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View Full Version : Slow gastric emptying - any experience?


Lifeisgood
02-17-2008, 01:50 PM
So, Harlie had a gastric motility study a few weeks ago. This is what they said:

(note she went 5 hours with no food and was fed 30 mls for the study)

It said that after 1 hour only 31% had emptied from her stomach. After 1.5 hours only 41% had emptied.

So my question is - how does this rank as far as "slowness"? I mean, she didn't even pass 15 mls in 1.5 hours?! I'm trying to feed her 135 mls in an hour! No wonder she's vomiting like a champ!

We see GI on Tuesday, but I just wanted to get your opinions first so I know if they tell me something way off base. If you have exp. with this, what kind of "repair" can they do, if any?

Thanks in advance!
-Christy

angelamclamb
02-17-2008, 02:21 PM
Jonathon GI put him on Reglan to get the stomach to empty faster. Of course he had reflux so bad he was refluxing up to his trach so he was on Reglan and Zantac until he had the Nissen. Good Luck, home you find out something to help her. Poor baby! :hug:

faywrayy
02-17-2008, 02:43 PM
Kate has delayed gastric emptying too, but no clue what her levels were. All I know is they put her on Reglan right away and that's worked fine.

Christamae
02-17-2008, 03:03 PM
I have severe delayed gastric emptying aka gastroperesis. It took 6 hours for mine to move and two days later some was still there. They will probably try a medication first. Reglan or erythromicine. Also bolus feeds are out. Using a pump at a slower rate could help. Farrell bags are the best-request them. They vent gas and if the stomach is too full the food backs up into the bag and drains down when there is room. The problem also causes a lot of gas. You will most likely need a semi-elemental/partially digested formula. Peptamine and Peptanex are the ones I know of.

My delay was bad enough that I had to switch to a gj-tube. My g line is on a drain because even the bile backs up and all my food/meds go through my j line via pump 24/7 with a Farrell bag.

There is an experimental surgery that places some kind of stimulator in the stomach. But basically you try meds and pump feeds and formula changes. If that doesn't work you switch to a jtube (that has to be pump fed). There is a mic-key gj tube that uses the same stoma-no more surgery- and has two lines, one to the stomach and one to the jejunum. That's what I have.



Hope that helped.

drct1245
02-17-2008, 03:22 PM
Christy,
Looks like you got a lot of good info. I am glad you got a dx... now you just need a plan. You might have to switch to slow all day feeds too. (?)

We have been on reglan too before when they thought Ayden had delayed gastric emptying and didn't have any issues. I have read that some kid's systems don't take to it too well. Just a heads up.
:hug:

Lifeisgood
02-17-2008, 03:52 PM
Wow Christamae!!! Lots of good info! We've talked about a g-j tube in the past. It is really good to know that they can do it through the same stoma.

Okay, so she's already on Reglan - yikes! And she's on Peptamine, Jr. She used to be on 21-hour continuous feeds - still vomited all the time. It took months, but we now have her on 3, 1-hour feeds during the day and 11-hour continuous over night. Granted, she vomits a lot - so maybe the continuous is the way to go. I was just thinking that eventually her stomach would "learn" how to work. I suppose that was wishful thinking.

I was hopeful that we could switch to pureed foods sometime soon - but I'm thinking that they would not empty faster than Peptamine, huh? Darn it!

Thanks for all the info so far! I'll let you know what the doc says on Tuesday.

drct1245
02-17-2008, 04:43 PM
I wonder if the pureed foods would help or be harder. The reason I as is b/c Ayden used to have issues w/ water and according the NP at the GI's office, sometimes the water is too simple/light and the stomach doesn't empty it. So when we gave meds we had to use pedialyte... maybe something to ask the GI.
Or maybe I just didn't understand the NP and the workings of the stomach. :D
Although Ayden's scan came back OK, it sure seemed like he digested pureed foods better....???

Christamae
02-17-2008, 05:51 PM
I started out on Peptamine and had a lot of issues. So many that I was on supplemental IV lipids. Now I use Peptanex DT. Much better. And I add poi which regulates my bowel and helps with gas.

I am almost positive that you can't put pureed food into the jejunum. It doesn't have the squeezing motion of the stomach so it has to be liquid. Also no bolus feeds because the jejunum doesn't stretch.

Good luck!

suzanne2545
02-17-2008, 05:59 PM
Christy, Good luck on Tuesday. Hope there are some answers. You have a lot of good info here.

Suzanne

faywrayy
02-17-2008, 07:05 PM
I'm guessing Kate's levels must be really low based on what Christamae says...she tolerates bolus feeds, and has for a long time. She also had no problem with regular formula (Enfamil Lipil) and now Pediasure.

Good to know!

cariaad
02-18-2008, 07:50 AM
The Reglan may be doing more harm than good, in our experience. It made Allison agitated, which lent itself to the vomiting. All the information so far has been right on target tho, so you have lots to consider. The slower, 24 hour feed might be the way you have to go. No one really wnats that, but the constant vomiting isnt something you want to keep on with, wither. Sometimes a different formula (I think Christamae had some names, all I can remember is Peptamen Jr because it worked for us) are good to try, it can make a huge difference. I hope you get this worked out. I remember the days of constnat puking, not fondly! Deb

annettevz
02-18-2008, 08:36 AM
Christy,

Ashley has a been a super puker her whole life. She also has delayed gastric emptying. When she had her study done back in Nov 05, It was discovered that Ash had malrotated intestines. She had that repaired and everyone thought that was theanswer. About 2 weeks later, the puking started again. Ashley was put on erythromycin as well as the domperidone and prevacid she was already on. It sort of worked. Ash was also on 22 hour con. feeds. I found that she threw up more because she always had something in her stont mach. Last fall, Ash was switched to Neocate JR from Peptamin JR. It really helped. She still throws up if she swallows a lot of mucus, but its much better than the constant puking. If the formula switch didn't work, Ash was going to either try cisapride, a medication thats been taken off the market but apparently works wonders, or get a j-tube.

