Is it IBS or Gastroparesis?

[kangaSue]

I see a lot of people with functional gastrointestinal disorders are simply given a diagnosis of IBS but mention a symptom set that I recognize as being gastroparesis.

I can't find how old it is but the following brochure (put out by the (non profit) Canadian Gastroparesis and Dysmotility Association) makes some distinctions between the two in relation to ME/CFS.
http://www.digestivedistress.com/sites/default/files/pdf/ibs.pdf

Symptoms common to it being gastroparesis are;
An early feeling of fullness after a few bites of food
Abdominal bloating
Persistent feeling of fullness
Acid reflux / Heartburn
Upper, mid abdominal pain, and a feeling of heaviness in your stomach, especially after
eating
Belching
Regurgitation of food, especially when lying down
Occasional vomiting

Reading the last paragraph makes me consider myself lucky that I don't have ME/CFS on top of chronic GI dysfunction;
[For many with idiopathic gastroparesis, it is closely coupled to FM/CFS/ME and with more research may demonstrate that, for some, it is part of the same clinical picture.]

 

[CFS_for_19_years]

I recently had two long discussions with a GI doc who I really like. He was thorough, had a caring attitude and answered all of my questions. We discussed having a diagnostic test for gastroparesis, but trying some changes in diet first to see if this had any effect on my intermittent nausea. I also take opioids, which can cause gastroparesis.

I would urge you to see a GI doc to discuss your concerns if you're having GI problems. Gastroparesis cannot be diagnosed by symptoms alone. It can be suspected, but in order to get a firm diagnosis, you would need to have a gastric emptying test done in radiology. He also mentioned that the drugs that treat gastroparesis have worse side effects than the promethazine I'm taking for the nausea.

He's waiting to hear back from me regarding if changes in my diet help (smaller meals, eating 4-5 times a day, avoiding fiber/fat at breakfast), then if those changes don't help, we'll do the gastric emptying test. He also suspects that the opioids I'm taking may be causing some nausea and we've discussed the possibility of having my primary doc or pain doc prescribe a different type of opioid, since MSContin is notorious for causing nausea.

He seems very intent on getting to the bottom of the problem, whereas my pdoc just refused to refill an rx for promethazine until I saw a GI doc!

I'm pretty sure I had some gastroparesis before starting opioids - feeling bloated after eating, etc.

A long time ago, when I was well, I was diagnosed with IBS, and only had it for a year or so. It felt totally different from what I've been experiencing since coming down with ME/CFS and now, taking opioids.

 

[kangaSue]

would urge you to see a GI doc to discuss your concerns if you're having GI problems. Gastroparesis cannot be diagnosed by symptoms alone.

I wasn't worried about me, just wanting to point out that IBS is often wrongly diagnosed.

I've had 16 years of long discussions with GI doctors, diagnosed with Idiopathic Gastroparesis, Non-occlusive Mesenteric Ischemia and Small bowel pseudo-obstruction.

Opiates and NSAIDS can all slow gastric motility so re definitely best used as sparingly as possible. I assume your doctor gave the advice that the drugs that treat gastroparesis have worse side effects than the promethazine your taking for the nausea in regard to the adverse cardiac affects that some people get. The facts are that this applies only to a small at risk cohort and these all encompassing assertions are contrary to the available evidence for the vast majority of gastroparesis patients.

I have been on the maximum dose of domperidone for ten years without incident since cisapride was withdrawn from market as a knee jerk reaction to a few with adverse cardiac effects who shouldn't have been given the drug in the first place (susceptible to long QT Syndrome). Actually, the most beneficial drug I have found for my symptoms is peripheral artery vasodilators as mine is caused by a non-occlusive impairment of blood flow to the bowel resulting in intestinal ischemia (Ischemic Gastroparesis from suspected spasms in the mesentery artery microvascular network, related to low blood pressure).

Smaller meals more often and cutting back on fiber and fat does make a lot of difference to a majority with gastroparesis in my experience so that is another factor to look for in differentiating IBS from gastroparesis.