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last week I had posted that her Upper GI showed No more reflux. And me with my forgetful mind lately. I sat down Friday and wrote a letter to the doctor with my conerns and mailed it to him. When the Upper GI was done at the hospital they faxed over results that said No reflux. Then they send over the pictures and the report.
the dr has referred us to a Pediatric Gastroenterologist. Eliana has gastroparesis (delayed gastric emptying). we will be seeing Dr Stephens in Louisville Ky. at Kosair Children's Hospital March 6th at 845am.
Gastroparesis - Delayed Gastric Emptying (DGE)
Also known as delayed gastric emptying or DGE for short, gastroparesis (gastro - meaning stomach, paresis - meaning paralysis) is a condition in which the stomach takes longer to empty than it should.
Some estimates suggest that approximately half of babies with reflux will also have some degree of DGE which, as with the reflux, can likely be attributed to immaturity of the digestive system.
symptoms of DGE
Feeling full quickly while eating
Nausea after meals
Vomiting and heartburn
Abdominal bloating and / or pain
Babies with DGE may get full quickly, take longer to get hungry again, and perhaps the best indication in babies is throwing up undigested, or partially digested food several hours after feeding.
treatments for DGE
Medications called prokinetics and possibly diet changes are the usual courses of treatment for gastroparesis.
These drugs work to increase the speed at which stomach contents move through the digestive track. How they do this depends on the drug itself as listed below.
Reglan® - U.S. /Maxeran® Canada (Metoclopramide)
This drug is a dopamine antagonist which is beneficial in the GI tract where dopamine inhibits motility. It stimulates and coordinates esophageal (esophagus), gastric (stomach), pyloric (valve between the stomach and small intestine), and duodenal (small intestine) peristalsis. Peristalsis refers to the smooth, rhythmic muscle contractions that cause food to pass through the digestive tract. It also works to increase lower esophageal sphincter (LES) tone and stimulates gastric contractions. Unfortunately, metoclopramide crosses the blood-brain barrier which can cause negative (and if not discontinued-possibly irreversible) side effects such as involuntary muscle spasms, motor restlessness, and inappropriate aggression. These side effects are more common in long term use (12 or more months).
Motilium® - (Domperidone) - Currently not available in the U.S.
This is also a dopamine antagonist; however, domperidone does not cross the blood-brain barrier so it does not have the undesirable side effects that metoclopramide may. It works to increase esophageal peristalsis, LES pressure and gastric contractions.
Erythromycin - An antibiotic with the side effect of increasing gastric motility. This is currently being widely used in low doses (not the higher antibiotic doses) for delayed gastric emptying as this does not have the unfortunate side effects that are possible with metoclopramide.
Urecholine® (Bethanchol) - Urecholine is used to treat urinary and bladder problems. It helps to empty the bladder and often stimulates gastric motility, increases gastric tone, and restores rhythmic peristalsis improving gastric emptying time.
Adding cereal to baby's bottle as is usually recommended by the doctor for reflux, may make DGE worse since solids take longer to empty from the stomach than liquids. Breastfeeding is by far the best for a baby with DGE as breastmilk moves through the digestive system up to twice as fast as formula. If the baby is not breast fed, switching to a hypoallergenic formula, may also help, as they are already partially digested, making transit time out of the stomach potentially faster.
Many children with reflux will be put on prokinetic medications whether or not they are diagnosed with DGE simply because it can help lessen reflux episodes by leaving less food in the stomach available to be refluxed.
If DGE is suspected, the doctor may order certain tests to obtain a positive diagnosis.
Upper Endoscopy (aka Scope)
A flexible tube (endoscope) with lights and a camera is passed down the child's mouth into the esophagus, stomach and first part of the small bowel (duodenum). The doctor may take biopsies at this time which involves removing small pieces of tissue from each location. The gastrointestinal tract will be examined for ulcers, inflammation, hernias or other abnormalities that can cause symptoms similar to DGE.
Gastric Emptying Study
The baby is required to ingest a small amount of radioactive material which is followed by a special machine as it empties out of the stomach. This test will determine the length of time it takes the material to move from the stomach. A delay would result in a positive diagnosis of DGE.
Reflux and DGE seem to go hand in hand for many babies and unfortunately, DGE can make reflux worse. Reflux episodes can become more frequent by having too much food lingering around in the stomach for long periods of time. Fortunately, as with reflux, most babies will outgrow their DGE problems as their digestive track matures and becomes more coordinated.