Doc: Slow-moving GI system might be caused by norovirus
Dear Dr. Roach: My 30-year-old son recently was diagnosed with gastroparesis. This occurred a few months after having a norovirus infection. Is there a cure? Are there medications to help? What can be done to reduce the symptoms of nausea and belching?
Dear C.R.: Gastroparesis (from the Greek roots for “stomach paralysis”) is when the stomach, and often the rest of the intestines, is impaired in its ability to move food forward through the gastrointestinal tract. The hallmark symptoms are abdominal distention and bloating, and a sense of feeling full, even to the point of nausea. The diagnosis is most often confirmed by a gastric emptying study, which measures the amount of time it takes for a radioactive meal to move through the GI tract.
Gastroparesis might be associated with other neurological diseases, such as multiple sclerosis; might be related to (usually longstanding) diabetes; might occur after a viral illness; or could have no known cause (which is most likely). In your son’s case, the recent norovirus infection is suggestive, as norovirus is one of the infections most commonly associated with gastroparesis. If so, his prognosis is good: Most cases will get better by themselves within a year.
Gastroparesis often is initially treated with diet and medications. Dietary advice is to eat smaller meals with low fat and very little insoluble fiber; alcohol, tobacco and carbonated beverages all are recommended against. A dietitian nutritionist can be a very helpful consultant.
If diet alone is inadequate, medications to help speed up the GI tract are necessary. Metoclopramide is an effective treatment, but it should not be used for more than 12 weeks without a careful understanding of the long-term risks of taking this drug, especially the risk of movement disorders. Other treatments, such as domperidone in Canada (not easily available in the U.S.) or erythromycin can be helpful, but have their own risks. Cisapride is very effective, but since it can cause a fatal type of arrhythmia, it is available only as a last resort through a program with the drug manufacturer.
Dear Dr. Roach: I am a 66-year-old woman in good physical condition. I take no medications. I was recently informed that I have a cataract, and that surgery would be a good improvement to my vision. I was told a physical and EKG would be necessary. My younger brother, who has high blood pressure and stomach ulcers, was told neither a physical nor an EKG would be required. Why?
Dear J.O.: Cataract surgery is a low-risk procedure, and does not require extensive preoperative evaluation. An EKG is not necessary for most people. No blood testing is needed for most people. In fact, a study found that people undergoing cataract surgery who underwent routine testing had no benefit compared with those who received no preoperative testing.
However, it is appropriate to do a thorough history and physical examination prior to any surgery. Someone with a respiratory infection with prominent cough should postpone: Coughing can complicate surgery and recovery. Some hospitals have regulations requiring preoperative testing. Although these are well-meaning, they make no sense, waste time and add expense.
Email questions to ToYourGoodHealth@ med.cornell.edu.