Good luck tommorow!!!

Annette

welovelucy
02-18-2008, 08:45 AM
Hi Christy, add us to the list of kiddos who do *worse* on the Reglan. Lucy would puke and puke and puke while on that. Granted, she still pukes a couple times a day, but it's mainly because it's always been very slow for to get used to any changes in feeding regimen (e.g., different formula, more formula, etc.), and we've recently been monkeying with her boluses... The Reglan really contributed a lot, though, to her puking. Her cardiologist (and some of our nurses) said that it sometimes has the reverse effect on kids, especially after long-term use. So ask them about that--it might be worth trying to get off that med, just to see what happens. Harlie can always go back on it.

Getting the GJ might also be an option, but I have to tell you, that the GJ was a REAL pain for us. (Lucy just got the G-tube about 6 months ago after being on GJ for about 12 months). You wouldn't think that having the GJ would be that much worse, since she's on the vent too and is always "very well connected" :rofl:, but that extra little bit of equipment (pump, feed bags, formula) used to just put me over the edge!! Also, the 24/7 feeds were a real PITA. (someone else, Christamae I think (??) was right that you won't be able to do bolus feeds or pureed feeds when on the GJ)

OTOH, Lucy hardly EVER puked while on the GJ. So maybe it would be something to try when Harlie is still little. But IMHO, it seems like a step "backward" (KWIM?) If it's what she needs, obviously then it's what she needs, but for us, the months on the GJ really *hindered* Lucy's ability to empty her stomach. The docs told us that her pyloric valve (b/t stomach and jejunem) got "lazy" or floppy during that time b/c she didn't ever use it (no feeds in stomach). So she is now having to "re-train" it to open and close as it should. So that is one other drawback of having the GJ.

GL!! I hope you get some answers. I know how frustrating this whole feeding business is!!! After all the other stuff that our kiddos go through, it seems like feeding is one of the most insidious stressful problems. I really feel your pain...:hug:

Heart hugs! Sarah

ETA: FWIW, Lucy had a gastric emptying study long ago, and does NOT have delayed emptying. But she still has the puking... Go figure. (she does not have the nissen, though...)

Hanna
02-18-2008, 11:56 AM
Svana was always a puker,
We tried all the meds and nothing worked and she does not have delayed gastric emptying, she does not have reflux and pretty much no one has any idea why she pukes so much,
She did have the Nissen done when she was 3 and was still puking 3 months after surgery.
Finally they thought it might be neurological so she is on Neurontin and that seams to work now she only pukes if she has increased mucus.
( knock on wood)

curt's mom
02-18-2008, 02:45 PM
with the gj tube did you have problems with it clogging up alot? Our hospital uses soda pop to flush it!
Arlene

Mom2TwinsPlus1
02-18-2008, 03:56 PM
Well I normally have an ok gi system myself but when I was pregnant with the girls I had horrible morning sickness all day long, and slow gastric empty. Which was actually ultrasound, because of course xrays and pregoo woman don't mix. They put me on reglan and my first dose I realized I was highly allergic! They then put me on zofran for the vomiting and had me eat very small amounts of food/liquid. I took iv quite often for the loss of fluid since I couldn't drink it. Once I had the girls i was ok again, they arent sure really why I did that other than the fact I was having twins and everything was squished.

madelyn and rynns mom
02-18-2008, 10:33 PM
Sorry so long!!

Maddy has severe gastroparesis as well!! We went through a year of arguing with the docs as to why she would gag and vomit continuously on no more than a 35cc/hour rate. After I finally threw the biggest fit known to man while reading off all of her symptoms and the fact that they ALL pointed to gastroparesis, they finally agreed to run a gastric emptying study(helped a little that I told them we were not leaving the hospital without the orders and an appointment scheduled for within a week!!!! I laughed hysterically when they came in all excited saying that "THEY found her problem"!! :eek: "I'm sorry to have to tell you this, but your daughter has gastroparesis." Ummmm, NO @#%$ Sherlock!!! Now tell me why she had to go through a YEAR of every test and argument, BUT the one we wanted???!! Their only response was that they had to follow proper protocol and rule out everything else first. JERKS, let it be their child and it would have been different!!!!

Maddy has been on Elecare since the dx and has been fine since!! It is an Amino Acid based formula, that provides complete nutrition for infants and children with gastric problems. It requires no work from her stomach to digest it, they told me it is considered "predigested" because it is already broken down as far as it can be. She now takes 135 or more cc/hour with NO problems!!! It has truly been a miracle for her!!! Hope this helps!

Love Kris:hug:

madelyn and rynns mom
02-18-2008, 10:34 PM
Well I normally have an ok gi system myself but when I was pregnant with the girls I had horrible morning sickness all day long, and slow gastric empty. Which was actually ultrasound, because of course xrays and pregoo woman don't mix. They put me on reglan and my first dose I realized I was highly allergic! They then put me on zofran for the vomiting and had me eat very small amounts of food/liquid. I took iv quite often for the loss of fluid since I couldn't drink it. Once I had the girls i was ok again, they arent sure really why I did that other than the fact I was having twins and everything was squished.

I had the same problem and that was what they told me too!!

Love Kris:hug:

Mom2TwinsPlus1
02-18-2008, 10:39 PM
yea not that I am not preggo the only digestive issue I have is gallbladder, and that makes me stay a puker sometimes! LOL