Gastroparesis or psychosomatic chronic nausea

I have kind of a rough history of the symptoms of GP and I am going to finally get tested for it next month.

Please tell me if this sounds typical or if maybe I am just nuts - okay, I have anxiety disorder and spent a couple of years slowly tapering off of sedatives because they no longer worked for me. The taper went smoothly until the end and things got rough, my anxiety came back, etc. but I pushed through it and got free. I had long term withdrawal symptoms including occasional nausea... BUT then I caught a virus. I had a sore throat with swollen tonsils, a cough, a high fever for over 5 days and really bad nausea. The night I started catching the virus I was very hungry and made a pizza expecting to eat at least 3 slices but after only a couple of bites I was full. The next day the virus was in full swing and I developed some GI symptoms from it as well as the sore throat and congestion and fever. 7 days went by, fever finally went away, but my appetite never came back and in fact I have been waking up with severe nausea every morning. It made my anxiety worse and I dry heaved any time I tried to get something down, including water. In fact the water would just come back up. My anxiety went off the charts as I became weak and dehydrated so I relapsed onto my sedatives. Well despite my relapse back onto my sedatives I am still waking up every morning with extreme nausea and when I do try to forcefeed at nighttime when it abates a little, I get full after only a few bites. My actual stomach area is sore-ish at night and in the morning. I get momentary relief from small burps a lot. Need zofran frequently.
I mean seriously - does this not sound like GP?!

to thicken the plot, when I was 14 (I am 25) I had this same thing happen - had a stomach bug and every day after that I was waking up dry heaving and would not eat to save my life. Ended up hospitalized for dehydration many times. Doctors convinced my parents I was anorexic so they put me on Remeron, an antidepressant that stimulates appetite and helps with Gastroparesis. after the first dose I had 3 bowls of cereal - the first time I got hungry in a year. My parents were ecstatic. Things slowly improved from there but now here I am again, 25 years old, just got over a virus and now dry heaving every morning with bad nausea that doesnt calm down until late at night.
I know none of you are doctors but please share your opinion?

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GP often originates after a viral infection or severe gastroenteritis. I was very ill after a string of joint replacement surgeries (6 in 4 years!) got a fecal impaction, nausea and weight loss. NO vomiting or pain. I saw an excellent gastroenterologist who immediately ordered upper endoscopy, CT abdomen and pelvis, and a gastric emptying study. The upper endoscopy includes biopsies for celiac disease and H. pylori, look for ulcers and masses and GERD. I I had H pylori and that was eradicated. My biopsy for celiac disease was negative. I had a gastric ulcer (NSAIDS, aspirin) with responded to Prilosec (on 2nd endoscopy, which confirmed that the H. pylori also was cured). BUt my gastric emptying was abnormal and I got sicker and sicker. Finally got on domperidone, which saved me. (inhousepharmacy.biz/free shipping, 11 cents/pill when ordered in largest amounts, fast service). Then started having relapses. Upped the dom to 10 pills in divided doses and Prilosec to 20 mg 1/2 hr before breakfast and dinner. Improved but still relapses. Now on nortriptylene 25 mg. (I started at 10 mg for 3 wks), and so far no relapses. I am very hopeful.

Only side effect is dry mouth. The dom doesn't produce lactation, which it can, but then I'm an old lady ;).

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Hi, and welcome!

Sorry you are having such a hard time.

I can relate a bit to your experience, but it's different for everyone. What you described sounds like it could be GP, but the only way to KNOW is to get some tests done. You may have to push and push for them, but don't give up if you think something is wrong. I had symptoms of GP from the age of 4 or 5 but wasn't diagnosed until last year when I was 26. Domperidone has also changed my life.

Just a thought though--I worked for many years as an addictions counselor so would like to comment on your anxiety meds. Not sure what exactly you take, but many of the benzodiazepines (sedatives, tranquilizers, etc.) can cause dysmotility in the GI tract. Esepcially if they are taken chronically. I know you've tried to get off of them before, and that can often exacerbate your GI trouble for quite some time. The detox from benzos can take upwards of 6 months or more before your system gets back to normal.

I know it can be tremendously hard to get off of them, and your anxiety sounds like it can get pretty bad. I'm no doctor, but you may want to consider getting on an anxiety medication that doesn't produce these effects. Drugs like SSRIs that are approved for panic disorder (like Zoloft for instance) might be a better fit for you. They are extremely effective in reducing anxiety and don't come with the same side effect as addictive drugs like Klonopin, Xanax, or Valium.

And one more thing, not that it necessarily applies to you--long-term use of opiates (Vicodin, Oxy, etc.) have definitely been linked with gastroparesis and are actually considered a "cause" of GP and chronic dysmotility.

Just a thought!!!

As for the rest of the stuff--I saw my gastroparesis symptoms take a HUGE turn for the worse after 2 consecutive bouts of food poisoning in 2005. It was all downhill from there, and it took 6 more years to actually get my diagnosis. I lost 1/3 of my body weight and like you, couldn't seem to get/keep anything down past 1 or 2 bites of food or sips of water. Post-infectious gastroparesis is quite common, and sometimes goes away on its own. For me, it seems to be a permanent condition, but like I said, it appears in retrospect I probably had milder GP from infancy. Viruses can definitely make GP worse, or bring it on to begin with.

