Dear Dr. Roach: I read your recent column on gastroparesis. I have both diabetes and this condition, which was referred to by my doctors as a "motility" problem, but it was explained to me that my motility problem lies in the small intestine, not in the stomach itself. My problem started after a gallbladder operation. The result was extreme nausea and, inevitably, fairly violent vomiting. I may go a number of days (even a couple of weeks) without any problem, and then I may have an almost daily occurrence for several days.
These problems start with extreme fullness. My first remedy is always a massage of my stomach area above the navel (which can be quite painful), sometimes followed by an over-the-counter gas pill; my last resort is Reglan. I am confused by some of the terminology. -- E.K.G.
Answer: The same issues that affect the nerves to the stomach, causing poor contraction and motility, also can affect the small intestine.
The term "diabetic autonomic neuropathy" probably is more accurate, to reflect that the problem can be at multiple levels. I don't think I have ever seen it myself where it affects the small intestine and not the stomach. This would be very difficult to diagnose -- the usual test, the gastric emptying study, looks at the stomach's ability to empty, and if the stomach is normal and the intestines are affected, the test would appear normal. I suspect that in most cases, the stomach might be less affected than the small bowel but still abnormal on testing.
Treatment with metoclopramide (Reglan) works for the stomach and the intestines, as does erythromycin.
Readers: The booklet on constipation explains this common disorder and its treatments. Readers can order a copy by writing:
Dr. Roach
Book No. 504
628 Virginia Drive
Orlando, FL 32803
Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery.