Gastroparesis - Problem w/Fluid Emptying Only - Need help with rare symptom / diagnosis

[Howard]

Can low stomach acid be a possible cause for gastroparesis, specifically, fluid not emptying from the stomach?

Being in the hospital, I didn't have much to work with, but last night I experimented by eating packets of pickled relish, and sucking on pickle juice while eating protein in the form of Gerber's baby food (turkey).

My nausea did reappear 45 minutes after eating, but with additional pickled relish it was relieved soon thereafter.

After a brief search, I cannot find any literature to support this.

Thanks

 

[Howard]

Also, I had some success forcing stomach emptying back in January through March by drinking tart cherry juice.

If I remember correctly, tart cherry juice causes or enhances activation of Serotonin in the body, which works on tryptophan, which causes contractions with the stomach muscles.

Or maybe it enhances contractions, I'm not sure.

 

[Hope4]

@Howard Good for you for thinking of the pickle relish. I'm hoping you noticed an improvement, due to the vinegar and salt.

I'm looking on the internet to try to find out if low stomach acid can cause gastroparesis.

So far, no clear answer.

But, did find this page on gastroparesis:

http://patients.gi.org/topics/gastroparesis/

An excerpt from that page, on tests:

Upper Endoscopy is a test that is performed by inserting a thin flexible tube through the mouth into the stomach. The endoscope has camera capabilities and allows the upper gastrointestinal tract to be evaluated for ulcers, inflammation, infection, cancer, hernias or other abnormalities. These conditions can cause symptoms similar to gastroparesis. Upper endoscopy usually requires 10-15 minutes to complete. Medication is usually administered intravenously immediately before the test for comfort and sedation. If abnormal findings such as an ulcer or inflammation are noted biopsies can be obtained. Fluid samples may be collected testing for bacterial overgrowth.

Gastric Emptying Study is a widely available nuclear medicine test that examines the rate of emptying of solid or liquid material from the stomach. A delay in gastric emptying indicates a diagnosis of gastroparesis. Subjects consume an egg and toast or oatmeal meal along with milk or orange juice. The food portion contains a tiny amount of the radioactive material (99m Tc), which is measured by a scanning technique as it empties from the stomach. A longer test can examine if small intestine transit is also affected.

Scintigraphic Gastric Accommodation is a test that measures the volume of stomach contents before and after a meal, and how well the stomach relaxes in response to food intake. This test uses a tiny amount of radioactive material (99m Tc) which is selectively taken up by the lining of the stomach, and indirectly measures the volume of the stomach. The subject consumes a nutrient drink over 30 seconds. A scan of the stomach is taken before and after the nutrient drink. The test indicates whether the stomach relaxes appropriately when filled. Symptoms of poor stomach relaxation can be identical to poor emptying, and this test can help distinguish the processes. Scintigraphic gastric accommodation is not readily available.

Gastroduodenal manometry is a test that measures how well the smooth muscle of the stomach and small intestine contracts and relaxes. The test is performed by placing a thin tube into the stomach usually with the aid of the endoscope. The tube is advanced into the small intestine and over the next few hours the contractile responses while the subject is fasting and eating are observed and recorded. The manometry catheter provides information on how strong and how often the muscles of the stomach and intestine contract and whether the stomach contractions are coordinated with the contractions in the small bowel. Gastric duodenal manometry may be helpful but is often not needed to make a diagnosis of gastroparesis. This test is not widely available.

A Small Intestinal X-ray is a contrast radiograph used to outline the anatomy of the small bowel. This study is not generally needed to make a diagnosis of gastroparesis, but a blockage anywhere in the small intestine will result in a back up of material and could account for delayed gastric emptying. An obstruction in the small bowel may cause symptoms similar to gastroparesis, but the treatment is different. Treatment for intestinal obstruction is avoiding intake of any food or liquid until the cause of obstruction such as inflammation resolves or surgery is performed to remove the blockage.

Wireless capsule GI monitoring system (SmartPill®)
The wireless capsule monitoring system is a non-digestible capsule that records pH, temperature and pressure changes as it travels through the intestine (figure 3). The information from the wireless capsule is transmitted to a receiver worn by the patient around their waist. The information is used to determine how fast or slow the stomach empties, and similarly how food and liquid move through the intestine. The test is done in an outpatient setting, takes generally 3-6 hours and within 24-72 hours the pill is passed from the body. A potential advantage of the wireless capsule system over conventional gastric emptying or scintigraphy would be that the study could be done in the outpatient setting and would not involve radiation, though the amount of radiation used in alternative tests is very small and not considered harmful. Occasionally, if the capsule is not passed within three days your doctor may request an abdominal x-ray to assure it has left the body. Use of the wireless capsule monitoring system is not recommended in patients who have had previous surgery to decrease the amount of acid they are secreting, in patients who are unable to stop their antacid medications for the study or in patients with narrowing of the bowel lumen.

