Gastroparesis

[@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.

[@giomgiom8985]

I'm 20 years old and I don't know what to do I'm suffering this for 2 weeks now Even eating a few soup feel nervors and throwing up

[@danny9732]

@@giomgiom8985 Have you gotten better? I’m 21 and have been dealing with this for 4 months

[@phyllisdenise7687]

I've had it for 6 years

[@ElizabethMillerTX]

We have too many things in this 'underappreciated' series. It almost reads like a list of hEDS comorbidities. LMAO. #funnynotfunny

[@samia6888]

@@danny9732how are you now

[@lauriejordan2716]

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.

[@bconns39]

Hi Laurie I hope you are doing better than you were a few months ago. My friend and co work just got diagnosed with this disease, do you have any advice I can pass along?

[@michelecavanary1399]

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

[@musiqal333]

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

[@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.

[@Luna-wh6tq]

I commented earlier without seeing your comment . I’m on a wait list to be tested for EDS. Did you have pancreatic issues ( specifically severe damage )?

[@ElizabethMillerTX]

@@Luna-wh6tq Nope.

[@kaylavognsen9162]

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.

[@modernthinker.7504]

What were your initial symptoms? Can you please share

[@kaylavognsen9162]

@@modernthinker.7504 feeling full early, bloating, bad reflux, and vomiting up undigested food like a day or two after eating it were my initial symptoms. Also one of my medication levels was wildly fluctuating and at first we didn’t realize it was from gastroparesis. My body was digesting/absorbing the med like it should.

[@Steven-fy3wj]

Thanks!

[@StrongMed]

You are very welcome, and thank you!

[@rida3922]

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

[@-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.

[@sherrielane1602]

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

[@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?

[@ILoveMyselPH-D]

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

[@tamsynd613]

Wait weight lose only occurs in more severe cases?

[@KMx108]

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.

[@StrongMed]

Given the necessity of Vitamin B12 for normal functioning of the nervous system, a causative role for B12 deficiency in gastroparesis is very plausible. However, there is a lack of information on this in the medical literature. This doesn't contradict your personal experience, and I'm glad you had your diagnosis made, but a search of PubMed only turned up two relevant papers, neither of which are a smoking gun for a cause-effect relationship: journals.lww.com/jcge/abstract/2003/09000/the_impact_of_b12_treatment_on_gastric_emptying.8.aspx www.ncbi.nlm.nih.gov/pmc/articles/PMC9976380/ It's a topic worthy of more study. If you (or other viewers) know of additional literature on this, I'd be happy to read it!

[@cornelbacauanu1544]

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

[@lauriejordan2716]

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.

[@RGRaj_1977]

I thought having 2 movements in a week is bad!

[@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

[@Lena-fg4vj]

I picked up a gastroparesis in an elderly patient because she vomited after supper, and her vomit contained eggs, which she ate at breakfast. Symptoms completely resolved with metoclopramide trial and returned when the trial ended. No fancy radioactive sandwich needed, lol.

[@realness_rarity]

My gp was diagnosed by gastric emptying study; mine has been caused by small fibre neuropathy

[@dailydoseofmedicinee]

Thanks

[@FullTimePatient37]

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.

[@michelecavanary1399]

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.

[@thomaspalmer7900]

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

[@user-wi8hs9ih5w]

Just wondering do it still help you.

[@mikevasapollo6349]

Thank you

[@Stonefalconetti]

That is a very *STRONG* video... The rock music sounds like some strong Alice in chains riffs and the guy's name is Eric Strong... Very strong, indeed..

[@realness_rarity]

My gastroparesis has been caused by small fibre neuropathy ( diagnose by ienfd biopsy) ( although I have hypermobile eds, pots, dysautonomia etc)

[@behemothking3114]

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.

[@dulef90]

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.

[@Dulcimerist]

Domperidone was banned by the FDA, due to high risk of cardiac events. A special application can be sent in for exceptions to be made on a patient by patient basis. Mayo Clinic has had success in repurposing Pyridostigmine to treat gastroparesis, and it has a 75-year-old track record for safety. Vanderbilt has repurposed Pyridostigmine to treat dysautonomia and POTS, which accompanies gastroparesis in some patients, which makes it especially appealing in those patients.

