Help! Delayed stomach emptying, bloating, indigestion

Dear Tiffany,

Thanks for your response. I did a barium scan and thats how my doctor saw the obstruction in my duodenum (first part of the small intestine). Is the gastric emptying test safe? I read that it can make you very sick. Any thoughts?

Dear  Farah,

if an obstruction in your duodenum was seen,

this is highly highly indicating SMAS/Wilkie! (the 3rd part of duodenum runs between aorta and SMA, that can, if the angle is to acute, act as a clamp for the duodenum and or left renal vein - hence called nutcracker)

It can be seen and measured in MRI sagittal and axial plane,

it can be seen in ultrasound, when you try to eat a solid,

barium is so liquid and if that get's already obstructed, it is a very strong clamp and I don't know how you are doing it without a nasal-jejunal feeding tube or parenteral feeds.

Please let the doc explain to you, what a duodenum obstruction should mean.

It sounds a lot like SMAS/Wilkie. Many less clamped SMAS get liquid through and the hint is often reverse peristalsis only. If the third part of duodenum is blown up and cut off where SMA runs, it is Wilkie! You need to get more weight on, there is a fat pad around aorta, that can give the SMA a less acute angle. It is a problem as one is so sick to eat. So often a feeding tube and parenteral feeds are used to get weight up and have less symptoms.

Often lying on the left side with knees bent to the chest can help.

Liquid food if at all.

The surgical helps are often not that successful unless the SMA is transpositioned so that no angle can squeeze duodenum (or left renal vein). Often they start with a bypass and connect stomach directly to jejunum avoiding the clamp. It's often not successful.

I got a shock reading that you have already a proven duodenum obstruction/compression in barium liquid swallow!

 

Dear Pippa,

Thanks for your response. I did a barium scan and thats how my doctor saw the obstruction in my duodenum (first part of the small intestine). Is the gastric emptying test safe? I read that it can make you very sick. Any thoughts?

Thanks so much for the support. I did a barium scan and thats how my doctor saw the obstruction in my duodenum (first part of the small intestine). Is the gastric emptying test safe? I read that it can make you very sick. Any thoughts?

The gastric emptying test is safe.  However, if you are intolerant to the carrier food they give you, that could cause a reaction.  There are alternatives to this test if you are unsure about it. Talk to your doctor about any concerns you have.

Thanks I will read up on it. Smoothies are the best!!!

Dear Sanya,

Thanks for the link. I read up on it. I do experience some of the symptoms of SMAS. However, I do not experience any pain and the throwing up is not frequent. I suspect that if I had SMAS I would be throwing up a lot more. I am seeing my doctor tomorrow and will ask for an ultrasound and any other test that he sees fit. Hoping the results are not too serious. Wish me luck!! And thank you again. 

Also, I am able to keep solid foods down so that may indicate that its not SMAS. I should mention that my doctor is a general practitioner and not a specialist (gastroenterologist). I will have to see a specialist soon to determine if it indeed was an obstruction that was seen on the barium scan. 

Yes, the 'obstruction in duodenum' has to be clarified!

All all the best!

My girl with renal vein compression (same aorta/SMA clamp, but her duodenum can widen to 8mm still in peristalsis) was overlooked multiple times and clearly there in MRI.

One thing: symptoms vary highly depending on the degree of obstruction/compression.

Some do not vomit much, others can't live without a NJ tube.

If the disease is managable, it's fine, but good to know about (so that one keeps weight up and takes care of not loosing weight and if starting to loose weight doing everything to push it up with smoothies and the likes)

Only one doc finally picked up on my daughter's condition after 2 years!, I could see it in MRI and was denied to exist as 'radiologist didn't say about it', and I, yes I, had to do the search for a doc, who knew about nutcracker, MALS, SMAS..... you need to go to a specialist, who has heard of those conditions, otherwise you are not getting even a correct exclusion.

You have this finding in writing, now you do need an explanation and what to do about it. Or if it was a wrong finding. Because the barium study needs more a cinetic study for SMAS than single pics out of context. (Every third part of duodenum can look blown up within a peristalsis wave, only in film or very close pics it can be seen if that was coincidence pic or real obstruction)

Yes, keep on digging please!

And all the best!

We tried gastric motility drugs (has gastroparesis), but didn't help. Clear for us, because it's a different root cause.

 

Dear Sanya,

I forgot to mention the latest symptom....dizziness. My doctor seems to think i'm not absorbing enough electrolytes through my diet. My pressure is low too. 

Woke up this morning with stomach cramping and loose stool. Could not go to work. Having the ultrasound done tomorrow. I have to keep digging for answers. 

Thank you for the private messages. 

Yes, keep on digging please!

There is so much to look at and need to tick through list.

Wishing you some answers soon as knowledge is power!