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Test for Gastroparesis

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Unread 10-10-2012, 10:58 AM   #11
Idiopathic PN
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Upper GI: Drink barium and get evaluated under fluoroscopy. Fluoroscopy equals dynamic x-rays, thus involves radiation. Primarily used for anatomic evaluation, such has hernias, reflux, masses, ulcers, and abnormal rotation. If gastroparesis was severe, it could be detected. The main issue with gastroparesis assessment is that barium is a liquid. Most people with gastroparesis, will have normal emptying of liquids with delayed emptying of solids. If gastroparesis was severe, it could effect liquids and thus be seen on the upper GI. Gatroparesis would also be a subjective call made by the radiologist.

Gastric emptying study: Eat a radio-labelled meal, which usually includes eggs with a small amount of tracer. Our protocol involves getting imaged at 0, 30, 60, 120, 180, and 240 minutes. Imaging takes about 5 minutes at each time slot. You do not have to be still for the entire portion of the exam. The benefit of this exam is that it assesses solid emptying. There are also standard criteria to determine if it is delayed or not, so this gets an objective result.
Thank you very Kwinkler for that explaination. I will have my upper Gi test on Tuesday/Oct 16.
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Unread 11-17-2012, 06:16 AM   #12
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I have persistent stomach problems - the bloating has been minimized but the heartburn and the feeling of always empty have been always constant. From the moment I wake up till I sleep, the discomfort in my stomach is the same. I am sure that this stomach problem has been exacerbated by the antibiotics but with the regular yogurt and Kefir, I was hoping that it could be tolerable. I am on daily Nexium and 2x ranitidine but it seems not doing the trick. I was given by the GI dr Carafate suspension, but I am not taking it as Ithought it might have some effects on the other supplements and medications.

Below is the result of the Upper GI I had last Oct. 16. It says that I have a mild reflux, but I dont think what I feel is mild. After this result was out, my GI's PA called advising me that the doctor wants me to have an endoscopy. I reminded him about the doctor's position on deferring any endoscopy because of a recent bronchoscopy. Well, until now, he has not called me yet. I dont want to follow up because I am not sure if I want an endoscopy at this time. I remember what Mrs.D said about the risk of frequent scopes.....


Esophagus is unremarkable without mucosal abnormality, obstruction or intrinsic or extrinsic mass effect. There was questioned mucosal irregularity at the gastric cardia; however, this did not persist on additional imaging and may have been artifactual. If abnormality such as ulceration is suspected in this region endoscopy for direct visualization may be helpful. The stomach is otherwise unremarkable with no evidence of extrinsic and intrinsic mass effect or obstruction. Proximal small bowel is also within normal limits. A barium tablet was administered and passed promptly through the GE junction. No evidence of hiatal hernia. There is mild reflux into the distal esophagus when the patient is in the recumbent position.
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Unread 11-17-2012, 07:04 AM   #13
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If your stomach problems are this persistent after trying various remedies, etc, then you may need to consider further testing. Missing something serious because you want to avoid testing could be costly. It is always good to try and avoid some of the medical intervention (invasive procedures etc) first. I understand not want to scope frequently. How long has it been since your last GI scope? If the last one was normal I would doubt something horrible just popped up in a short time.

The GI track is a complex system with many possible problems that can occur...that can share similar symptoms. What does your GI suggest at this point? Does he have any ideas?
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Unread 11-17-2012, 08:48 AM   #14
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If your stomach problems are this persistent after trying various remedies, etc, then you may need to consider further testing. Missing something serious because you want to avoid testing could be costly. It is always good to try and avoid some of the medical intervention (invasive procedures etc) first. I understand not want to scope frequently. How long has it been since your last GI scope? If the last one was normal I would doubt something horrible just popped up in a short time.

The GI track is a complex system with many possible problems that can occur...that can share similar symptoms. What does your GI suggest at this point? Does he have any ideas?
The last one was not endoscopy. It was bronchoscopy last July -- finding was the MAC. After the abdomen cat scan in September -- result was normal -- GI Dr said it must only be benign. She asked to continue the Nexium, undergo Gi series and defer the endoscopy. After the upper gi the nurse called asking me to undergo an endoscopy. So I reminded him about the deferment I thought the Dr might just have forgotten what she said. The nurse said he 'll talk with the Dr. That was 1week ago.
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Unread 11-17-2012, 10:14 AM   #15
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I remember the bronchoscopy. But if you've never had a GI endoscopy before, other tests are negative, various attempts to treat have failed, and this continues to be a problem, then I can see why your GI may want to do the scope after all. Seems pretty reasonable.

If I remember right wasn't this a significant problem before the addition of the antibiotics for the MAC? Just thinking out loud...in case this is related to the antibiotics.



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Originally Posted by Idiopathic PN View Post
The last one was not endoscopy. It was bronchoscopy last July -- finding was the MAC. After the abdomen cat scan in September -- result was normal -- GI Dr said it must only be benign. She asked to continue the Nexium, undergo Gi series and defer the endoscopy. After the upper gi the nurse called asking me to undergo an endoscopy. So I reminded him about the deferment I thought the Dr might just have forgotten what she said. The nurse said he 'll talk with the Dr. That was 1week ago.
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Unread 11-17-2012, 11:46 AM   #16
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I was just reading how Mrs D. said that anticholinergics can cause slow emptying of gastric content. I'm taking 15 mg of amitriptylene a day for Interstitial Cystitis, Fybromyalgia and neuropathy. I'm wondering if this might be another source of my worsening GERD? If it doesn't eventually settle down with elimination of the R-lipoic acid, I'm not sure what to do. My GP wanted me to have a CAT scan of my pelvis, abdomen and chest but I've been deferring it in favour of ultrasound, mammogram, chest X-Ray and such to avoid so much radiation. Do you think I should ask to see a gastrointestinal specialist and get the problem evaluated that way or just go for the CAT scan? Would the CAT scan even be able to identify the problem? I hope I don't have gastroparesis from nerve damage but I wouldn't be surprised with the way it seems to be everywhere throughout my body. I think I really need to find the source of this awful neurological problem.
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Unread 11-17-2012, 01:01 PM   #17
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That is really a low dose. If you have any blurred vision from a drug with anticholinergic potential, it is more pronounced in the elderly (over 60), and typically when it is exerting this side effect you will have some blurred vision too. If nothing is noticeable vision wise, you may be tolerating it okay. Dry mouth is another side effect possible.

People vary with drugs that have anticholinergic potential. Some get constipated on them, as well. But the little doses of amitriptyline typically are tolerated very well. As people become elderly however, this changes.
The old antidepressant doses of this drug were 150mg-300mg a day by comparison. Amitriptyline is not used much anymore for depression.
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Unread 11-17-2012, 01:36 PM   #18
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I remember the bronchoscopy. But if you've never had a GI endoscopy before, other tests are negative, various attempts to treat have failed, and this continues to be a problem, then I can see why your GI may want to do the scope after all. Seems pretty reasonable.

If I remember right wasn't this a significant problem before the addition of the antibiotics for the MAC? Just thinking out loud...in case this is related to the antibiotics.
The reason why I am hesitant to undergo the endoscopy is because my pulmonary will do another cat scan and bronchodcopy after 6 months of treatment (march 2013). But if the GI Dr recommends thee endoscopy I think I should go for it.
Yes en bloc. This stomach problem was present prior to MAC treatment but the antibiotics, I think make it worse.
You remember about the stomach distress PRE MAC. That was sweet of you to remember! Thank you.
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