[@DRJANAKJPATELMDMEDICINEALL]

Wonderful lecture 🙏

[@gameguy3080]

They always forget dehydration. I'm always going to the er for severe dehydration.but I have controlled the nausea through dieting and meds.

[@tammyrobinson1613]

Fibromyalgia is also a cause of gastroparesis. The intense stress, and holding the body tight

[@ElizabethMillerTX]

I think many fibro dx are undiagnosed connective tissue disease and/or undiagnosed dysautonomias, which could easily explain the fibro-gastro correlation.

[@saidmo1797]

Great presentation. Thank you Dr

[@rakeshmandal6284]

Endoscopy normally

[@benxamin13]

My doctor never spoke to me about dietary changes. Straight to pills. No improvement.

[@sunving]

Thank you very much. Good lecture indeed.

[@rjkm1950]

Thanks Dr. Strong for the excellent video once again! Is anything in the works to summarize symptomatic hiatal hernia in this category of topics? Kind regards!

[@KironKabir]

Gordon Ryan has this

[@alialsalami7934]

Thank you alot

[@NinjaSheepa]

Very nice video! I learnt a lot

[@yunilee6927]

Not many good information of gastroparesis. Thanks for the video.

[@ko0974]

Im on resolor for tis..is that a good med?

[@StrongMed]

I have limited familiarity with it, and have not heard of it being used specifically for gastroparesis (though that doesn't mean it wouldn't be effective for it).

[@ko0974]

@@StrongMed Thanking you for quick response, particularly since this was broadcast while back... Resolor is a medicine that contains the active substance prucalopride....is other name its known as ..

[@zwink928]

Can diphenhydramine be used as an antiemetic? Or did you mean to put dimenhydrinate instead?

[@StrongMed]

Yes, diphenhydramine is used as an antiemetic in certain conditions such as gastroparesis, motion sickness, opiate-induced nausea (i.e. patients w severe acute pain on PCAs), and to prevent/treat immediate post-operative nausea. Anecdotally, I have not seen dimenhydrinate used for anything other than motion sickness. I do *not* recommend either for acute primary gastrointestinal conditions (e.g. gastroenteritis, pancreatitis), though I also do not know of any studies that have looked at their effectiveness for these conditions. (Side note: dimenhydrinate is a actually a mixture of 2 drugs; one of which is diphenhydramine; the other is a mild CNS stimulant 8-chlorotheophylline, with similar structure and pharmacologic effect as caffeine)

[@zwink928]

@@StrongMed oh wow, very interesting! Thanks for the clarification!

[@Steven-fy3wj]

Wife is a new sufferer of this since 2020. Broken teams of doctors couldn’t get it as right as this video does in one shot. Unfortunately, her only relief after failure of Reglan, Metachlopramide and Erythromycin drove her to the cannabinoid hyperemesis stage, she only feels better outside of the hospital that way. She’s probably going to die this way in her early 40s unless further understanding is spread.

[@twistedtea7046]

radioactive egg whites haha.

[@mooshmooshie]

can confirm they are absolutely disgusting BUT CMON, we literally are constantly nauseous, AND THEY MAKE US EAT EGG WHITES PLAIN. and sir SERVED WITH JAM!? WHAT IS THIS, HIGH TEA? I ONLY GOT THE EGGS, 4 oz OF WATER, AND A SNARKY OLD MAN WHO TOLD ME IF I VOMITED WHILE EATING THE EGGS THEN ID BE WASTING HIS TIME.

[@mooshmooshie]

no hate to you, it is funny lol

[@sxli3340]

Can you do an episode on climate crisis and health?? I remember you said in a video, if you are not a doctor, you'd probably study climate science.

[@StrongMed]

Thanks for the suggestion! I've considered doing this before, because I do think it's a really important topic, but it's also really broad to try to pull together and organize into a single video. I keep it on my list of possible future topics, pending some additional creative inspiration to pull it off.

[@345bru]

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