Texas Tech University Health Sciences Center Paul L. Foster School of Medicine continues its growth in medical education, patient care and clinical research through a number of new diagnostic and treatment options, especially in gastrointestinal care.

Disorders of gastrointestinal motility and function, although not well-recognized by primary care physicians, affect 40 percent of the population in the United States, according to the American Neurogastroenterology and Motility Society. Such disorders include constipation, diarrhea, irritable bowel syndrome, functional dyspepsia, gastroparesis, gastroesophageal reflux disease, abdominal pain and gas.

They can pose a heavy burden of illness, as well as decreasing quality of life.

Our team of investigators in the Department of Internal Medicine and the Division of Gastroenterology is evaluating ways to improve the health as well as quality of life for patients in El Paso, and to assist community physicians who need special studies and treatment options for their patients.

We are one of six centers in the nation funded by the National Institute of Health and National Institute of Diabetes and Digestive and Kidney Disease for projects related to gastroparesis — a condition of very slow movement of food out of a paralyzed stomach. many patients with diabetes mellitus develop this complication. Sometimes people who have experienced a viral infection of the stomach or small intestine such as food poisoning may not recover stomach function and can develop gastroparesis.

Symptoms of this disorder include nausea, vomiting, feeling excessively full after a meal, pain in the stomach after eating, including heartburn, diminished appetite, gas , bloating and subsequent weight loss. These presentations are often referred to as symptoms of “indigestion.”

Medications

There are a limited number of medications prescribed by physicians for gastroparesis. These medications block nausea and also stimulate the stomach to empty. Our research program, under the supervision of several well-known motility experts, offers new therapies for the paralyzed stomach — two FDA-approved drugs, Nortriptyline for brain-gut balance, and Aprepitant, an anti-vomiting agent, are being studied at this time.

Motilium (domperidone) an investigational medication not approved in the United States, but allowed by the FDA for use under certain medical and regulatory conditions, is also available to patients who experience nausea and vomiting and have been diagnosed with a slow stomach.

Another medication, actually a hormone called ghrelin, produced in the stomach is an interesting new agent available in a clinical trial. Diabetics who come to us for help are also taught to manage their glucose levels with an insulin pump for better control of symptoms related to slow stomach.

Other options

We are also exploring Chinese acupuncture, which provides stimulation to the well-established nausea and vomiting points in the body, and can halt or at least decrease the frequency and severity of these symptoms in gastroparetic patients.

One therapy unique to our center is Enterra Therapy–surgical placement of a gastric stimulation system. Gastric electrical stimulation involves the implantation of two electrodes into the stomach and connecting them with a device that delivers neuromodulating signals to the muscles and nerves of the stomach and then sends electrical pulses along nerves to the brain. This treatment is proven to turn off nausea and to control frequency and severity of vomiting.

We are the only site in El Paso and West Texas and the New Mexico area to provide this therapy. Eight patients have already undergone placement of the system, and more surgeries are planned this year for people suffering from this debilitating condition.

Finding new diagnostic tests and procedures is another goal of the motility center. Currently, we are investigating a wireless capsule, the SmartPill, to traverse the gastrointestinal tract from the mouth to being passed in the stool. This is a three-day outpatient study with no sedation or radiation. the SmartPill capsule, about the size of a prenatal vitamin, captures specific information about how the muscles work and move food down the tract.

For patients who have trouble swallowing, along with heartburn and acid reflux, a study called an esophageal manometry test, can determine the strength of their esophagus.

A glucose drink combined with collection of breath samples for 90 minutes is another option available for patients with unexplained gas, bloating and diarrhea, to determine if there are increased bacterial counts in their intestine.

Patients with constipation not being helped by laxatives can undergo a test, called an ano-rectal motility study, measuring the effectiveness of the muscles involved with straining during bowel movements. If a defect is detected, biofeedback exercises can help to relax the responsible muscle. This test could also indicate if there is a loss of control of bowel movements, called incontinence.

For many years, patients with severe gastrointestinal illnesses had to go out of town for procedures such as the Enterra Therapy and other diagnostic tests. that is no longer the case. Now people from all over the United States are traveling to our little part of the world for relief. We are glad to provide these new diagnostic and therapeutic opportunities to the residents of El Paso.

For more information, call Dr. Irene Sarosiek at 915-545-6626, ext. 230.

Dr. Richard McCallum is professor and chairman of the Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. he is a specialist in gastroenterology.