Input about gastroparesis

[Sassy5d]

I've been having what seems like an abundance of Pts lately with gastroparesis. I'm really trying to understand it. I *know* what it is but I'm feeling like I'm not doing my Pts any good.

What do your er's do for treatment? Does anyone have it that can give me good nursing care tips?

I don't understand why the recent Pts come in with blood curdling screaming until they are given multiple doses of pain medication, and start screaming again about 30 mins post dose.

I'm wondering if there isn't a psych/psychological/behavioral component to these Pts. As I just don't understand their behaviors.

Any input??

[emtb2rn, BSN, RN, EMT-B]

I still can't see why a pt. would be running around screaming however...if anything my symptoms make me curl into the fetal position and lay very still otherwise I vomit if I move too much...

The curled up presentation is what I usually see with our known gastro pts when they come in. Histrionics always make me suspicious, regardless of complaint.

[valzRN, ASN, RN]

My husband has idiopathic gastroparesis and has recently gotten so bad in the last 4-5 years that he has lost a career that he absolutely loved and has no life at all anymore. His stomach totally dictates his life.

There are several different ways that they can treat gastroparesis (GP). There is no cure for this disorder but there are ways that they can reduce the symptoms. The most severe symptoms are crippling abdominal cramping, nausea, vomiting, diarrhea, heart palpitations, and dyphoresis. This is what my husband, John has been going through for the last 10 years. It started out as maybe 2-3 flare ups a year that lasted a couple of days. Now they come around about once every month or two and can last for weeks at a time. The only way that he can get relief is to be admitted to the hospital and to be given fluids and medications through IV. The only time he is admitted is if his electrolytes are off or (god forbid) his Albumin level has spiked so high that he's totally out of his mind. (That's something new that has developed over the last 3 flare ups.)

The Drs wanted to insert a G-tube or J-tube to focus more on nutrition maintenance. He drinks about 7 Ensures a day (which gets VERY expensive) because he has absolutely NO gastric motility. He refuses to get the tube though. The Dr has also spoken with my husband about another surgical intervention... a gastrectomy, and / or multi-visceral transplant. Although these can improve the ability to eat, they also carry a high risk and should only be considered as a last resort. About 2 years ago he was FINALLY approved by our insurance for a Gastric Pacemaker. This is a gastric electrical stimulator (GES). It's an implantable device used to stimulate the smooth muscles of the stomach in patients with refractory GP who have failed with all other drug treatment programs. This is true for John. This was approved by the FDA in 2000 for use as a humanitarian device in cases of idiopathic or diabetic GP. This means that it is only available in certain hospitals which have been reviewed and approved to perform the procedure. Dr. Stockamp in Pensacola, FL. is the only Dr. in our town that performs this surgery. The next closest Dr. that is approved for this surgery is in Mississippi. Because it is humanitarian in nature, the insurance does not often approve it and the process process can be quite complicated. While the device is not a cure, it does control the symptoms of nausea and vomiting in many patients. The settings on the device are increased or decreased based on symptom control and patient tolerance. Settings can be done in the Dr's office by an external remote control. This does not control any of the n / v s/s that he has. It's excruciating and believe me when I say that someone that has this... they are not faking. Hope I shed a little light on this for you.

[icuRNmaggie, BSN, RN]

I give my gastroparesis pts mint tea with sugar or splenda to sip on. It really seems to help with the nausea and gi distress.

[psu_213, BSN, RN]

I would think that gastroparesis is a horrible disease to suffer from. I know there are many people who suffer from the disorder and I feel horrible for most of them. We have a few that are gastroparesis on top of a psych issue. I know one who will go through the histrionics, then drink large amounts of water directly from the tap in order to produce large amounts of emesis if she is not getting what she wants.

[JenERally]

I absolutely empathize with pts who suffer from gastroparesis, and in no way doubt how painful and debilitating it is, but I also wonder if the opiates used to treat the acute pain can also exacerbate and intensify the pain. Many of our IBD pts require extremely high doses of narcotic pain medications during and after their procedures because of the incredibly high doses that they are prescribed at home. One of the IBD docs categorically refuses to prescribe anything aside from tramadol not to be a jerk; instead he explained to me that pts on high doses of opiates for prolonged periods often go on to develop "narcotic gut syndrome" in which higher and higher doses are required to treat the original pain. Eventually high dosages become ineffective and result in new, more severe abdominal pain related to visceral nerve and smooth muscle damage. There's a physician at a neighboring hospital who is currently sponsoring a study of low dose opiate combined with naloxone to treat and/or prevent narcotic gut syndrome.

[delphine22]

My husband used to get bad GP. . .during a very stressful time in our lives. It was definitely stress-induced. Now that things are better, he gets it far less often. (It was definitely GP, he is type 1 diabetic and he flunked his gastric emptying study.) When he starts to get upset and start retching, I throw a Reglan down him and if we're fast enough that he can keep the PO dose down, we're good.

And yes, he was the fetal-position one. Though I understand the OP's comment. A lot of our frequent flyers who are uncontrolled diabetics tend to have GP, and it certainly mimics pain-seeking.

Side note to the person worried about TD: Have you tried erythromicin? Sometimes that's used in place of or rotated with Reglan to cut down the risk of TD.

If you ever see a gastric pacemaker, take a good look at the telemetry. It was our extra credit question on our dysrhythmia test.

[Christy1019, ASN, RN]

My husband used to get bad GP. . .during a very stressful time in our lives. It was definitely stress-induced. Now that things are better, he gets it far less often. (It was definitely GP, he is type 1 diabetic and he flunked his gastric emptying study.) When he starts to get upset and start retching, I throw a Reglan down him and if we're fast enough that he can keep the PO dose down, we're good.

And yes, he was the fetal-position one. Though I understand the OP's comment. A lot of our frequent flyers who are uncontrolled diabetics tend to have GP, and it certainly mimics pain-seeking.

Side note to the person worried about TD: Have you tried erythromicin? Sometimes that's used in place of or rotated with Reglan to cut down the risk of TD.

If you ever see a gastric pacemaker, take a good look at the telemetry. It was our extra credit question on our dysrhythmia test.

Yeah the first time I saw the EKG of someone with a gastric pacemaker, I couldn't figure out what was going on! Lol

[milinda27]

I have gastroparesis, and I have the answer , why morphine does not take away that pain!

Is because Gastroparesis is the damage in the vagus nerve, in the stomach, so, with nerve damage its very hard to stop the pain, but at least with opiois you can rest few hours with almos any pain. This disease is terrible you can not tolerate not even semi soft food, or even liquids, you feel just so full and blowed and heavy. And this is why the pain is there, " nerve damage" is the tough pain in the world. I have polyneuropathy. I know what I am talking about . Thanks