy gastroscopy and a swallow study, I'm severely underwear and malnourished..I have a lot of neurological diseases too.. suspected MNGIE, which is a MiTo disease that affects the gastric system.. could this be related?

Thanks for the amazing video.

[tamsynd]

Wait weight lose only occurs in more severe cases?

[rida]

Don't miss a chronic gastritis due to helicobacter pylori, an upper endoscopy is the first step, then perhaps a MRI if we suspect a disease of the small intestine, Gastric emptying scan is in practice the last exam to be performed.
Azithromycin > Erythromycin
Larson and al Neurogastroenterol Motil. 2010;16: 407–13

[michelecavanary]

I had severe Gastro 2023. By the time I got to the hospital 2024I was so depleted that I had to go on a feeding tube since G-Poem takes 5 to 6 weeks to be approved by insurance. I would not have made it. No nausea no vomiting no restrictions since day one overnight stay, have since returned to work, eat almost everything. I would like to tell you where I got the procedure but they will wipe my post. good luck and God bless.

[KMx]

I experienced gastroparesis caused by B12 deficiency related to pernicious anemia. Starting B12 injections reversed the problem. I'd suggest adding B12 deficiency to your list of possible causes. My pernicious anemia diagnosis was delayed in part because B12 deficiency was not associated with gastroparesis in the minds of my doctors. You mentioned dietary supplements as a treatment but this doesn't specifically address the fact that gastroparesis can be *caused* by B12 deficiency. Please help spread the word and please know that B12 serum tests can not always be relied upon to indicate the amount of B12 getting into the cells. Note - I also experienced dysautonomia which went away with my B12 injections. This was another connection that doctors don't seem to be trained to consider. I had a lot of B12 deficiency symptoms that were missed by a LOT of doctors. You don't have to be a senior citizen to have a B12 problem.

[dulef]

Thank you Dr. Strong for (another) very clear, concisive and useful video. Do you have any idea why Domperidone is not registered by FDA and European Medicines Agency (EMA)? I have been successfully treating GERD and gastroparesis with Domperidone for past 10 years. Metoclopramide is not my choice for a long run due to CNS side effects, including neuroleptic syndrome.

[MedSurvival]

Gastroparesis should be suspected in patients with nausea, vomiting, early satiety, abdominal pain or bloating. We perform upper endoscopy followed if clinically indicated by computed tomography/magnetic resonance enterography to exclude mechanical obstruction or mucosal disease as a cause of impaired gastric emptying. Delayed gastric emptying on scintigraphy is required to establish the diagnosis of gastroparesis

[cornelbacauanu]

This is a very interesting entity. I did not know about the isotopic diagnosis and the DDx. Thank you.

[lauriejordan]

My test was much different. I took a pill with little radioactive circles in it. I went every day for a week. I also only have about 1 to 2 bowel movements a month.

[thomaspalmer]

I was diagnosed with Gastroparesis. I was put on Protonix and it does help.

[behemothking]

Excellent video, was recently diagnosed with this but i've been dealing with it since i was 17 (i'm 28 now) it's pretty much ruined my life. If you decide to follow up this video could you possibly cover the link between this and mental health? For a long time i've dealt with constant overall panicking daily along with waves of nausea and once i began taking Reglan for treatment after about a week i had a calm mind for the first time in a long while. I don't know if many other sufferers of gp had this experience but this was mine.