Test for Gastroparesis
 

May I ask if Upper GI test using barium can also be used to diagnose slow emptying problem as an alternative for the gastric emptying study (using radioactive)?

My GI doctor does not think I have problems with gastroparesis because normally, patients would vomit after eating. Though, I dont vomit after eating but I feel bloated after eating. I eat frequent, small amounts of food, but even with this, I still feel so full. When I start feeling bloated, my breathing becomes more difficult. Its a cycle.

My abdomen cat scan was normal. NOrmally, she said she would have given me an endoscopy but since I just had a bronchoscopy, she gave me request for upper GI test intead. While searching on the net, I found this article about alternative tests for gastric emptying test and upper GI was one.

It is important that I should gain more weight. I am thin for my height and for patients with Mycobacterium Avium, it is really required to add more calories.

Thank you.

A spasm of the pylorus will also cause this type of symptom.

It can be tested for with the upper GI. (also it can be relieved with an antispasmotic drug like Levsin.) I often get this because my GI tract is twisted... a rare congenital thing I was born with.

Also an upper GI "may" show a hiatal hernia. Mine showed up dramatically and I even had to lie on my right side and drink MORE Barium! However, my doctor said only about 10% of hiatal hernias show up.

When the stomach and esophagus move up thru the hernia, there is a pressure and feeling of "doom". I have learned to live with it. One thing is to NOT bend over after eating and not eat large amounts of food at a time.

For bloating, you can take Gas-X (or any simethacone product) and it will help you to burp and reduce discomforts. Gas is one thing that will make GERD/heartburn much worse.

I use a Maalox product with both calcium and simethacone in it to help move things along better, sometimes. I avoid carbonated drinks, and gassy foods too. But you can do the simethacone alone if you want.

I'd get the upper GI... it will probably be useful. The upper GI can be ordered with a small intestine request. They will have you sit around after the upper GI and see how long the barium takes to move thru the upper intestine. For me it was 20 minutes instead of 3 hrs (normal)...because of the maltodextrin in the suspending agent for the barium. I am intolerant of that, so my barium moved thru in a BLAST! They barely had time to take the X-rays to show it even. If your stomach holds the barium too long, that will show up as well.

The gastric empty test is the gold standard to diagnose gastroparesis. It is a very easy test...just eat some scrambled eggs laced with contrast (you can't taste it), then lay down flat for 2-3 hours and watch TV, listen to music, or nap...just can't move. Images are taken over the 2-3 hours to track the food/contrast and determine the empty time.

Sorry for the short reply. I'll try to elaborate more later.

Thank you en bloc. Your short reply is okay and appreciated. I was hoping that I could maximize the results of the upper gi test. So I could avoid other diagnostic tests.

Does the diaphragm show on chest cat scan, even if its not the focus of the test? I am trying to rule out every possible cause. I asked the doctor about my diaphragm but he said that its normal because if its not it will be "elevated". But you know, when he said this he was already on his way out of the room (on to the next patient). I am not sure if that reply was "reliable" :-).

Thank you Mrs.D! It is really so frustrating. This bloating contributes to my discomforts. Me and my husband were on Nexium but recently his med was changed to Protonix because it seemed that he was no longer getting relief (he has been on Nexium for a long time). I know its wrong, but I have been trying his new medicine. So far, I dont see any improvement in my bloating.

In between I take Ranitidine.

I am not sure if I have gas. I used to hve so much gas (big time) when I did not know that I am lactose intolerant. But now that I have corrected that, I seldom hear my stomach grumbles.

I am trying to minimize my exposure to x-rays and radiation because I will need several cat scans to monitor the improvements of my lungs. Please pray for me that I complete the whole course of the antibiotics with minimal side effects. Needless to say, the antibiotics adding to my stomach problems.

I will try that Maalox with calcium and semithacone. Does calcium affect the absorption of all medicines/vitamins ?

Does anyone know if the barium that is used for the upper GI test is same as used in culturing the mycobacterium avium in the laboratories?
Or, does anybody can point me to the right field of expertise to ask this question. I just read this from one of those online discussions and I want to validate the veracity of this claim. I dont want to be drinking something that will encourage the growth of this bugs.:D

Will appreciate your feedback.

You don't have to take the Maalox with the calcium, it is just that I use it. Simethacone comes alone without anything and is
called Gas-X (and other names).

Bloating means GAS and gas will come from all the acid blockers.
These drugs impair breakdown of protein, which then is fermented nastily in the intestines by bacteria. The gas will move up when high in the tract and will move down if lower.
It is a consequence of acid blocking drugs and really leads to more heartburn as the gas bubbles up and splashes the esophagus.

Gas-X? We have plenty of that here at home, in boxes! My husband is using it. The feeling of pressure is right in the middle below the breasts. (sorry, I dont know what exact words to use to point the exact spot.) Its the spot which I feel pressing my lungs which in turn giving me more shortness of breath.

Thank you Mrs.D!

There are esophageal spasms that can occur there.

And the hiatal hernia will come up into the chest and cause pressure there or generally. I find lying on my left side reduces any pressure when it comes for me. (my stomach is twisted to the right).

If gas I have my hubby gently pounds my back...sometimes even just pressing on spots with his fingers while I am sitting up, will
move the gas around and enable my burping. This may be only true for me however, because my stomach is twisted 90 degrees towards my back to the right, and that is where the food is moved along to the intestine (for me only). People with normal positioning would feel otherwise I would think.

difference in exams
 

Upper GI: Drink barium and get evaluated under fluoroscopy. Fluoroscopy equals dynamic x-rays, thus involves radiation. Primarily used for anatomic evaluation, such has hernias, reflux, masses, ulcers, and abnormal rotation. If gastroparesis was severe, it could be detected. The main issue with gastroparesis assessment is that barium is a liquid. Most people with gastroparesis, will have normal emptying of liquids with delayed emptying of solids. If gastroparesis was severe, it could effect liquids and thus be seen on the upper GI. Gatroparesis would also be a subjective call made by the radiologist.

