G-POEM: non-invasive pyloroplasty

by Jim Sliney Jr

For patients whose primary symptoms of gastroparesis are nausea and vomiting, and in whom other gastric procedures have failed, there is a hopeful procedure and a related study going on.

G-POEM stands for Gastric per-oral Endoscopic Myotomy, which is a procedure using endoscopy (a camera attached to a tube that, in this case, goes down your throat and into your stomach) to perform myotomy, which is the cutting of muscle tissue. In this procedure the pyloric sphincter, which is the muscle between the stomach and the small intestine which is meant to open and close to let food out or keep it in as needed, is cut allowing a wider vent for food to leave the stomach. The desired result of a G-POEM procedure is to improve the gastric emptying rate which in turn should reduce the nausea and vomiting which are associated with slow gastric emptying.

I spoke with Dr. Mouen Khashab, the Director of Therapeutic Endoscopy at Johns Hopkins Medical Center, and the principal investigator of a study that looks at the safety of the G-POEM procedure and its effectiveness over the course of two-years. Dr. Khashab explained that not everyone is a good candidate for G-POEM, noting that only those who present with nausea and vomiting as their primary symptoms would be right for his study. However, the procedure is showing itself to be effective to relieve nausea, vomiting, and to a lesser degree, abdominal pain, while improving the rate of gastric emptying.

Pyloroplasty is a similar procedure, the goal of which is also to cut the pyloric sphincter allowing for food to leave the stomach faster. There are also stent placing procedures designed to do this. The primary difference between pyloroplasty, stent placement and G-POEM is that pyloroplasty is performed laparoscopically (a small incision is made in the wall of the abdomen and an instrument is inserted through it) while G-POEM is non-invasive. Also, stents run a risk of moving over time, losing their effectiveness and requiring follow up procedures.


Dr. Kenneth Koch, Director of the Digestive Health Center of Wake Forest School of Medicine (and member of the medical advisory board of G-PACT) added that patients with pyloric dysfunction, a subgroup of GP patients, might benefit from procedures like G-POEM and pyloroplasty since pyloric dysfunction is associated with delayed gastric emptying, which in turn is associated with nausea and vomiting.

Dr. Khashab recently presented the results of his study at an international meeting of gastroenterologists and has an article in the Gastrointestinal Endoscopy journal. His findings include the following:

During the first six months of observation after the G-POEM procedure,

  • 47% of the patients reported that their nausea was completely resolved and 50% reported that it was improved, while one patient reported that nausea was worsened.
  • 57% of patients reported their vomiting was resolved, while 10% reported improvement. 33% reported no change to vomiting while 1 patient reported worsening of vomiting symptom.
  • 53% of patients reported that abdominal pain was resolved, 20% said it improved, 23% reported no change, and 1 patient reported worsening of abdominal pain.

Of note, the patients in this study had gastroparesis either from diabetes, post-surgery, or of unknown origin. The 1 patient who reported worsening of nausea, vomiting and abdominal pain had diabetic gastroparesis.

Studies investigating the safety and effectiveness of G-POEM as a treatment for GP related nausea and vomiting are ongoing, including Dr. Khashab’s study.

If your primary GP symptoms are nausea and vomiting and you have tried different therapies and they have not worked, and you wish to consider Dr. Khashab’s study. You can learn more about it and how to contact Dr. Khashab by following this link .


Jim Sliney Jr is the Editor for ThePactBlog, G-PACT’s newsletter. He is a part time student at Columbia University and a freelance writer, working in both fiction and medical writing. He lives in New York City with his wife, an ophthalmic researcher.

*graphics from creative commons

URGENT: 21st Century Cures Act needs your support RIGHT NOW

Patient Alert: In a much more rapid fashion than expected, the House of Representatives is currently voting on a final version of the 21st Century Cures Act. Though certainly only representing an initial foundation, the Act is the broadest effort in the fight for FDA reform that I have seen in nearly 25 years.  
If you or a child, or a parent suffers from Digestive Tract Paralysis or any one of nearly 10,000 chronic diseases that are currently incurable in the US, PLEASE take the time to call your senators or Congressperson to push the need for treatment regulatory reform that the best available treatments do not remain blocked simply by Federal regulation and not for a lack of scientific progress.
For G-PACT and the Digestive Disease National Coalition, this is a defining moment in the fight that guarantees a future in which well-tailored conservative treatments rather permanent artifiical nutrition, ostomy and digestive tract transplant are not the choices for the current generation and for our children and grandchildren.
For the chronic disease commnuity at large, this is the foundation of a future that will guarantee, properly and personally tailored treatments and cures for a population of 30 million Americans.
In tribute of the memory of those that we have lost, and to start the fight for those that we wish a cure and a return to function.
#CuresNow #CuresForever

Amitriptyline: A Sound Release

by Rita Griffin

Both constant and periodic vomiting and nausea plagued my son off and on for several years during high school. When he entered college in 2011, the frequency of stomach upsets increased. Numerous visits to the emergency room interrupted his college experience, and made his life unbearable.