I would really try to go in for a gastric emptying study and get an upper endoscopy (EGD) to rule out other issues in the stomach or esophagus. This will at least be a first step. Your symptoms do sound like GP, but I've also seen the same thing in people with bad anxiety. All of our bodies react differently to anxiety--some people get chronic headaches, some get panic attacks, and others get nausea and lack of appetite. My stomach gets really out-of-whack when I'm anxious, so I can relate to that.

Good luck to you sweetheart! Hope you get some answers and relief.

A.

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Hello!

Your story sounds a little similar to mine...I never had any anxiety issues before GP.

BUT, my symptoms started after I got food poisoning on a trip to egypt...a few weeks later I got a terrible virus/cold (not sure) that just seemed to attack my throat. I remember having a coughing fit for around 40minutes and I was literally close to vomiting because of the heaving. A few weeks after that my GP symptoms came on strong and I couldn't eat anything more than a few bites of cracker and cucumber, I lost about 20kg in 3 weeks. It was awful.

Since then I was given domperidone which has allowed me to eat (not completely as normal) and helps some of my nausea. But the nausea is still chronic, and this gives me anxiety. Travelling around on the bus/car/train I get very anxious because I worry that I may throw up and it would be terribly embarrassing...Also being in busy closed spaces makes me anxious too. I NEVER had any of this before GP and I have even had two panic attacks recently.

This has been going on for two years - I have had an endoscopy, barium swallow/meal, CT scan on head, MRi on abdomen and nothing has been found.

My doctor put me on amitriptyline and I stayed on it for 3 weeks and I felt a little better but it made me fat and I was having awful dreams so I came off of it. I recently saw a new doctor who suggested I see a psychologist and he will be referring me for a gastric emptying study FINALLY! - I made a vlog on youtube, have a watch http://www.youtube.com/watch?v=V4Ly77TCpV8

All the best and keep us updated

Ashley xoxo

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I sure do hope I can get a gastric emptying study. I kinda feel that my constant nausea and wretching was greatly exacerbated by the severe withdrawal syndrome I had from benzodiazepines. The only way to get it to stop was to relapse onto them which has devastated me, because I spent quite a bit of time (3-4 years) slowly tapering off of them.

I also think that if I had not caught that throat virus with the 7 day high fever, my GP symptoms would not have become so severe. I mean, I had GP problems through-out my entire life, but when you're in drug withdrawal and then catch a virus like that it all just comes crashing down...

I am very much underweight by now, I look skeletal, so maybe I might someday qualify for the gastric pacemaker.

Even when I get an appetite at night, after only a few bites I start to feel pretty full and not hungry anymore. It seems maybe my GP eases at nighttime. Is that pretty common, too?

And - let's just say hypothetically that my chronic nausea is psychological (anxiety) induced. Could a gastric pacemaker help with that also?

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Ahshley, you might try nortriptyline instead of amytriptylene. Nor is the second generation tricyclic with fewer side effects than amy. I am on 25 mg., a low dose, and it has helped by breakthrough episodes of dyspepsia I was having. I have vivid dreams, which I have anyway. I have trouble controlling my weight as I am so much better and gained back the 18 lbs. I lost, but the nor doesn't appear to be making this any worse. Nor is now being studied seriously as a treatment for GP. Results to come out this yr or next.

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be that there is some psychiatric therapeutic benefit, also.

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I'm sorry there was a lot more that I lost. You should be followed by a motility expert, if possible. They realize that anxiety and depression are part of this disease, that they are PRODUCED by the disease. Their literature is filled with referrals to the quality of life issues.

You must get the FOUR HOUR gastric emptying study, NOT any shorter . Motility experts won't accept anything else.

No one really understands how Enterra works. Yes, it can help nausea. You usually have to have failed on maximum dose (120 mg) of domperidone and probably also nortriptyline. You start at 10 mg then gradually move up to 25, 50 and 75 mg at night depending on your response. If you have acid problems, you can take omeprazole (Prilosec). You should try to get on a waiting list for Enterra early--it may take months to 1-2 years. You can experiment with other meds while you're on it.

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I think the Enterra should be first line treatment in GP and I will tell you why;

Drugs, medications, poison, whatever you want to call it, physically change parts of our brain (central nervous system) and as our human bodies naturally fight against these changes to compensate for homeostasis, the parts of our brain affected by the drugs actually become damaged. So the drug not only stops working after a while, but when you remove the drug due to that fact, the brain parts that it affects are then working even less efficiently than they were prior to getting dependent on the drug. Not to mention "side effects" - which, are actually direct effects of the drugs, just undesirable ones.

This whole thing is such bs. Society reallyneeds to evolve.

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Domperidone and nortriptyline have been around for a long time and appear to work for many people--nor as an antidepressant before it became a GI drug. I think that it's off-label effects were probably discovered by the patients taking it for depression. Many/most drugs that work appear to keep on working. It is true that opiates and benzos develop tolerance and addition---but coffee is addicting, too.

For severe cases, Enterra may indeed be a final solution. But waiting lists are long and getting longer as the epidemic of diabetics produces their masses of gastroparesis, terrible for all of us. And if "horrible"'s experience with Kaiser is any indication , many HMO-types are going to be slow to adopt it. Too 'expensive' even tho' it will save millions in the long run. Wait list at U Miss is 1-2 years. This is why it is important for diagnosis and drug therapy to continue.

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