Gastroparesis Vs. Dysmotility?

[cardiactec]

Hi,

I was wondering if any of you knew if there was a difference between gastroparesis and dysmotility? my GI doc called me today after having had many bad weeks with nausea and finding minimal solutions for it (i cant take the typical type of meds that are used for GI problems cuz i'm taking sotalol)........anyway, he started the convo by saying "have you tried any anti-depressants" and i asked him why and he asked "well, have you been stressed at all cuz stress can cause nausea"...........i told him i hadnt been particularly stressed, just over the fact that i was nauseated and nothing seemed to help....i got a little confused as to why he was asking such questions since i had a motility/emptying study that confirmed delayed gastric emptying as the cause for my nausea.........so i said to him that i thought my study showed gastroparesis and asked him why he questioned stress as the cause when i thought the test proved the cause of the nausea was from paresis..........he told me that most places, for the criteria of gastroparesis, you have to have a four hour emptying study and i only had the two hour..........i was wondering why he hadnt ordered the four hour then in the first place??? anyway, so i asked him towards the end of the convo if in fact i had paresis and if he thought still that the nausea was from the paresis and he said that he definitely believed i had delayed gastric emptying but for the diagnosis of gastroparesis, a four hour study has to be performed........

?? can someone explain this to me?

i am also pretty mad that he would entertain ideas about anti-depressants and "stress" as a supposed culprit for my nausea one second, then the next tell me that the nausea is from delayed emptying and that he would suggest a pacemaker implantation for the stomach....?? so which the heck is it that he thinks is the problem, stress of delayed emptying? ugh. docs drive me crazy..............then i dont even know if there's a difference btwn gastroparsis and delayed empting cuz from what he said, the two hour test isnt enough to confirm gastroparesis, that you need the four hour test.........

help!

[MightyMouse]

dysmotility = slow OR fast emptying

gastroparesis = no, or nearly no motility of the stomach

[cardiactec]

so a two hour test JUST determines if you have dysmotility or not and a four hour test actually shows if there is paresis to the stomach? i wonder why they dont just do the four hour study on everyone to begin with......

[cardiactec]

i just read this online:

Gastric Emptying Assessment

Gastric scintigraphy is the best method for diagnosing delayed gastric emptying. A 4-hour test which has the patient eat low-fat egg meals (egg substitute) is standard. Normal ranges for gastric emptying in healthy subjects at 1 hour, 2 hours and 4 hours is 90, 60 and 10 percent, respectively. Gastric retention of greater than 10 percent at 4 hours is indicative of delayed gastric emptying. Unfortunately, many centers use only a 2-hour study to save costs. In a soon-to-be-published multicenter study, we compared 2-hour and 4-hour results in patients suspected of having gastroparesis and showed that limiting the gastric emptying time to 2 hours would have missed 44 percent of patients studied who went on to have delayed gastric emptying at 4 hours (See graph). Thus, while an abnormal result at 2 hours is fairly reliable, and the test may be stopped at that point for patients with abnormal results, the study should be continued for patients with normal results for the full 4 hours.

.........................so if my gastric emptying study was abnormal at 2 hours, why would they need to go further on to a four hour study when the two hour showed that i had abnormal delayed emptying? just to show that it is really abnormally abnormal? abnormal is abnormal, what more would they see with an added two hours onto my already two hour study?

i am so confused.........?

[MightyMouse]

Actually, even if the doc went in the wrong direction with the ssri discussion, ssri's can help some people with gastroparesis--I'm one of them. Dr. Grubb told me it's b/c the CNS supports the function of the ANS, and since ssri's operate on the CNS, if it stabilizes someone somewhat, it can help improve ANS function. Does that help?

Nina

[Sunfish]

like what you read online, a four hour study is generally only considered necessary if the two hour study doesn't show enough information. as for why your doctor ordered the two hour, most hospitals don't do the four hour study - even if a doctor finds it necessary - due to the added time, expense, etc. you definitely don't need a four hour study for a gastroparesis diagnosis, though particularly if a two hour study is "borderline" it could provide valuable additional information.

regarding dysmotility vs. gastroparesis, another distinction is that gastroparesis refers only to the stomach whereas dysmotility can occur anywhere in the GI tract. gastroparesis is thus one of the many types of dysmotilities.

there are wide ranges in abnormal stomach emptying/motility and obviously a result that is slightly abnormal is different than a result that shows almost no stomach motility. i'm guessing that your GI doc isn't a motility specialist though? you may want to try to find one....

melissa

[cardiactec]

hey melissa,

thanks for the response..........no my GI doc isnt a motility specialist..i would love to see one though as my stomach continues to feel so sick........

i am beginning to think that the values or percents they look at for the gastric emptying study are where they pull out a "true" paresis diagnosis. i read that some people can have normal empting at two hours that end up with abnormal testing with the four hour testing........

for example, perhaps if they have, say, 50% of their food leave the stomach at 90 minutes than that is considered normal, whereas if they continued that patient on for another two hours, the patient may only empty out an added 20%, still leaving more than 10% in their stomach at four hours - gastroparesis .........

i had 41% leave my stomach at 101 minutes (i still had 59% in my stomach) - i think they classify gastroparesis based on whether or not there is 10% or more still remaining in the stomach at four hours, at least that is the way mayo clinic criteria works for paresis.........perhaps it is just a "severity" check to tack on the two extra hours, even if a patient is abnormal at two hours alone..........