In the fall of 2014, he was finally diagnosed as having idiopathic gastroparesis. The gastroenterologist, at that time, had first thought that he had cyclic vomiting syndrome. However, after performing the gastric emptying study, it was concluded that he indeed had gastroparesis.

Now that we knew what the problem was, it was decided by the doctor to prescribe nortriptyline, a tricyclic antidepressant, which helped alleviate the nausea for a while. The gastroenterologist was hesitant when he prescribed Reglan (metoclopramide), despite the overt side effects. Neither drug was helping my son, who at this time, was suffering emotionally from being sick, and missing college classes.

Another doctor with GP sufferers in his practice recommended placing my son on amitriptyline, also a tricyclic antidepressant. He also wanted him to cease gradually from the Reglan. My son stopped taking nortriptyline, and has now ceased from the Reglan.

Happily, I can say that amitriptyline has really aided my son with the nausea and vomiting associated with gastroparesis. Yet, he still has to avoid spicy, acidic foods to get the full potential of the drug.

Amitriptyline is used to help relieve symptoms of depression. My son takes his at bedtime, because it can cause drowsiness (his only complaint in the last six months). His local GI doctor and the GP specialist have both advised that they can increase his dosage, if needed. The highest dosage recommended is 150mg.

At first I was unaware that amitriptyline was used to treat depression. I could not understand how this could help with gastroparesis. After careful study, I learned that the drug works on the central nervous system to increase levels of certain chemicals in the brain. His GI doctor told us that stress could be a factor in our son’s sickness, because around the time of college exams and tests, his condition would worsened.

My son has shown no episodes of nausea, only rare occasions of pain. Pain is common with GP. When I first saw my son bent over in agony, I told him to stay calm and be more relaxed thinking that would help, but I did not really understand the pain he was experiencing. Based on my readings and information from the GP specialist doctor, the cause of GP related pain is unknown. The GP specialist who prescribed amitriptyline for my son gave an interesting finding in a report with the International Foundation for Functional Gastrointestinal Disorders (IFFGD, regarding tricyclic medications: “Low doses of trycyclic medications, such as amitriptyline, nortriptyline, and desipramine, have been shown to reduce pain in other functional gastrointestinal (GI) conditions and may reduce pain associated with gastroparesis.” The amitriptyline seems to help my son with pain.

As with all medications, there are diverse side effects. According to healthline.com the most common are “headache, constipation or diarrhea, confusion, numbness or tingling in arms and legs, unexpected weight gain or loss. The more serious side effects are chest pain, shortness of breath, weakness on side of body and slurred speech. There can also be interactions with herbs and vitamins.” So, it is important to check with your doctor before taking anything else while on amitriptyline.

Taking too much can lower your blood pressure and cause an irregular heart rate, confusion, hallucinations, and even convulsions. Your physician must monitor dosages. In fact, the Mayo Clinic advises that a doctor should check you at regular intervals for changes in dosage or to check for unwanted side effects. Amitriptyline may cause some people to be agitated, irritable, or display other abnormal behaviors.

Amitriptyline has given my son much needed relief from the nausea and vomiting associated with gastroparesis. In addition to the medication, he does chiropractic care, which has proven to be a positive benefit. My son has his spinal cord adjusted about once a month. The Chiropractor uses his hands “ to apply a specific application of forces to facilitate the body’s correction of nerve interference.” [Chiropractic First, page 67] This helps to relax his stomach muscles.

My son has no other medical conditions, and he gets a good report from his general practitioner visits. He has to be conscious of his diet. This has to be the most daunting aspect for him because he is young, and like young people, he wants to be able to eat whatever he wants. Usually, he does okay when he takes his medication and adheres to what he has to do to stay healthy.

Amitriptyline may not be a cure, but it has proven to be a constant relief for my son. Until a cure, he can at least experience a sound release from the pitfalls of gastroparesis.

Related Sources





Rondberg, Terry A., D.C., Chiropractic First, The Chiropractic Journal, 1996 & 1998

Rita Griffin is a Georgia native. She has a Bachelor of Science degree in Psychology and worked for the Georgia Department of Transportation for 15 years. She loves studying the Bible, reading, traveling, writing, and meeting people. Rita has published 4 books of poetry. She is married with two sons. Rita is a volunteer writer for G-PACT.


