I am Dr. Arun and will be helping you today.
Gastroparesis or slow emptying stomach needs a very comprehensive management regime. Judicious and persistent intervention by various measures should be able to control the symptoms quite nicely. Following is the management plan. If the initial conservative plan does not help, surgical intervention should be considered.
1) nutritional modifications,
a) multiple small meals,
b) favor liquids over solids,
c) avoiding indigestible solids,
d) consuming low-fat meals
2) medications to stimulate gastric emptying,
d) phenothiazines (prochlorperazine, thiethylperazine),
g) Nitrates, buspirone, sumatriptan
3) endoscopic and surgical approaches,
a) Injection of botulinum toxin
b) gastric electrical stimulator implantation
c) surgical pyloroplasty
4) psychological interventions
a) treatment of anxiety and depression
b) biofeedback and/or hypnosis
So a comprehensive approach is essential for controlling of the symptoms and various specialists like gastroenterologist, primary care physician, psychologist, etc would be needed to work in cohesiveness to get the optimal outcome.
The bloating and gas can also be due to;
1) Irritable bowel syndrome (IBS)
3) Gall bladder dyspepsia (poorly functioning gall bladder).
4) Sub acute intestinal obstruction
Following may help you;
2) This may help;
a) Bismuth subsalicylate
b) Activated charcoal
c) Simethicone; (Maalox, Mylanta); Simethicone causes gas bubbles to break up.
d) Beano; contains an enzyme (alpha-galactosidase), which helps to breakdown certain complex carbohydrates.
All are available without prescription.
Avoid foods that appear to aggravate symptoms. These may include milk and dairy products, certain fruits or vegetables, whole grains, artificial sweeteners etc. But this is based on the personal observation for the aggravating food.
3) Investigations by your physician (if not done recently); Ideally you should consult a gastroenterologist who can perform the following investigations which are the mainstay of the evaluation and which will give true perspective of the cause;
1) Blood investigations do give the clue. A complete blood count, biochemical profile, serum calcium, blood glucose, and thyroid function test.
2) Depending on these blood results further blood work is done; serum protein electrophoresis, urine porphyrins, serum parathyroid hormone, and serum cortisol levels, may be done to identify or rule out myeloma, porphyria, hyperparathyroidism, and Addison's disease. These causes are not common causes so clinical manifestation and physical examination clues are important.
3) Barium enema or barium meal with follow through study
4) Colonic transit time; it can provide a better understanding of the rate of stool movement through the colon.
5) Other investigations like Anorectal manometry, balloon expulsion test, Defecography etc.
6) Colonoscopy / sigmoidoscopy
7) CT scan of abdomen.
Discontinue the following if you do them;
1) gum chewing,
3) drinking carbonated beverages, and
4) gulping food and liquids.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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