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What causes incomplete bowel movements and vomiting with normal gastric emptying study?

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Posted on Sat, 30 May 2015
Question: What conditions mimic gastroparesis, except are intermittent? I was diagnosed with gastroparesis 10 yrs ago and have had LOTS of attacks/trouble ever since. Frequent trips to ER for hydration, nausea meds, & usually potassium. One time kidneys failed & ended up hospitalized for 2 weeks. Now my recent gastric emptying study was normal. I'm sick of being sick! Sick of vomiting & retching!
doctor
Answered by Dr. Klerida Shehu (21 hours later)
Brief Answer:
Following causes&information required...

Detailed Answer:
Hi,

I have gone through your medical history carefully and understood your concerns.

1. If the emptying study was normal, then, I do not think your symptoms are related to gastroparesis.

2. You are saying that you had frequent trips to ER with nausea and vomiting attacks. At this point, I'd like to ask if the attacks you had were after consuming certain foods? Food poisoning is to be excluded first.

3. I want to also know if you had any upper endoscopy. Gastritis/duodenitis should be also ruled out.

4. Any abdominal ultrasound so far? Gallbladder issues (sludge, inflammation) should be also considered.

5. Your psychological status plays also an important role and might trigger such problems.

6. At the end, have you measured your blood sugar levels so far? Diabetes is a possible cause to gastroparesis and all symptoms you are having.

Looking forward to have the requested information in.
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Klerida Shehu (2 days later)
When I am having an episode, my stomach does NOT empty normally. I start out with the early satiety, and a few days or week later I'm vomiting and can't keep ANYTHING down. For periods of time stomach does not empty at all, and contents, even small amounts of clear liquids, come back up; it may be many hours later, or even more than a day later, but comes back up recognizable. This kind of episode may last a few days to a couple weeks, but with IV fluids, nausea meds, and often potassium, my stomach eventually begins to function again. The longest bout was in 2010 when I was diagnosed with gastroparesis. (Emptying study was not normal at that time. But it was only a 2-hr test; 80% of food was still in stomach after 2 hours.) Had upper endoscopy at that time. That episode lasted about a month. I quit eating because I was sick to death of vomiting and retching. Then I ended up in kidney failure and was hospitalized for 2 weeks, getting IV potassium and getting stomach to work again. Hooray if I don't have gastroparesis! Options for treating are not so hot. But SOMETHING is causing me to be very sick too often and for too long.

This has been going on for YEARS. Not an isolated instance. ER visits several times a year. More recently, every 2 months. This current "episode" lasted a couple weeks. Now stomach is functioning again, but not without lots of discomfort.

Chronically constipated as a child.

Definitely have "mixed IBS"... since about 11 years old, often with "dumping syndrome" & severe nausea & vomiting. Had this for so many years that I have learned to control the vomiting most times.

They tell me I'm diabetic (pre-diabetic?), but when I eat right, my sugars are in normal range. If I don't eat right, sugars may go up into high 100's, but RARELY (almost never) 200 or more. A1C always below 7.

Gall bladder removed in 1983.

Wonder about possibility of HAE. I have a lot of itching and occasional swelling of ankles, bloating of upper and/or lower abdomen. When my hands and fingers itch, I rub my fingers together to try to stop it, and my fingers and hands swell up. Itching is anywhere... legs, feet, hands, arms, trunk... usually no hives or rash. Sometimes when arms or legs itch and I rub them, I break out in big bruises, looking as though someone beat me. This happened much more often when I was younger, say between 20 and 50. (Now I'm 66).

Definitely have GERD, and nightly dose of 40mg of Nexium keeps that pretty well controlled. Omeprazole alone doesn't work nearly as well as Nexium, but affordability is a problem.

doctor
Answered by Dr. Klerida Shehu (19 hours later)
Brief Answer:
Stenosis of pylori;medications;neurological issues to rule out

Detailed Answer:
Hi back,

Thank you for providing additional information. Based on your description, I can say as following:

1. You are saying to vomit even small amounts of liquids after 1 day. One possible cause might be stenosis (narrowing) of the pylori. At this point, I'd advise to:
- repeat upper endoscopy
- or run capsulated endoscopy
- ct-scan of abdomen

to rule it out.

