Someone told you, at some point, that your stomach empties slowly — gastroparesis, or delayed gastric emptying, depending on who wrote it down. That was years ago and it has mostly stopped being something you think about. Now there is a medical-history form in front of you, a weekly injection for weight on the other side of it, and a question about stomach conditions that you have already worked out might be the one that ends the conversation.
That diagnosis is named in the approved labeling for the one product whose label is linked above, in a single sentence, and that sentence applies only to the severe form. Nobody has measured how severe yours is in years. Answer the form accurately tonight, and this week ask for the test that says how severe it is now.
Say it, and say it in the words you were given. This kind of medicine slows the stomach down, which is the direction your diagnosis already points, so the person deciding whether to prescribe is deciding about an organ whose history you have and they do not. It is the severe form that is not recommended, and that is a far smaller group than everyone who has ever been handed the word gastroparesis. If your last stomach-emptying test is years old, a new one can say where you sit now, and it takes a single appointment.
What a stomach that already empties slowly changes
A stomach that already empties slowly gets slower, and the added slowing is at its largest at the start. The medicine delays gastric emptying, and that delay is largest at the beginning of treatment and diminishes over time. The weeks when the two effects add up hardest are the early ones, which are also the weeks you have least experience of what the combination feels like.
The second change is harder to see coming. Symptoms of slow stomach emptying include feeling full soon after starting a meal, feeling full long after eating one, nausea, vomiting, bloating, belching, pain in the upper abdomen, heartburn and poor appetite. The most common adverse reactions listed for the medicine include nausea, vomiting, diarrhea, constipation, abdominal pain, indigestion and reflux. Nausea, vomiting, abdominal pain, constipation and reflux sit on both lists, so a bad two weeks in month three will look the same either way.
That is what makes this week, the one before anything starts, worth writing down. Record how soon after starting a meal you feel full, how long the fullness lasts, how often you vomit in an ordinary week, and whether heartburn wakes you. With that on paper, month three has something to be measured against. Without it, the comparison is your memory of an ordinary year, and nobody's is that good.
Some of what is already in your cupboard slows the stomach too: narcotic pain medicines and some antidepressants are among the things that can make slow emptying worse. Whether that slowing also changes how the medicines you already swallow are absorbed is a different question.
Why the question is on the form at all
You are the person that question was written for. The medication guide packed with the medicine instructs patients to tell a healthcare provider about severe problems with the stomach, such as slowed emptying of the stomach. The form is one place to do that. A call to the prescriber is another.
What a clinician does with the answer turns on how bad yours is. In the approved labeling, the medicine is not recommended in patients with severe gastroparesis. A diagnosis sitting in your history and a severe stomach today are two different facts, and that sentence is about the second one. A physician may decide that treatment is not appropriate for you, and answering the question is what puts them in a position to decide either way.
Left off the form, your stomach empties at the rate it emptied at before. The early weeks are still the ones where the two slowings add up. A call in month two about vomiting still reaches someone who has to work out where it came from, now without the one fact that would settle it fastest — and the new medicine is the obvious suspect.
Who can measure your stomach now
Measuring your stomach now takes a clinician's order and one of three tests, each of which times a meal on its way out. Alongside it a clinician takes a history covering your current symptoms, the medicines you take now, and past health problems including diabetes, scleroderma, nervous system disorders and hypothyroidism, so it is worth arriving with all three written down.
You will be offered one of these, and the first two take most of a morning:
- A gastric emptying scan. You eat a bland meal — eggs or an egg substitute — containing a small amount of radioactive material, and a camera outside your body scans your abdomen. Usually about four hours.
- A breath test. The meal contains a substance that is absorbed in your intestines and passed into your breath, and samples of your breath are collected over a few hours.
- A wireless motility capsule. A small electronic device you swallow, which moves through your whole digestive tract and sends information to a recorder.
Diabetes is the most common known underlying cause, so if that is the route yours came by, the notes you want are probably held by whoever manages it. Otherwise they sit with the clinician who ordered the original test, or the one who sent you for it. Ask for a copy, and ask for the specifics: which test, in what year, and what the result was.
Slow stomach emptying is a chronic condition, so the diagnosis is unlikely to have gone away on its own, and a fresh test is a measurement rather than a second opinion. Whether what it shows adds up to severe is a judgement a prescriber makes, from that result together with what your stomach is doing now — which is the second reason to keep the week of notes.
Tonight, and then this week
- Answer the stomach question on the form in the words you were given, and add the year you were told and who told you.
- Start the page of notes tonight, before anything begins: fullness, how long it lasts, vomiting, heartburn at night. Date it.
- Ask whoever made the diagnosis for a copy of the note — which test, when, and what it showed.
- Ask a clinician for a current stomach-emptying test if the last one is years old, and say the injection is why you are asking.
- Take the whole list of what you swallow to that conversation, including anything for pain or for mood.
- If you reach a point where you cannot keep fluids down, that is a same-day problem and not a form problem.
A clinician applies the word severe; you supply what they apply it to. The year you were diagnosed, what the old test showed, and what your stomach did this week all fit on one page, and you can have that page finished before anybody asks you for it.
