Stony Brook Gastroparesis Center

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Dr. Salvatore Docimo Jr.

The Stony Brook Gastroparesis Center, under the direction of Salvatore Docimo Jr., DO, MS, offers a multidisciplinary approach that brings together experts in the areas of surgery, gastroenterology, psychology, and nutrition. Consultations/appointments: 631-444-8330/-2274.

The center's goal is to provide patients with digestive disorders, especially gastroparesis, a wide spectrum of diagnostic and treatment options under one roof.

Gastroparesis, or delayed gastric emptying, is a stomach disorder in which food moves through the stomach into the intestines slower than normal. (The etymology of "gastroparesis" is: gastro- from ancient Greek γαστήρ gaster, "stomach" and πάρεσις -paresis, "partial paralysis.")

Patients often experience chronic nausea, vomiting, bloating, feeling full too soon after starting to eat, and weight loss. It is a debilitating condition, at times requiring hospitalization, and can significantly affect a person's quality of life.

Common causes include diabetes and previous surgery. Diabetes has been noted to be a cause in 30% of gastroparesis cases. However, neurological disease, collagen vascular disorders, viral infection, and drugs have all been blamed.

Gastroparesis, if not cured, requires management with a long-term care plan.

Gastroparesis is believed to occur in 9.6 per 100,000 people in men and 37.8 per 100,000 people in women. A recent study has also demonstrated an increase in gastroparesis-related hospital admissions by nearly 300% over a 16-year period.

Gastroparesis may result in the following complications, which, in addition to potentially problematic symptoms, justify treatment:

  • Severe dehydration: This condition is due to chronic vomiting.
  • Malnutrition: Patients tend to have poor appetites and cannot meet their daily caloric requirements.
  • Poor glucose control: Poor control over the amount and rate of food passing from the stomach to the small bowel can cause poorly controlled blood sugar levels.
  • Poor quality of life: Symptoms can make it difficult to maintain a normal quality of life and may affect a patient's work and social life.

Treatments for Gastroparesis

Dietary

Smaller and more frequent meals (typically lower in fat and non-digestible residue) are typically used as a first-line treatment. Foods such as orange juice, fried chicken, oranges, sausage, pizza, peppers, onions, coffee salsa, broccoli, and bacon have been reported to aggravate gastroparesis.

Saltine crackers, jello, and graham crackers have been reported to improve symptoms. Patients with severe nutritional deficiencies may require having a feeding tube placed.

Medical

A thorough review of medications may identity certain medications that are known to cause or worsen symptoms of gastroparesis.

Metoclopramide is FDA approved for use in treating gastroparesis. However, side effects such as sedation, restlessness, and acute dystonia have been noted.

Any discontinuation and prescribing of medications must be discussed with a patient's surgeon and primary care physician.

Surgical

Surgical treatment options for gastroparesis include implantation of a gastric electrical stimulator (GES), pyloroplasty (open or laparoscopic), total gastrectomy (removal of the stomach), and the per-oral pyloromyotomy (POP) procedure.

These options should be reserved for patients with symptoms that have not responded well to lifestyle modifications and medical management.

Gastric Electrical Stimulator

GES involves surgical implantation of an electrode device in the muscle of the stomach. The device delivers high-frequency, low-energy stimuli to improve gastric contraction.

Studies have demonstrated a significant overall improvement in symptom scores and gastric emptying with GES. However, the benefit appeared to be less for those with idiopathic (no known cause) and post-surgical gastroparesis.

Feeding Tubes

Feeding tubes are often placed surgically for treating gastroparesis. One approach is to place a feeding tube through the abdominal wall into a part of the small bowel. Liquid nutrition is then administered through the feeding tube.

Another method, using a gastroscope, is to place a feeding tube into the stomach and an additional tube extending into a portion of the small bowel.

Such feeding tubes may or may not improve symptoms such as nausea or vomiting. However, most patients will experience some amount of weight regain.

Laparoscopic Pyloromyotomy

This minimally invasive procedure involves surgically cutting the pylorus, a disc-shaped muscle that allows emptying of the stomach.

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The stomach showing location of pylorus (red circle); source, Henry Gray's Anatomy of the Human Body (1918). (Click on image to enlarge.)

Cutting of this muscle aims to improve passage of food contents from the stomach into the small intestine.

Per-Oral Pyloromyotomy

The POP procedure is a newly developed minimally invasive treatment that offers patients attractive benefits, compared with other surgical therapies. (It also is called G-POEM, which stands for gastric per-oral endoscopic myotomy.)

POP involves use of an endoscope (thin flexible tube). It is an alternative to surgical pyloroplasty.

There are generally no incisions made on the body, as everything is done through an endoscope that is passed through the mouth, into the esophagus, and down into the stomach.

The physician uses a small knife at the tip of the endoscope to create a tunnel to the pylorus, which is then cut, and the tunnel is closed.

The POP procedure offers an option for patients who need to avoid the problems associated with surgery. Most patients will be in the hospital for one day and require a post-procedural upper gastrointestinal study.

"POP is a novel, minimally invasive procedure that is at the forefront of gastroparesis treatment. We are excited to offer the POP procedure as an option for our patients," says Dr. Docimo, who performed the first POP procedure in Suffolk County.

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Learn more about gastroparesis. For consultations/appointments with the specialists of the Gastroparesis Center, please call 631-444-8330/-2274.