 

[Howard]

@Hope4 thanks

We've discussed many of the tests that we haven't run, as well as the ones they have. I guess we'll see what they come up with today.

 

[Howard]

Blood work results from yesterday, specifically targeting gastroparesis related deficiencies:


Ferritin
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73.1 ng/mL
Date: Apr 25, 2019 08:20 a.m. MST
Reference Range:23.9 ng/mL - 336.2 ng/mL


Vit B12 Lvl
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409 pg/mL
Date: Apr 25, 2019 08:20 a.m. MST
Reference Range:211 pg/mL - 911 pg/mL


Vit D 25 Hydrox
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41.6 ng/mL
Date: Apr 25, 2019 08:20 a.m. MST
Reference Range:30.0 ng/mL - 100.0 ng/mL


I believe my increase in vitamin D levels has had a positive impact in my improving energy levels over the past 3 years. Back then, I scored in the teens.

 

[andyguitar]

I think that in your case @Howard it's going to be the tests that reveal what is going on. The strangest thing about your symptoms is the fact that food seems to be transiting but not liquids. This is particulrly odd as food in the stomach is gradually turned into a semi-liquid state. I have been seeing what I can find out but not had any luck so far.

 

[Hufsamor]

@andyguitar
The link from @kangaSue was interesting

I fit that bill.

There is one Australian study around specifically into people who have gastroparesis-like problems with ME/CFS. They found that liquids emptying was a greater problem than solids emptying.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC544348/

"An abnormality in solid or liquid emptying or combinations of these study parameters was more common in the more symptomatic patients, and liquid was more frequently affected. This is the opposite of the abnormality seen in diabetic subjects [8], where the major abnormality, delay in the solid phase of gastric emptying has been ascribed to autonomic dysfunction or hyperglycaemia. A group of elderly subjects with a number of neurological defects showed a delay in the liquid rather than the solid emptying [11]."

But no suggestion as to what to do with the problem

 

[Howard]

An abnormality in solid or liquid emptying or combinations of these study parameters was more common in the more symptomatic patients, and liquid was more frequently affected.

Interesting. So it appears I'm not the only one.

And this is going to sound very non-scientific, but it's almost as if my mouth, esophagus, and stomach don't recognize fluids as readily... food is sensed, fluid is not.

 

[Howard]

I'd check both vitamin B12 and vitamin D, both contribute to GI motility function (vitamin D in something of a roundabout way though).

One research study indicated vitamin D levels that are higher also encouraged faster gastric emptying. I seem to recall 75 or 80 being the magic number. I'm at 41, which isn't too bad, but that could be an area to focus on as well.

 

[Howard]

Sites with user suggested remedies for gastroparesis include EarthClinic, and CureZone

These sites and Facebook are good suggestions. I'd like to avoid these medications if possible, the side effects don't sound all that impressive. Perhaps some of these people have tried these medications and have an informed opinion.

 

[Tammy]

Just a thought. Viruses can inflame nerves and sometimes in a really damaging way. (paralysis) This can prevent proper signals and messages from getting to their destination such as your digestive tract. I believe this may be what is happening. Note: nerve paralysis does not have to be permanent. When nerve inflammation calms down...........messages get to where they need to go.

AS far as diet......................Howard, consider Avocado. It is one of the most easily assimilated foods. Also papaya..........is one of the best for the digestive tract.


I am sharing my experience with diet. (I realize everyone's diet experience is different). The following is based on almost 4 yrs of observing which foods gave me inflammation. 1)Eggs..........the absolute worst for me
2)Dairy
3)wheat.............the only grains which seem to not affect me are quinoa and millet. I can eat some GF oatmeal sometimes.
4) sugar. Fruit sugar is OK for me.............not from concentrate juices from the store............but only from the fruit itself.

Edited to share more info.

 

[Howard]

Just a thought. Viruses can inflame nerves and sometimes in a really damaging way. (paralysis) This can prevent proper signals and messages from getting to their destination such as your digestive tract. I believe this may be what is happening. Note: nerve paralysis does not have to be permanent. When nerve inflammation calms down...........messages get to where they need to go.

