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Gastroparesis slows stomach's ability to digest food
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For the past two years, Franklin Twp. resident Peggy Knepper has struggled with extreme fatigue, heartburn and nausea so severe that she lost her appetite - and 30 pounds.
"I've felt like my quality of life was at an all-time low because I never knew how I would feel when I'd wake in the morning," said Knepper, 68, who lived on crackers, pudding and noodle soup. "Some days I felt like all I could do was sleep, and some days that's all I did."
Recently, however, Knepper has started feeling better, and so she has hope that the chronic disease she has - gastroparesis - is quieting down, at least for a while.
Gastroparesis, a condition that strikes an estimated 1.5 million Americans, means the stomach takes too long to empty its contents. In a person with gastroparesis, the vagus nerve, which controls the movement of food from the stomach into the small intestine for digestion, doesn't work properly.
"If you think of the stomach as a bowl with acid and you add food to it and let it sit for a day, the food starts to break down and spoil," said Dr. John Michel, gastroenterologist with Jackson Siegelbaum Gastroenterology in Camp Hill. "The acid from the stomach starts to metabolize the food and irritates the stomach lining."
This causes nausea, bloating and reflux, all common symptoms that patients complain of when they seek a doctor's advice, Michel said. Patients might also have heartburn, insomnia and notice intolerance of heavy meals.
"Often these symptoms have been going on for a while and people have tried different things to relieve them and come to the doctor as a last-ditch effort," Michel said. "If people have these symptoms and especially if they progress as the day goes on, they should see a doctor."
Diagnosis is made with a gastric emptying study, where patients eat a radioactive-laced meal of, typically, applesauce, eggs and a piece of toast. Abdominal X-rays are taken 45 minutes after the meal and at 15- to 20-minute intervals thereafter for a total of 90 minutes to measure how much of the meal empties from the stomach, Michel said.
"When you eat a hamburger, half of it should be out of the stomach within 90 minutes and half of the remainder should be out in the next 90 minutes," he said. "There are some people for whom it takes four and a half hours to move that first half out of the stomach."
The disease is graded from mild to severe depending on how much food is emptied out of the stomach, Michel said. In severe cases, patients vomit the undigested food and sometimes need to have a feeding tube surgically inserted to ensure they receive the nutrition they need.
The disease is often caused by diabetes, which causes a buildup of glucose that damages the vagus nerve, Michel said. Other causes include previous abdominal surgery or a virus, but often no cause can be found.
Newly diagnosed patients are given a three-step diet to follow. Step one is liquids and clear broths for a month followed by step two, which introduces a small amount of low-fat dairy products and soups with a cloudy broth and pasta. Step three includes more proteins such as skinless chicken, fish and low-fat crackers.
As patients can tolerate it, more foods are introduced, and small, frequent meals for easier digestion are stressed, Michel said. Depending on the cause, many patients can work their way back to a near-normal diet, although a low-fat, low-fiber diet becomes a way of life for most patients, he said.
Knepper was initially diagnosed 11 years ago with a moderate form of idiopathic gastroparesis, meaning no cause is known. Once she began taking metoclopramide, a medicine that stimulates her stomach to contract, and began eating a bland, low-fat, low-fiber diet, she started feeling better.
"I was able to go to back to my nursing job and everything seemed much improved," Knepper said. Twice since then, however, she has suffered flare-ups that are characteristic of the disease.
"I know for the rest of my life, I'll have to be on a restricted diet and on oral medication," said Knepper, who credits the support of her husband, Ray, with helping her combat the disease.
Knepper also takes a drug called domperidone, which also improves stomach emptying and decreases nausea. However, because it's not approved by the Federal Drug Administration, patients must get it elsewhere, often from Canada, Michel said. That means it isn't covered by insurance - a typical supply costs $100 a month - which prohibits some of his patients from access to it, he said.
There is promising research going on into gastric pacing, which would involve putting a pacemaker into the stomach to improve gastric emptying, Michel said.
Because of its chronic, unpredictable nature, the disease can exact an emotional toll. "People learn to live with it, but it's a tough one. Some patients get depressed, anxious or angry," Michel said.
Knepper, who has also had to cancel vacations and restrict her love of gardening because frequent bending makes her heartburn worse, said she does get discouraged. "But with what I'm doing, I feel like I have some control over it rather than it having control over me," she said.
Signs and symptoms of gastroparesis:
Feeling of fullness after only a few bites
Nausea
Bloating
Excessive belching
Nagging ache in upper abdomen
Vomiting
Heartburn
Regurgitation of stomach fluid into the mouth
Source: Jackson Siegelbaum Gastroenterology
The leading non-profit in the world fighting on behalf of patients with gastroparesis and chronic intestinal pseudo-obstruction is located in Lewisberry, PA, right in your backyard! We are a national organization with a worldwide impact and have approximately 9,000 members. We are members of the Digestive Diseases National Coalition and sit on the board with 28 other leading GI non-profit organizations. Our website is HonCode accredited and we work with leading researchers, physicians, drug companies, politicians, and the FDA on seeking a cure and increasing awareness. Our website is www.g-pact.org. Check us out. I'm the president and founder, Carissa Haston. Our volunteers are scattered throughout the country. We provide a lot of services and all of our services are free to patients. Nobody in G-PACT is paid for our work. We operate on a fully voluntary basis.
It is also estimated that 5 million Americans suffer from either GP or CIP or both. I personally have both and had a five organ transplant (stomach, small bowel, pancreas, liver, duodenum) at the University of Pittsburgh Medical Center in March 2006. Gastroparesis and Chronic Intestinal Pseudo Obstruction almost took my life. I relied on IV nutrition for years and due to frequent sepsis (infections in bloodstream) I eventually lost all venous access and they couldn't feed me anymore. I was 62 pounds and starving to death. It can be much more serious than people think. The condition can range from mild to severe where diet modification and meds are helpful, all the way to people actually dying from malnutrition, dehydration, and other complications developed from the inability to eat. Yet, the condition is often ignored and research has been limited. A new drug study has begin, but it will be years before it will be on the market, if approved. G-PACT is working closely with the FDA and drug manufacturer to help fast track this process and develop additional drug studies.
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