Scott-Winful, M.D., a gastroenterologist at Baylor Scott & White Health, talks about a rare condition that paralyzes a person’s stomach and makes it difficult for them to digest food.
Interview conducted by Ivanhoe Broadcast News in March 2017.
As a gastroenterologist, basically what do you do on a daily basis?
Dr. Scott-Winful: A gastroenterologist takes care of patients that have digestive diseases including esophageal diseases, liver diseases, stomach, intestinal, colon. One of our mainstays is performing screening colonoscopy and March is colon cancer awareness month.
You do a lot of colonoscopies. You see a lot of people with a lot of different things and Erica is an interesting case we were learning a little bit about her issues. In the beginning she saw a lot of doctors but nobody seemed to know what her problem was.
Dr. Scott-Winful: Erica presented with severe nausea that was actually preventing her from going to work and that’s one of the mainstays of her eventual diagnosis. We ended up doing a lot of the testing procedures like endoscopies, x-rays and finally we performed a gastric emptying study and that diagnosed her with gastroparesis.
One of the things about Erica’s condition it sounds kind of devastating. It seems nobody knows what it is but the pain is excruciating, you feel like you’re going to throw up all the time.
Dr. Scott-Winful: Certainly, with gastroparesis it’s not very common; with men and women combined the diagnosis is about less than one percent of the population. It’s usually one of the last things that we end up diagnosing because it’s so uncommon. But certainly the symptoms are nausea, vomiting, abdominal pain and the sense of being full all the time after eating and having prolonged fullness after consuming a meal and even before.
It’s got something to do with the vagus nerve?
Dr. Scott-Winful: Yes, so believe it or not our GI track is our second nervous system and with the constant movement and peristalsis of the luminal organs, there is this complex network of cells and nerves that allow your stomach and other intestinal organs to move naturally and constantly. In gastroparesis there is relative abnormality in those cells, dysfunction and so they don’t move in a propulsive fashion and you get stasis of food bile in the stomach.
Is it a type of paralysis of the stomach?
Dr. Scott-Winful: It’s actually similar to that. Gastroparesis actually means “gastro” stomach paresis weak so it’s a weak stomach and the motility is weak. It’s a motility problem that you don’t have the normal parastaHic action that you should have to have the food leave the stomach and enter in to the small intestine for digestion.
Is that a muscular thing?
Dr. Scott-Winful: It’s a muscular thing; secondarily it’s primarily a nerve thing. You have abnormalities in the myenleric plexi in the stomach and that could be for a variety of reasons which leads to a relative inability for the muscles to move muscles. The muscles only do what nerves tell them to do. The muscles don’t work.
In this case the nerves aren’t working, the muscles aren’t working and that means the foods not moving?
Dr. Scott-Winful: That’s really uncomfortable. One part of the gastroparesis is that you have delayed accommodation in the top part of the stomach and a second part is that the actual motor propulsive part, the antrum does not grind the food enough to push it in to the small intestine. You have delayed ability to distend and then the stomach can’t contract in order to be able to push the food out in to the small intestine.
So you can’t eat?
Dr. Scott-Winful: Pretty much, I mean you try to, you vomit it back up.
You’re not getting nutrition?
Dr. Scott-Winful: That’s one of the problems is that patients who have this can become severely dehydrated and in extreme cases malnourished and lose weight.
She’s doing real well but my understanding is that a lot of people this gets really bad to the point where they need tubes and things like that for feeding.
Dr. Scott-Winful: Some of the extreme cases where medical therapy and diet therapy don’t work there is a need for surgery which usually means having feeding tubes placed in the small intestine to totally bypass the stomach but also having tubes placed in to the stomach for venting to allow that little valve to let all of the air and the pressure that builds up relieved without having to vomit or in the hospital with medications.
You’ve seen people who have that you probably have treated those.
Dr. Scott-Winful: Yes I have. But that is as uncommon as gastroparesis is having to have a surgery to have a feeding tube placed or even a venting gastrostomy tube that’s even more uncommon.
That’s the worst case scenario?
Dr. Scott-Winful: That’s the very worst case scenario.
Being a nurse her mind goes there right?
Dr. Scott-Winful: In Erica’s case it was special. She had a moderate case of it enough to again to affect her ability to work. She did not do well with just diet therapy and also had adverse reactions to medical therapy. The mainstay of medical therapy is using metoclopramide. It however is not intended for long term use and there are some possible long term side effects even with a small duration of use. In her case our next recourse was to consider something more invasive. I didn’t think that she really needed to have a feeding tube or a venting tube. So we pursued looking to see if she was a candidate for a gastric stimulator.
That’s what you did?
Dr. Scott-Winful: Well I didn’t do it; I enlisted the help of a very good surgeon who performs that surgery. I was there for part of it, the surgery, but that placed a few years ago.
That was your recommendation?
Dr, Scott-Winful: Based on her testing, her history, her inability to tolerate medical therapy she was deemed a candidate for having the gastro stimulator placed.
How did it work out?
Dr. Scott-Winful: Wonderfully. She felt wonderful soon after having it placed. There’s an adjustment period afterwards. What happens is it’s similar to a pacemaker actually that’s used for the heart. But they’re actually little leads that go from the motor that directs the impulses and that is attached to the stomach. It kind of gives the stomach a shock to try to get those nerves shocked to give the muscles the impulse to be able to move and contract to push through to the stomach.
She had the original procedure done and then you had to do a subsequent procedure because those little leads weren’t in the right place?
Dr. Scott-Winful: You just can’t place a gastro stimulator and say, ”hi I’ll see you later.” You have to actually do some follow up. The reason for doing follow up and interrogate the pace maker is to look for that problem. One thing to look for is an increase in the impedance which means that electrical pulses are not going through the tissue normally. Her impedance was rising and that correlated with her having more nausea. We ended up having her leads replaced and that pretty much took care of the nausea. Since then she’s been doing well.
When you look at her case how would you size it up, would you say a great success or what?
Dr. Scott-Winful: It’s an unusual diagnosis for someone so young. That being said idiopathic gastroparesis is one of the most common kinds. Diabetics can also have this condition. For her to have the nausea and then have side effects to the medical therapy to be able to get this surgery and have this device to place is a great success.
This procedure the overall title of a lot of these stories is medical breakthroughs. This is not brand new.
Dr. Scott-Winful: It is not brand new. Having a gastro stimulator has been around for a long time. In general it’s a little bit challenge to get it approved. So that more than anything is the miracle and situation that got it approved. But for in patients who do get it, especially those who have nausea and vomiting as their symptoms, it can make a difference in their quality of life.
How do you feel about your work in terms of her?
Dr. Scott-Winful: I am very pleased and I’m proud to have been able to help her in this way. She has a life to live and a job, family, and it helps her to be able to not worry about her symptoms, her diet, she gets to go ahead and live her life normally.
Have you ever seen her wrestle?
Dr. Scott-Winful: I haven’t. I heard about it and I’m scared of her.
It sounds like this is kind of an usual case but a really good outcome.
Dr. Scott-Winful: One thing is that they’re having my colleagues to be persistent in trying to get this device for the patients. Again it’s not that common that it’s needed but when a patient needs it and they get it, it can make a world of difference. Quality of life is priceless.
I’ve heard that she considers you a lifesaver.
Dr. Scott-Winful: That’s a very great compliment. Anything that any of us would love to hear the patient say but I’m just here doing my job to help the patients and to heal them.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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