2. Next, besides taking nexium, may I know any other medication you take on regular basis? Or just occasionally especially when you're having itchy fingers?
Other medications you might take can also be a possible cause to your actual GI problems.

3. If no organic issue will be noted after all these examinations, then, neurological issues should be considered and ruled out by neurologist.

Hope it was of help!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Neel Kudchadkar
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Follow up: Dr. Klerida Shehu (28 hours later)
I believe I do need a neurological work up. I have a friend who insists I do! She says sometimes when she talks to me, it's like I'm not even there and don't respond. Sometimes the pupils of my eyes are not the same size (other times they are). My urinary incontinence could possibly be something neurological. (?)

I KNOW if the gastric emptying test had been done a week earlier, it would NOT have been normal! NOTHING was moving thru the stomach, but coming back up, even hours later! However, stomach had begun functioning again by time test was performed. My nurse friend says her mother had gastroparesis for years, and it was intermittent, like my symptoms. I am gathering that if it is not consistent/constant/unchanging, doctors now don't consider it gastroparesis.

Nothing I have read about seems clear cut and curable... only "treatable". All I want is treatment that will keep me from being SO sick, SO often, for SO long. And I'd very much like to be able to eat without feeling sick, or bloated, etc.

I have an upper endoscopy scheduled, but not until XXXXXXX 25. I will be calling my doctor's office to try to get that moved up via a cancellation or something. They tell me next step after that will be the "smart pill" (capsulated endoscopy) to see remainder of small intestine.

I guess I am in wait and see mode right now, while I struggle to eat and remain comfortable in the process. Not working very well right now.

I appreciate your taking a look at my situation/symptoms/history. I am baffled. I wouldn't even mind being baffled if I were just under some consistent treatment that would help on a long-term basis.
doctor
Answered by Dr. Klerida Shehu (18 hours later)
Brief Answer:
Can wait until XXXXXXX 25 for endoscopy...

Detailed Answer:
Hi back,

1. You might have neurological problems related to multiple organs. And this should be further evaluated. We cannot judge without a deep neurological examination. Please bare in mind that we are talking about organic neurological issues and not of psychological pattern.

2. Once again, I do not think your symptoms are due to gastroparesis. I still insist to rule out stenosis of pylori.

3. Ok, you can have your endoscopy on XXXXXXX 25, unless, your symptoms will get worse.

4. With regards to long-term treatment:
- should rule out stenosis of pylori first
- eat often and small portions
- do not rush while chewing up
- avoid laying down immediately after eating
- try to be more physically active

These can help you for the moment; other specific treatment will be described after having your endoscopy report.

Take care!
Dr.Klerida
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. Klerida Shehu

Gastroenterologist

Practicing since :2006

Answered : 2266 Questions

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What causes incomplete bowel movements and vomiting with normal gastric emptying study?

Brief Answer: Following causes&information required... Detailed Answer: Hi, I have gone through your medical history carefully and understood your concerns. 1. If the emptying study was normal, then, I do not think your symptoms are related to gastroparesis. 2. You are saying that you had frequent trips to ER with nausea and vomiting attacks. At this point, I'd like to ask if the attacks you had were after consuming certain foods? Food poisoning is to be excluded first. 3. I want to also know if you had any upper endoscopy. Gastritis/duodenitis should be also ruled out. 4. Any abdominal ultrasound so far? Gallbladder issues (sludge, inflammation) should be also considered. 5. Your psychological status plays also an important role and might trigger such problems. 6. At the end, have you measured your blood sugar levels so far? Diabetes is a possible cause to gastroparesis and all symptoms you are having. Looking forward to have the requested information in. Dr.Klerida