Gastric emptying study: Eat a radio-labelled meal, which usually includes eggs with a small amount of tracer. Our protocol involves getting imaged at 0, 30, 60, 120, 180, and 240 minutes. Imaging takes about 5 minutes at each time slot. You do not have to be still for the entire portion of the exam. The benefit of this exam is that it assesses solid emptying. There are also standard criteria to determine if it is delayed or not, so this gets an objective result.

Thank you very Kwinkler for that explaination. I will have my upper Gi test on Tuesday/Oct 16.

I have persistent stomach problems - the bloating has been minimized but the heartburn and the feeling of always empty have been always constant. From the moment I wake up till I sleep, the discomfort in my stomach is the same. I am sure that this stomach problem has been exacerbated by the antibiotics but with the regular yogurt and Kefir, I was hoping that it could be tolerable. I am on daily Nexium and 2x ranitidine but it seems not doing the trick. I was given by the GI dr Carafate suspension, but I am not taking it as Ithought it might have some effects on the other supplements and medications.

Below is the result of the Upper GI I had last Oct. 16. It says that I have a mild reflux, but I dont think what I feel is mild. After this result was out, my GI's PA called advising me that the doctor wants me to have an endoscopy. I reminded him about the doctor's position on deferring any endoscopy because of a recent bronchoscopy. Well, until now, he has not called me yet. I dont want to follow up because I am not sure if I want an endoscopy at this time. I remember what Mrs.D said about the risk of frequent scopes.....


Esophagus is unremarkable without mucosal abnormality, obstruction or intrinsic or extrinsic mass effect. There was questioned mucosal irregularity at the gastric cardia; however, this did not persist on additional imaging and may have been artifactual. If abnormality such as ulceration is suspected in this region endoscopy for direct visualization may be helpful. The stomach is otherwise unremarkable with no evidence of extrinsic and intrinsic mass effect or obstruction. Proximal small bowel is also within normal limits. A barium tablet was administered and passed promptly through the GE junction. No evidence of hiatal hernia. There is mild reflux into the distal esophagus when the patient is in the recumbent position.

If your stomach problems are this persistent after trying various remedies, etc, then you may need to consider further testing. Missing something serious because you want to avoid testing could be costly. It is always good to try and avoid some of the medical intervention (invasive procedures etc) first. I understand not want to scope frequently. How long has it been since your last GI scope? If the last one was normal I would doubt something horrible just popped up in a short time.

The GI track is a complex system with many possible problems that can occur...that can share similar symptoms. What does your GI suggest at this point? Does he have any ideas?

The last one was not endoscopy. It was bronchoscopy last July -- finding was the MAC. After the abdomen cat scan in September -- result was normal -- GI Dr said it must only be benign. She asked to continue the Nexium, undergo Gi series and defer the endoscopy. After the upper gi the nurse called asking me to undergo an endoscopy. So I reminded him about the deferment I thought the Dr might just have forgotten what she said. The nurse said he 'll talk with the Dr. That was 1week ago.

I remember the bronchoscopy. But if you've never had a GI endoscopy before, other tests are negative, various attempts to treat have failed, and this continues to be a problem, then I can see why your GI may want to do the scope after all. Seems pretty reasonable.

If I remember right wasn't this a significant problem before the addition of the antibiotics for the MAC? Just thinking out loud...in case this is related to the antibiotics.

I was just reading how Mrs D. said that anticholinergics can cause slow emptying of gastric content. I'm taking 15 mg of amitriptylene a day for Interstitial Cystitis, Fybromyalgia and neuropathy. I'm wondering if this might be another source of my worsening GERD? If it doesn't eventually settle down with elimination of the R-lipoic acid, I'm not sure what to do. My GP wanted me to have a CAT scan of my pelvis, abdomen and chest but I've been deferring it in favour of ultrasound, mammogram, chest X-Ray and such to avoid so much radiation. Do you think I should ask to see a gastrointestinal specialist and get the problem evaluated that way or just go for the CAT scan? Would the CAT scan even be able to identify the problem? I hope I don't have gastroparesis from nerve damage but I wouldn't be surprised with the way it seems to be everywhere throughout my body. I think I really need to find the source of this awful neurological problem.

That is really a low dose. If you have any blurred vision from a drug with anticholinergic potential, it is more pronounced in the elderly (over 60), and typically when it is exerting this side effect you will have some blurred vision too. If nothing is noticeable vision wise, you may be tolerating it okay. Dry mouth is another side effect possible.

People vary with drugs that have anticholinergic potential. Some get constipated on them, as well. But the little doses of amitriptyline typically are tolerated very well. As people become elderly however, this changes.
The old antidepressant doses of this drug were 150mg-300mg a day by comparison. Amitriptyline is not used much anymore for depression.

The reason why I am hesitant to undergo the endoscopy is because my pulmonary will do another cat scan and bronchodcopy after 6 months of treatment (march 2013). But if the GI Dr recommends thee endoscopy I think I should go for it.
Yes en bloc. This stomach problem was present prior to MAC treatment but the antibiotics, I think make it worse.
You remember about the stomach distress PRE MAC. That was sweet of you to remember! Thank you.