Dr. Ghulam Fareed
Medical Gastroenterology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
Answered by
Medically reviewed by
Patient's Query
Hi doctor,
Is it unreasonable with grade two gastroparesis, extreme weight loss, and unable to maintain weight for a PEG-J tube at this point? I have been hospitalized for failure to thrive twice and I have had GI issues for a long time. My first GES was not valid. My second one showed grade 2 gastroparesis. My sitzmark was actually seven days. But I want a PEG-J tube with a mic-key button as I can not take Motilium since I live in the West, and all the other gastroparesis medications interact with my stiff-person syndrome medications. I take Valium 50 mg a day spread out on a schedule with an extra 10 mg for severe stiff-person syndrome attacks and Baclofen 40 mg spread out on a scheduled day. I also take IVIG Gamunex-C 40 grams monthly. I have done a gastric emptying study and sitz mark colon transit. Please help.
Thank you.
Hi,
Welcome to Icliniq.com.
I am reviewing your case history and attached files (attachments removed to protect patient privacy). I will get back to you in a while. Please wait for my detailed responsePlease revert in case of further queries.
Thank you.
Patient's Query
Hi doctor,
My weight is 84 pounds current and I have been as low as 79 pounds this year. I am struggling to maintain and gain weight. I now have a medical reason when for a long time my GI and other doctors were saying it is psychological, except the hospital doctors who witnessed and treated my motility symptoms. I cannot take or tolerate the medications for them with my SPS medicines. Please help.
Thank you.
Hi,
Welcome back to Icliniq.com.
I understand your concern.
According to your reports (attachments removed to protect patient privacy), there is gastroparesis and slow transient constipation. But, before moving to a surgical or endoscopic intervention like PEG-J (percutaneous endoscopic gastro-jejunal tube), one should put all his efforts into avoiding this, including adjustment of medicine. Considering the prolonged duration of your illness, unable to gain weight, and relative compromised immunity due to inadequate nutritional status, you need nutritional built-up. I can understand grade-two gastroparesis, but still PEG-J tube itself should be on board or at least included in discussions. Give yourself some time to recover, try little lifestyle modifications, and try other prokinetics after consulting with a neurologist. In the meantime, ask your primary physician to discuss your case in an MDT (multi-disciplinary team) meeting and come up with a final decision regarding your health.
I hope this information will help you. Please revert in case of further queries.
Thank you.
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Medical Gastroenterology
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