The Domperidone Problem – The Goldwater Institute tells the story

Domperidone is a drug that has been used to treat patients with gastroparesis. It is not available by prescription in the United States, and while it was once able to be formulated in compounding pharmacies, that practice has been banned by the FDA. Domperidone is also available in many other countries, including Canada, but the FDA has blocked those channels for acquiring the drug as well.

Why is such a successful medication being targeted by the FDA?

The Goldwater Institute’s Mark Flatten has, with cooperation from G-PACT, written a powerful article explaining the many problems patients face getting access to Domperidone, titled, SICKENING: FDA BUREAUCRACY BLOCKS COMMON “MIRACLE DRUG”

We encourage you to read it. Then we encourage you to take action with your legislative representatives.

Learn more about Domperidone from The Mayo Clinic, here.

See what the Food and Drug Administration have to say about Domperidone and how to get it, here.


The Right-To-Try legislation

Right To Try is a legislative effort to expand the ability of terminally ill patients to gain access to experimental medicines. It would prohibit the federal government, including the US Food and Drug Administration, from taking any action to prevent patient access to life saving treatments.
“The FDA does have its own Compassionate Use program aimed at providing access to therapies still under evaluation — however the application is cumbersome, largely unworkable for practicing physicians, and time consuming when a patient’s time is running out. State Right-to-Try laws give patients who have exhausted every government-approved option another chance to fight for their lives. The laws are aimed at reducing the often two to four month waiting period under the FDA’s Compassionate Use down to two to four weeks, and eventually two to four days.”

To learn more search “Right-to-try legislation”

Effect of Endoscopic Pyloric Therapies for Patients with Nausea and Vomiting and Functional Obstructive Gastroparesis

Here is an article from the Autonomic Neuroscience: Basic and Clinical Journal.

“Conclusion: Pyloric therapies appear to be effective treatments in symptomatic patients with GP and 3 cpm GMA and controlled trials are warranted.”

Wellington, J., et al., Effect of endoscopic pyloric therapies for patients with nausea and vomiting and functional obstructive gastroparesis, Auton. Neurosci. (2016), http://dx.doi.org/10.1016/j.autneu.2016.07.004

© 2016 Elsevier B.V. All rights reserved.



To the People Who Think My Chronic Illness Makes Me Weak

To those who think my illness makes me weak:

I see the way I’m looked at these days. Some of you look at me with pity, others with curiosity and still others with disdain. You think that because I have a chronic illness, I am weak and lazy and have no ambition. You see me as less than you. 

Don’t try to deny it, because I know how true it is. You see, I used to be you.

Before I became chronically ill, I didn’t realize that many people don’t have the energy to take a shower each day. Or that it’s not always possible to force yourself to complete a task because there’s just no way your body is able to cooperate. I didn’t realize that there are many diseases just waiting to ambush the innocent, diseases that cannot be cured or effectively treated. I certainly didn’t realize that I would one day be one of “those” people.

I thought I was strong, and then I found out what strong really is. Strong is just getting out of bed each morning. Strong is caring for your family when all you want to do is crawl into a hole and hide. Strong is navigating a health care system that is not always friendly to those of us with conditions that cannot be neatly categorized and handled by checking off treatment options on a predetermined list. Strong is persevering when you’re denied pain medications because you’re labeled a drug seeker, or fighting back when you’re told your insurance will not pay for a procedure or a medication because it’s not covered under your plan. Strong is the definition of each person who lives with a chronic illness.

You have no idea how hard we fight to maintain our lives after we become ill. We don’t want to stop working, exercising or socializing, but most of us cannot do these things any longer. We struggle with changing our ambitions and desires to fit within this new life we’ve been handed. Most people hate change and avoid it at all costs. We have no choice. 

We want you in our corner. But we are able to make it without you if we must. We’ve learned to find others like us and form bonds only we can understand. Our strength is not just for ourselves — it’s also for the millions battling our same enemies. Our shoulders are broad enough and strong enough to carry this load. Would yours be?

I believe life for the chronically ill is harder than it is for most people. We can’t always just fight through the pain, the fatigue, the desperation. Tasks that seem easy to the average person can push us to the edge of exhaustion and affect us for days afterwards. But please, don’t let any momentary weakness affect your perception of us. Because of our illnesses and how hard we have to fight each and every day, I believe we are stronger than most and more capable, too.