Cape Fear Center for Digestive Diseases, PA Fayetteville, NC
J. Wesley Jones, MD1, Katrina Lamont, MD2, Jennifer Stoltenberg3; 1Cape Fear Center for Digestive Diseases, PA, Fayetteville, NC; 2Campbell University School of Medicine, Raleigh, NC; 3Campbell University School of Medicine, Lillington, NC
Introduction: Recent research has challenged the premise that gastroparesis (GP) is a primary gastric motor disorder. Bloating and abdominal distention severity correlate with GP symptoms and treatment response, but not delayed gastric emptying rates. Further, motility studies suggest that GP is a global intestinal dysmotility disorder. These observations offer insight into other possible GP treatment strategies.
Methods: A 50-year-old diabetic female with coronary artery disease and end stage renal disease requiring hemodialysis presented for a second opinion to evaluate a 6-month history of severe nausea and vomiting with a 42.5 kg weight loss (45% of body mass). Diagnosis: Esophagogastroduodenoscopy (EGD) showed severe ulcerative esophagitis. Gastric emptying scintigraphy showed T1/2 of 101 minutes and severe reflux; also, abdominal, pelvic computed tomography (CT) scans and small bowel series were negative. Caloric intake was less than 100 calories/day. Severe diabetic gastroparesis (GP) was diagnosed. Interventions: A feeding jejunostomy tube was placed. Also, patient was given 1,000 mL warm water enemas to mobilize intestinal gas, and 17 gm polyethylene glycol 3350 (PEG) mixed with 3 gm partially hydrolyzed guar gum to increase stool bulk and enhance intestinal transit through the jejunostomy tube.
Jejunostomy tube was removed within 4 months of insertion. She regained 37.6 kg in weight and GP-related hospital admissions declined markedly during the 7 years of follow up. Notably, the patient reported that peritoneal dialysis exacerbated, and water enemas alleviated her GP symptoms. Her current gastrointestinal (GI) medications include pantoprazole 40 mg twice daily, psyllium once daily, and PEG every other day. Discussion: The interventions utilized are low cost and readily available to clinicians everywhere. Her remarkable long-term improvement supports the concept that GP is a global intestinal dysmotility disorder. Further, this unconventional GP management approach is a practical application of Dr. Denis Burkitt’s fiber hypothesis that increased stool bulk is associated with accelerated intestinal transit. Prospective studies are needed to evaluate this novel approach for GP patients.
Figure 1: indicating the patient's decreasing frequency of hospital visits as fiber program was implemented
Disclosures: J. Wesley Jones: Berkley Books – Other Financial or Material Support, Author of a book for the general public, Cure Constipation Now, A Doctor’s Fiber Therapy to Cleanse and Heal, Berkley Publishing Group, New York, 2009.. Katrina Lamont indicated no relevant financial relationships. Jennifer Stoltenberg indicated no relevant financial relationships.