Gastric Emptying Study Follow-Up

On the 28th of December, I had a gastric emptying study done. Today, the 6th of January, I had my follow-up appointment with my gastroenterologist. It wasn’t quite what I expected…

First of all, let me explain what a gastric emptying study is. While the way they are conducted can vary quite a bit, the premise is the same: eat some food with a radioactive tracer in it, then get scanned periodically to see how fast the food empties from your stomach. For me, I had to eat some radioactive eggs (more like, one very small scrambled egg), then I could eat two pieces of toast with jelly, and I got a shot glass sized amount of water to wash it all down with. After I ate, they scanned me immediately to get a baseline (see what 100% looked like). For the next four hours, I was not allowed to eat or drink anything at all. Yes, four hours; I sat in a pretty, sunny hallway and read a book for four hours, minus the few minutes each scan took. The scanned me again at one hour, at two hours, and at four hours. After I left, they calculated the percentage of food left in my stomach at each scan, then sent the results to my doctor.

Gastric Emptying Study imaging machine

The scanning machine; I stood between the two giant paddles while they were scanning me.

As you can see, pretty straight forward test. Though it aggravated my POTS symptoms (dizziness specifically) thanks to not being allowed to drink any water for more than ten hours by the time the scan ended (you are not allowed anything by mouth for six hours prior to your scan).

Gastric Emptying Study Meal

The “meal” I got to eat for my gastric emptying study: radioactive scrambled egg, toast and jelly, shotglass size amount of water.

My results:

Time Elapsed Since Meal Percentage of
“Gastric Retention”
Normal Range
1 hour 80% 30-90%
2 hour 50% 60% or less
4 hour 7% 10% or less

Yes, as you can see, my results show that I do not have gastroparesis! Technically, I don’t even really have delayed gastric emptying, oddly enough. Though, Dr Springer did say I probably have some delayed emptying due to my IBS-C issues, and some other things that I’ll get into in a moment.

While I’m extremely excited that I don’t have gastroparesis, it means we’ve kind of run out of testable options (at least, easily testable with definitive results). I’m still doing a happy dance due to not have gastroparesis because it is a condition that can cause a lot of problems!

So, what are we doing next?

Well, first, Dr Springer wants to see if the low FODMAP diet I’m on right now will help at all. If it doesn’t help, he does really want me to get the LEAP testing to figure out what my allergens are. He’s also thinking he might put me on a stronger antibiotic than Xifaxin because the Xifaxin did something, but it didn’t feel like it was complete (please know what I’m talking about, it’s so hard to explain).

He’s thinking that a lot of my problems may be a combination of SIBO and eosinophilia of the small intestine. Eosinophilic gastroenteritis is apparently extremely rare (I swear, my body is a Pokemon trainer – gotta catch ’em all). It’s also difficult to really test for, and he’s thinking he’d probably just diagnose it after we’ve ruled out pretty much everything else. It’s quite difficult to get into the small intestine to do enough biopsies to be sure you catch the pockets of eosinophils. There is a scope that can reach part way into the small intestine – that it sounds like he may think about doing – it’s like an upper endoscopy but the scope goes further into your small intestine. However, he said the risk (other than biopsy and scope risks) are that he may not be able to biopsy an area where the eosinophils are concentrated, leading to a false negative. I’m thinking treatment for the eosinophilic gastroenteritis may be good for my eosinophilic esophagitis anyway, meaning it wouldn’t really harm me to treat it.

The reason he’s thinking eopsinophilic gastroenteritis is because he believes I may have inflammation in my small intestine. We know I don’t have Celiac, thankfully, so that’s not causing it. He thinks the inflammation is causing my motility issues, which would be why it feels like my stomach sometimes empties slowly (because my small intestine is inflamed and telling it not to empty). Since it’s, essentially, the middle portion of my digestive system, it could also be causing (or aggravating) my IBS-C by emptying into the large intestine too slowly to really trigger the proper intestinal movement. It really makes sense. And since I have such a confusing allergy syndrome of some undiagnosed variety, it really doesn’t seem like much of a leap to me.

Oh, and his opinion on the blood work was interesting. Even though some of my numbers were elevated, he wasn’t really concerned. My overall white blood cell count was normal, the percentages of the different types were all normal, and the two absolute counts that were raised were only a little higher than they should be. He agreed that the eosinophils were likely raised due to my eosinophilic esophagitis. He thinks the lymphocytes may have been elevated because I had some sort of virus or something that pushed them up a little. I will be taking the test results with me to my National Jewish Health immunology appointment (end of January), however, to see what they think. I’ll also give them to my primary care doctor so they’re in my record for comparison later. He also thought my protein and calcium were on the lower side due to individual variation. I’m guessing those numbers will probably improve with my new diet (at least the protein will), so I’m not really worried about it at all.

What do you think?

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