Thank you for posting this case here. There may be additional information that you are able to obtain from this woman when you visit with her pertaining to the aetiology of her diagnosis of gastroparesis. Gastroparesis can occur secondarily to conditions such as diabetes or neurological disease, but also can be due to a variety of other possibly causes. This includes surgery, the use of certain medications, and after a viral infection. It also may be associated with an autoimmune disease or other, including idiopathic, causes. If you are able to find out the cause of this condition it can help direct your treatment. For example, if a virus was an issue prior to the onset of the condition, you may want to do further testing to see what viruses may still be active in her system. If she has a known autoimmune disease, working to address inflammation and immune balance may be helpful. Given the lack of further details about this case, discussion will focus on support that can help to improve motility.
Patients with gastroparesis can present with nausea (93 percent), vomiting (68 to 84 percent), abdominal pain (46 to 90 percent), early satiety (60 to 86 percent), postprandial fullness, bloating, and, in severe cases, weight loss. Gastroparesis should be suspected when patients present with these common symptoms.
Hoogerwerf WA, et al. Pain: the overlooked symptom in gastroparesis. Am J Gastroenterol. 1999 Apr;94(4):1029-33. http://tinyurl.com/omq9pco
Documenting the presence of delayed gastric emptying and assessing the severity is best achieved by evaluating the gastric emptying of solids. The most cost-effective, simple, and widely available technique to confirm the presence of delayed gastric emptying is a technique called scintigraphy. However, although it may be useful to establish a diagnosis, idiopathic gastroparesis is the most common form of gastroparesis and there is no detectable primary underlying abnormality in approximately one-half of patients with delayed gastric emptying.
Soykan I, et al. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998 Nov;43(11):2398-404. http://tinyurl.com/ka7xypf
Gastrointestinal reflux disease and motility issues also may be associated with small intestine bacterial overgrowth (SIBO) as well as food sensitivities. SIBO has been shown to be a common issue in individuals with gastroparesis, and may be a contributor to symptoms. The use of PPIs can also contribute to the development of SIBO. SIBO can be assessed for with a breath test through Regenerus Labs (codes which cover SIBO are CMI26 and CMI27), and they can be contacted at http://www.regeneruslabs.com or by email on firstname.lastname@example.org or tel +44 (0)333 9000 979. Biolab in London also offer a breath test for SIBO and can be contacted at http://www.biolab.co.uk or tel 020 7636 5959 / 5905.
George NS, et al. Small intestinal bacterial overgrowth in gastroparesis. Dig Dis Sci. 2014 Mar;59(3):645-52. http://tinyurl.com/8fqz32d
I have seen many individuals in my practice have significantly improved reflux by elimination of food sensitivities as indicated by an IgG food sensitivity test – http://tinyurl.com/lnxe5cr. This is often one of the first things I suggest, along with the usage of a complete digestive enzyme to support digestion of all foodstuffs which may worsen the problem especially when the reflux is severe. There are many ways that antigenic foods can lead to symptoms of reflux, but one explanation that I find to best explain physiology is that with consumption of antigenic foods that the body is reactive to the intestinal motility is altered, and this may create a reflux of the things back into the stomach and upwards.
There are a variety of things which can help with motility which may improve her symptoms. Things to consider include ground flax seed with increased water, magnesium, vitamin C. Other gentle therapies which can help to improve motility are papaya and perilla. Perilla is a motility aid, and also functions as an antispasmodic, reducing many of the symptoms associated with irritable bowel syndrome. The combination of perilla with other supportive herbs can help the bowels to eliminate more completely, thereby relieving upper gastrointestinal symptoms. You may find more about the use of fermented Papaya here: http://tinyurl.com/q9xb7jt.
Asif, M. Nutritional and functional characterization of Perilla frutescens seed oil and evaluation of its effect on gastrointestinal motility. Malay J of Pharm Sci. 2010; 8:1-12. http://tinyurl.com/netbwko
Ox bile or other forms of bile salts, taken as a supplement before meals, also can help reduce digestive symptoms and improve motility as they naturally stimulate colon elimination.
Hellström PM, Nilsson I, Svenberg T. Role of bile in regulation of gut motility. J Intern Med. 1995 Apr;237(4):395-402. https://tinyurl.com/yal6k446
Other natural supportive things for nausea include having frequent small meals with salt and a starch (such as a cracker or toast), ginger (tea, or even a natural ginger soda), sips of a slightly sweetened clear soda (naturally sweetened would be preferred), and sucking on hard candies or drops containing ginger, lemon or chamomile. Ginger has anti-inflammatory and anti-spasmodic properties for gastric upset and also is a motility aid. Chamomile is calming and a mild bitter, and both chamomile and lemon stimulate saliva and gastric fluids, each of which may help with nausea and motility.
Topical castor oil to the abdomen and right upper quadrant of the liver is very supportive for gastrointestinal symptoms, liver/gallbladder support, and also supports relaxation and healthy motility. Dr Todd Born recently wrote about the many benefits of castor oil which can be read here – http://tinyurl.com/kqsrfga. I generally instruct clients to use a simplified castor oil pack by simply massaging castor oil into the region, applying a cotton cloth to protect other garments from the oil, and using the body heat to draw the oil internally. Generally, the use warm water pack is also often recommended for a period of 15 – 20 minutes.
Homeopathy also can be helpful in settings such as this, particularly if the condition has been determined to be idiopathic and lacks a promising route of treatment.
A link to a recent discussion on the topic of gastroparesis on the Clinical Education group is here: https://tinyurl.com/lf4xo2d. The search function (magnifying glass at top right when you are in the Clinical Education group) can be used to find additional discussions by searching for the term “gastroparesis” as there are several. You may find further tools that can help your client by reviewing these additional discussions.
The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Beta Plus (BRC): 1 tablet before meals. http://tinyurl.com/otttdvv Provides bile salts, digestive enzymes.
Ox Bile (ARG): 1 capsule before meals. https://tinyurl.com/yc4wspgq
Whole GI Wellness (ARG): 2 capsules twice a day. http://tinyurl.com/ohv6mqr Supports normal motility and elimination, as well as reduction of gas and bloating.
Bowel motility support
You may also want to consider:
Caricol (ARG): 1 -3 sachets per day until pattern of stability attained then 1 a day or as required. http://tinyurl.com/p5gjrkk Source of fermented papaya.
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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