AS far as diet......................Howard, consider Avocado. It is one of the most easily assimilated foods. Also papaya..........is one of the best for the digestive tract.

Thank you for responding. As of 9/2018 I do have active Epstein-Barr virus with a score greater than 600. And that's at least partially responsible for my severe neutropenia.

But yes, to me it seems as though there's a lack of proper communication from the top down.

... and yes, avocado has been one of my daily staples for the past two years. Haven't been able to eat it in a couple of weeks though.

 

[Tammy]

... and yes, avocado has been one of my daily staples for the past two years. Haven't been able to eat it in a couple of weeks though.

So very sorry you are having such a difficult time. I added more to my reply above regarding diet. I see that you are already wheat and dairy free. In the future you might experiment with taking eggs out for awhile to see if that helps with inflammation. Eggs are the ABSOLUTE WORST for me.

I'm curious...........what kind of reaction do you have to potatoes?

 

[Shoshana]

I am hoping that the info from your tests and inquiries, and with the help from the medical people, there, will help bring things into better focus for you soon, @Howard
And will guide you toward the plan of next steps to try, in some semblance of order.

It does seem to me, (very unscientific , as well )
that doctors often assume people need meds for reducing stomach acid,
when in actuality, many of us need increased stomach acid, to break things down
(again, it seems to me )

I dont know, too much, or i would be well, myself!

 

[Howard]

Also papaya..........is one of the best for the digestive tract.

Papaya actually made my stomach bleed. Way too strong for me.

1)Eggs..........the absolute worst for me
2)Dairy
3)wheat.............the only grains which seem to not affect me are quinoa and millet. I can eat some GF oatmeal sometimes.
4) sugar. Fruit sugar is OK for me.............not from concentrate juices from the store............but only from the fruit itself.

I only discovered this a few months ago through Reading someone else's post, but potato starch gives me brain fog, causes weakness, and I sweat profusely after ingesting.

I've been gluten-free for 20 years, dairy free for 30 years.

As soon as I stopped ingesting high fructose corn syrup, my ibs-d stopped immediately. I'd had diarrhea multiple times a day for three consecutive years before discovering this. Simple sugars are bad! Fruits are okay, but fruit juices I have to be careful.

Normally I eat eggs all the time, but I've had to stop since being in the hospital. So I guess we'll see where that takes us.

Up until this gastroparesis incident, my energy and cognitive abilities had been increasing over the past three years.

What's interesting is that I just had a discussion with the phlebotomist and she's having many of the similar issues I many of the similar issues I had when this illness began nine years ago.

And she's on the same exact diet I am on. She has ibs-d as well, daily diarrhea. I invited her to come back and speak to me in greater detail she felt comfortable doing so.

 

[Hufsamor]

Interesting. So it appears I'm not the only one.

Article says (about the me/cfs patients in this research):

The major abnormality shown is a delay in the emptying of the liquid phase in 23/32 72% of the patients,

 

[Howard]

Article says (about the me/cfs patients in this research):

The major abnormality shown is a delay in the emptying of the liquid phase in 23/32 72% of the patients,

I wonder if that means a "fluid only" delay, or there's a delay in both fluid and food.

 

[Hufsamor]

Ok,
I found another article.
It seems your problem is more common than one should think it was.
Just more difficult to discover, so it if often not detected.
This study is not about me/ CFS sufferers

https://www.ncbi.nlm.nih.gov/pubmed/19623689

"Liquid gastric emptying is commonly abnormal in patients who have normal solid studies. Liquid studies should be routinely performed in addition to solid studies to fully evaluate gastric motility in patients with symptoms suggestive of gastroparesis."

 

[Hufsamor]

And now I saw your last comment.
Both the article from @kangaSue (with the me sufferers) and the last post is talking about liquid only, solid no problem.
If you are capable of reading anything, I think both articles are worth reading and maybe show your doctors?
But they don't have any solutions, as far as I can see

 

[Howard]

Apparently they are sending me home, so I'll continue to figure out a solution by myself, and with the help of everyone here.

Thank you for your continuing efforts, I will investigate all possible avenues based on your recommendations.

Now I just wonder how I shall stay hydrated at home without having access to an IV.

What's the minimal daily fluid intake that would allow me to survive? 24oz?

And I'm assuming I should focus on hydration, rather than eating, so I've got to figure out the right balance.