Gastroparesis Treatment

Diabetes Complications and other Conditions Digestion
1

A report that was posted on the Mensa Google group on diabetes:

SURGEONS PIONEER NEW WAYS
TO TREAT DIABETES

Surgeons at New York Presbyterian Hospital/Columbia University Medical Center are innovating new ways to treat diabetes using techniques from weight-loss surgery, including experimental procedures to improve blood glucose levels and address a major complication of the disease. The hospital may be the first to use sleeve gastrectomy, a surgical technique first developed for weight-loss surgery, in the treatment of gastroparesis, a diabetes-related condition in which the stomach is unable to empty its contents into the intestines. Early results have been promising.

Because patients with gastroparesis cannot move food properly through their digestive system, they may experience symptoms including pain, nausea, vomiting, abdominal bloating and malnutrition. Although a number of conditions may cause gastroparesis, by far the most common is diabetes. In this case, continued high blood sugar levels damage the vagus nerve, which controls the movement of food through the digestive tract.

Conventional treatments may include medical therapies, dietary changes and implantation of a gastric electrical stimulator, or “gastric pacemaker,” a device that helps to control nausea and vomiting. If all of these fail to help, patients may have no choice but to receive nutrients through feeding tubes.

When four patients with gastroparesis were unable to receive gastric pacemakers, surgeons at New York-Presbyterian/Columbia performed sleeve gastrectomy to see if it might help. The technique, also known as a gastric sleeve or vertical or longitudinal gastrectomy, reduces the stomach to approximately 30 % of its original size, explains Dr. Melissa Bagloo, who leads the gastroparesis program at New York-Presbyterian/Columbia and is assistant professor of clinical surgery at Columbia University College of Physicians and Surgeons.

Dr. Bagloo stated that, “We had previously observed that after sleeve gastrectomy, patients who had difficulty emptying their stomachs showed significant improvement in their digestion. We do not know precisely why this is. Sleeve gastrectomy may have the effect of ‘resetting’ the natural gastric pacemaker, or it may be that the smaller size of the stomach increases intragastric pressure so that it helps facilitate gastric emptying. There could also be other reasons why the surgery helps.”

The four patients who underwent sleeve gastrectomy in 2010 all had diabetes with severe gastroparesis. For various reasons, they were not eligible to receive a gastric pacemaker. After surgery, two of the patients did very well right away, and the other two needed nutritional support for several months. “At six months after surgery, all four were eating and drinking and were no longer experiencing nausea or vomiting. For patients who faced the prospect of lifelong feeding tubes, the benefits of such a successful outcome cannot be overstated,” says Dr. Bagloo.

Source: New York-Presbyterian Hospital with Columbia University Medical Center

3

This surgery is apparently not the same as the gastric sleeve for weight loss. The good part of the sleeve for weight loss is that it can be reversed if it doesn’t work, whereas the Roux-en-Y cannot. But having the gastric sleeve for a temporary period will not help unless the person finds ways to modify their eating and exercise habits to maintain weight loss. And I’m sure that’s not easy. There are NO easy or truly good answers for weight problems! :frowning:

From what I can tell, this surgery for gastroparesis is something different. If it allowed people with severe gastroparesis who cannot eat or drink at all, and cannot use the gastric pacemaker, to regain that ability, it might be a good thing. Trying to live with a feeding tube must be miserable. I once met a lady who was doing that. We went out to a restaurant because I needed to eat. She ordered an ice tea, just to be companionable, but vomited it up later. How terrible to lose the pleasure of eating and drinking! And she said that the feeding tube was very uncomfortable. I felt so bad for her!

I’m sure they tested it on animals first, but SOMEONE has to be the pioneer for new medical and surgical techniques. I remember the guy who got the artificial heart and had to be tethered to a huge machine, and only lived maybe 60 days after he got it. He was a brave pioneer – he knew he was going to die anyway, and he made the sacrifice for the doctors’ learning. I respect and admire that, but hope I’m never put in that position!

4

Appreciate you posting this. I have gastroparesis, though not as severe as what some suffer. I live in fear of it getting worse & not being able to eat or drink. BG control with gastroparesis is a nightmare because it’s near impossible to time insulin to digestion.

This development is encouraging for a debilitating condition with no real treatment options. Gastric electrical stimulators aren’t all that successful. Faced with the prospect of a feeding tube, surgery would be my choice

5

You and Kelly were the people I was thinking about when I saw it – it’s a long way from being accepted treatment, and of course, at this time, insurance won’t cover it, but looking toward the future…

I sincerely hope that your efforts at good control, which I know is extremely difficult, will at least prevent it from getting worse. I hold you in my thoughts all the time!

6

Thanks for thinking of us! Fear of worsening gastroparesis keeps me on the straight & narrow. My doc says control is the best insurance, but that’s a Catch-22.

7

Natalie, I am curious why you think that this is different than than the one for weight loss? From what I am reading, it is the same procedure. It was even done at the obesity center at Columbia by one of the weight loss doctors.

8

I thought that because they called it a sleeve gastrectomy. Which is a term I hadn’t heard before. But maybe they ARE the same, I don’t know. But I figured you could research it further if you wanted to know more about it, because you are a smart girl! :slight_smile:

9

I don’t feel very smart today! Here is a link from Columbia - the part I copied is under the little pic on the right (I almost typed under the pancreas!): I am still tired from my Pittsburgh trips.

http://www.columbiasurgery.org/news/healthpoints/2011_winter/p3.html

Sleeve gastrectomy, also called vertical sleeve gastrectomy or gastric sleeve, has been long used as the first stage of weight loss surgery in patients with very high body mass index (BMI). In this laparoscopic procedure, the size of the stomach is reduced to about 15% of its size. Over many years, physicians observed that patients lost weight very effectively after sleeve gastrectomy without undergoing biliopancreatic diversion, the second and more invasive stage. As a result, bariatric surgeons frequently perform sleeve gastrectomy as a standalone procedure today.

10

OK, I understand. Basically the same thing as I posted above. I was thinking about something I was told about a gastric sleeve that is inserted through the mouth, for obese patients, and which lines the stomach and inhibits ghrelin, the hormone which is secreted by the stomach and causes hunger symptoms. THAT is a different thing!

11

I never heard the term either - I have always heard it called lap band surgery. After I read the article, I was wondering why you thought it was different. Yeah, the one going thru the mouth is different.

13

Well, people with severe gastroparesis, who can’t eat or drink at all and have to sleep with a feeding tube in them ARE pretty far gone. I just hope our Gerri and Kelly never get to that point!