GERD and Delayed Gastric Emptying: Symptoms and Solutions

Gastroesophageal reflux and digestive motility issues?

Hello Doctor: After eating every day, I often experience belching and start to feel a bitter taste in my mouth 2-3 hours later.
My gastroscopy showed no ulcers or tumors, and there is no Helicobacter pylori, but I do have gastroesophageal reflux disease (GERD), gastritis, and esophagitis.
I eat very little but have a distended abdomen.
An abdominal ultrasound was normal, and blood, urine, and stool tests all fall within normal ranges.
A physician mentioned that this might be related to delayed gastric emptying.
How can I confirm whether the discomfort is caused by delayed gastric emptying or by a relaxed pylorus leading to gastroesophageal reflux? I am taking proton pump inhibitors (PPIs) and medications to accelerate gastric emptying, which have alleviated my symptoms, but these medications have side effects and are not suitable for long-term use.
If my discomfort is indeed caused by delayed gastric emptying, what alternatives are there to medications that can help improve gastric emptying? Last year, my gastroscopy revealed gastritis and esophagitis.
How often should I undergo gastroscopy given my frequent symptoms of gastroesophageal reflux? Thanks.

L, 40~49 year old female. Ask Date: 2017/06/03

Dr. Lin Minghui reply Gastroenterology and Hepatology

1) General gastroscopy or upper gastrointestinal imaging can determine whether the cardia is relaxed, if there is a hiatal hernia, whether there is esophageal dilation affecting the pylorus, if there are any ulcers, and if there is deformation of the duodenal bulb that impacts gastric emptying.
2) Other examinations include: (1) esophageal manometry, which detects changes in esophageal pressure to identify motility disorders; (2) gastric emptying nuclear medicine scan, which can assess delayed gastric emptying.
3) How to improve delayed gastric emptying: (1) Identify the cause of the delay.
Improvement should be based on the underlying cause, which may include poorly controlled diabetes, medications, neurological disorders, and post-operative changes in the stomach and abdominal cavity; (2) Modify dietary habits.
Avoid eating too quickly and limit high-fat foods.
Certain foods and fruits can promote gastric emptying; (3) Medications; (4) Surgery.
4) Generally, if gastrointestinal symptoms are severe, recurrent, and unresponsive to treatment, and if there are indications without contraindications, a gastroscopy can be arranged.

Reply Date: 2017/06/03

More Info

Understanding Gastroesophageal Reflux Disease (GERD) and Delayed Gastric Emptying: Symptoms and Solutions
Gastroesophageal reflux disease (GERD) is a chronic condition where stomach contents flow back into the esophagus, leading to symptoms such as heartburn, regurgitation, and discomfort. In your case, the presence of symptoms like burping, a bitter taste in the mouth, and abdominal bloating after meals suggests that GERD may be a significant factor in your discomfort. Additionally, the fact that you have been diagnosed with gastritis and esophagitis further complicates your situation.

Delayed gastric emptying, also known as gastroparesis, is a condition where the stomach takes longer than normal to empty its contents. This can lead to symptoms such as bloating, nausea, and early satiety (feeling full after eating only a small amount). The relationship between GERD and delayed gastric emptying is complex; delayed gastric emptying can exacerbate GERD symptoms by increasing the volume of stomach contents that can reflux into the esophagus.

To differentiate between delayed gastric emptying and a relaxed lower esophageal sphincter (LES) as the cause of your GERD symptoms, a gastric emptying study can be performed. This test measures how quickly food leaves your stomach and can help determine if gastroparesis is present. If the study shows delayed gastric emptying, it may indicate that your symptoms are related to this condition rather than solely due to GERD.

In terms of management, you mentioned that you are currently taking proton pump inhibitors (PPIs) and medications to accelerate gastric emptying. While PPIs can be effective in reducing stomach acid and alleviating GERD symptoms, long-term use can lead to side effects such as nutrient malabsorption, increased risk of infections, and potential kidney issues. Therefore, it is essential to discuss with your healthcare provider the possibility of tapering off these medications or exploring alternative treatments.

For managing delayed gastric emptying, several lifestyle and dietary modifications can be beneficial:
1. Dietary Changes: Eating smaller, more frequent meals can help reduce the burden on your stomach. Focus on low-fat, easily digestible foods, and avoid high-fiber foods that can exacerbate bloating. Foods that are high in fat can slow gastric emptying, so it may be helpful to limit these.

2. Hydration: Staying well-hydrated can aid digestion. Drinking fluids between meals rather than during meals can help prevent feelings of fullness.

3. Physical Activity: Gentle exercise, such as walking, can help stimulate gastric motility. Avoid lying down immediately after eating, as this can worsen reflux symptoms.

4. Elevate the Head of Your Bed: If you experience nighttime symptoms, elevating the head of your bed can help prevent reflux during sleep.

5. Medications: Besides PPIs, prokinetic agents like metoclopramide or domperidone can help improve gastric emptying. However, these medications also have potential side effects and should be used under medical supervision.

Regarding the frequency of endoscopic evaluations, it is generally recommended to have a follow-up endoscopy if you experience worsening symptoms or if there are concerns about complications from GERD, such as Barrett's esophagus. Your healthcare provider can help determine the appropriate timing based on your individual risk factors and symptomatology.

In conclusion, managing GERD and delayed gastric emptying requires a multifaceted approach that includes dietary modifications, lifestyle changes, and careful medication management. Regular follow-up with your healthcare provider is essential to monitor your condition and adjust your treatment plan as needed. If you have further questions or concerns, do not hesitate to reach out to your healthcare team for personalized advice.

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