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.
About Prokinetics
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.
Diet Changes
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.
Surgery
In severe cases of gastroparesis surgery may be required. A new surgery
called gastric pacing makes use of a gastric electric stimulator, or
pacemaker to help coordinate peristalsis is being used in adults.
Another procedure is the injection of botulinum toxin into the
pylorus and finally as a last resort a pyloroplasty in which they make a
larger opening between the pylorus and the bowel.
diagnosing gastroparesis
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.
Final thoughts
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.
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