Allie has been puking the past couple nights (we are weaning her off of the Reglan). This is unusual for her so we think it's due to the lower doses of Reglan. We cut out her evening dose and that seems to be when she is puking. She is cutting two more teeth, which could be the cause, but we're not sure. She has severe DGE (emptied 13% after 75 minutes). Doc wrote us a new script for another emptying scan, but I don't think I can get her to lay still for an hour after eating.

I googled Reglan and realized that this stuff can cause some pretty nasty long term side effects and I'm not willing to put her back on it anymore (it's been four months now that she's been on it). I am really scared and want something else.

I am familiar with eurthromyacin (spelling). If your kids are on that, do you think it makes their stomach upset? I know it can be very hard on the stomach.

Any experiences with any other drug, please share. I am in the US and can't get motilum.

Thanks,
Christyn

Erythromycin did upset Daniel's stomach. Our GI told us to work up to the dose slowly and watch him closely -- and we never even got to the full dose.

There's another med out there -- becathonyl? Something like that? I know that's not quite right.

Benethocol? Gee, I can not recall either. I know Erin would be familiar with it and unfortunately she is away right now. I am moving this thread to the DGE forum for responses there as I think members with experience in these meds will respond from there.

I will try to keep an eye to see if you get answers.

Got it from the sticky here in the DGE forum. :wink:



treatments for dge


Medications called prokinetics and possibly diet changes are the usual courses of treatment for gastroparesis.
About Prokinetics These drugs work to increase the speed at which stomach contents move through the digestive track. How they do this depends on the drug itself as listed below.

Reglan® (http://www.drugs.com/reglan.html) - U.S. /Maxeran® Canada (Metoclopramide)
This drug is a dopamine antagonist which is beneficial in the GI tract where dopamine inhibits motility. It stimulates and coordinates esophageal (esophagus), gastric (stomach), pyloric (valve between the stomach and small intestine), and duodenal (small intestine) peristalsis. Peristalsis refers to the smooth, rhythmic muscle contractions that cause food to pass through the digestive tract. It also works to increase lower esophageal sphincter (LES) tone and stimulates gastric contractions. Unfortunately, metoclopramide crosses the blood-brain barrier which can cause negative (and if not discontinued-possibly irreversible) side effects such as involuntary muscle spasms, motor restlessness, and inappropriate aggression. These side effects are more common in long term use (12 or more months).
Motilium® (http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20M)/MOTILIUM.html) - (Domperidone) - Currently not available in the U.S.
This is also a dopamine antagonist; however, domperidone does not cross the blood-brain barrier so it does not have the undesirable side effects that metoclopramide may. It works to increase esophageal peristalsis, LES pressure and gastric contractions.
Erythromycin (http://www.drugs.com/xq/cfm/pageid_0/htm_D00046A1.htm/type_mtm/tgid_36/bn_erythromycin/qx/index.htm) - An antibiotic with the side effect of increasing gastric motility. This is currently being widely used in low doses (not the higher antibiotic doses) for delayed gastric emptying as this does not have the unfortunate side effects that are possible with metoclopramide.
Urecholine® (http://www.drugs.com/xq/cfm/pageID_0/htm_202090/type_cons/bn_Urecholine/micr_medex/qx/index.htm) (Bethanchol) - Urecholine is used to treat urinary and bladder problems. It helps to empty the bladder and often stimulates gastric motility, increases gastric tone, and restores rhythmic peristalsis improving gastric emptying time.Diet Changes
Adding cereal to baby's bottle as is usually recommended by the doctor for reflux, may make DGE worse since solids take longer to empty from the stomach than liquids. Breastfeeding is by far the best for a baby with DGE as breastmilk moves through the digestive system up to twice as fast as formula. If the baby is not breast fed, switching to a hypoallergenic formula, may also help, as they are already partially digested, making transit time out of the stomach potentially faster.
diagnosing gastroparesis

Many children with reflux will be put on prokinetic medications whether or not they are diagnosed with DGE simply because it can help lessen reflux episodes by leaving less food in the stomach available to be refluxed.
If DGE is suspected, the doctor may order certain tests to obtain a positive diagnosis.
Upper Endoscopy (aka Scope)
A flexible tube (endoscope) with lights and a camera is passed down the child's mouth into the esophagus, stomach and first part of the small bowel (duodenum). The doctor may take biopsies at this time which involves removing small pieces of tissue from each location. The gastrointestinal tract will be examined for ulcers, inflammation, hernias or other abnormalities that can cause symptoms similar to DGE.

Gastric Emptying Study
The baby is required to ingest a small amount of radioactive material which is followed by a special machine as it empties out of the stomach. This test will determine the length of time it takes the material to move from the stomach. A delay would result in a positive diagnosis of DGE.
Final thoughts

Reflux and DGE seem to go hand in hand for many babies and unfortunately, DGE can make reflux worse. Reflux episodes can become more frequent by having too much food lingering around in the stomach for long periods of time. Fortunately, as with reflux, most babies will outgrow their DGE problems as their digestive track matures and becomes more coordinated. Written by RMacLean, Author
April 2005
Reviewed By Dave Olson, MD
Fellow, American Academy of Pediatrics
Graduate University of Michigan School of Medicine
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Thanks for finding the name, Leigh. I was wracking my brain last night, knowing that it started with Beth, but unable to find the link to what you've posted (b/c I've had to change a few things to be able to use dial-up somewhat effectively on here). Thanks again!

Thanks - I had seen that on this site, but I wanted to hear from moms who had used something other than Reglan and saw sucess or not success with it.

So - is there anyone out there that has used the other medicines and has seen how it works?

Thanks,
C

We used reglan, propulsid (before it was taken off the market) and motilium. The propulsid is the only one that we saw a slight improvement with but it only lasted for a week and she was back to herself again. Shortly after that it was taken off the market.

We used Erythromycin, and saw definite improvement after about a week. We never saw any side effects with it... :)

we used erythromycin for awhile, then had to stop using it because alexys developed cdiff from prolonged antibiotic use. if you DO use erythro, i strongly recommend using a pribiotic with it to keep the level of the flora in the intestines balanced. i didnt really notice a diff with the erythro, but i know it has helped some kids. we tried bethanacol (sp) for awhile too, but didnt notice much of a diff there either. i guess it depends on the kid. our only other option was reglan, and i just wasnt willing to go there. so we just didnt medicate for it, mostly just modified her diet. alexys had very severe dge, around 10 percent emptying at 90 minutes. i think it is getting better though, it doesnt take her a week to poop stuff out anymore ;)

Catherine was on Bethanecol for about six months as a young infant. I don't think it did a thing for her. She still puked everything that she took in.

We haven't been successful at lowering it either - but I haven't seen any effects of it on either...My understanding is that the side effects are more of an issue if its used for over 12 months. We are only about 4-5 months out...so I'm gonna stick with it for a little bit longer, but I was going to ask our new ped (when we pick one) about Urecholine/Bethanechol but the most common side effects are stomach cramping and diarrhea...and Bryna gets such bad Diarrhea from almost anything so I'm not sure we have a choice.

KC has been on eyrithromicin for almost 8 months now and he does well with it and does not get tummy upset. We tried reglan first and he got worse on that.

we used erythromycin for awhile, then had to stop using it because alexys developed cdiff from prolonged antibiotic use. if you DO use erythro, i strongly recommend using a pribiotic with it to keep the level of the flora in the intestines balanced. i didnt really notice a diff with the erythro, but i know it has helped some kids. we tried bethanacol (sp) for awhile too, but didnt notice much of a diff there either. i guess it depends on the kid. our only other option was reglan, and i just wasnt willing to go there. so we just didnt medicate for it, mostly just modified her diet. alexys had very severe dge, around 10 percent emptying at 90 minutes. i think it is getting better though, it doesnt take her a week to poop stuff out anymore ;)

What is cdiff? I guess I haven't researched that at all.

Thanks,
C

We haven't been successful at lowering it either - but I haven't seen any effects of it on either...My understanding is that the side effects are more of an issue if its used for over 12 months. We are only about 4-5 months out...so I'm gonna stick with it for a little bit longer, but I was going to ask our new ped (when we pick one) about Urecholine/Bethanechol but the most common side effects are stomach cramping and diarrhea...and Bryna gets such bad Diarrhea from almost anything so I'm not sure we have a choice.

Cheryl,

I got on the FDA website yesterday b/c of the post that Roni made about REglan (it scared the crap out of me) and saw that the FDA DOES NOT recommend the use of REglan by ANYONE - adults or kids - longer than 12 weeks b/c of the risk of tardive diskenesia. Allie is starting to act strange with jerky movements and lip smacking, etc. so that is why we're worried. Allie has been on it since March 30, so we are on 4 months of it as well. How much does Bryna weigh and how much does she take? How bad is her DGE, or is she just taking it for GERD?

Thanks,
C

How was the g tube? they are talking about putting one in my 3 month old daughter.