That tummy or choking issue just might be your MS.
You may experience difficulty swallowing with MS, especially if you have brainstem involvement. Others can have difficulty chewing, choke when they eat, or dribble drinks on their cheeks. Swallowing problems may occur when you’re first diagnosed with multiple sclerosis or as it progresses.
What can be done?
Many patients find that they choke or sputter when ingesting thin liquids (water-like consistency). Slowly drinking more thick, shake-like consistency liquids may help. Taking small bites of food and chewing extensively before swallowing can help as well. Food thickeners for liquids that often cause you to choke may also help.
In general, bending one’s head forward closes the entrance to the airway and opens the opening to the food pipe “esophagus”. Swallowing in this “chin-tuck” position should favor the passage of food and/or drink without choking. One should avoid eating or drinking while lying down or reclining.
Practitioners in this field of medicine can help identify specific problems, recommend dietary changes, and help with physical therapies and exercises to improve swallowing function.
Heartburn is a burning sensation typically located in the low to mid chest and accompanied by either sour taste in the mouth, regurgitation, or abdominal discomfort. Patients with MS can suffer from heartburn at rates that appear to be comparable to the general population (about 10-15%). Heartburn is classically felt as being worse after meals or while lying flat. Heartburn can arise from anatomical defects or impairment in the neural control of the muscle barrier between the esophagus (“food pipe”) and the stomach. Most of the symptoms of heartburn are due to the presence of acidic material from the stomach refluxing up into the esophagus and irritating the esophageal lining.
What can be done?
There are numerous products available to neutralize acid and provide quick heartburn relief. These include calcium carbonate (TUMS), milk of magnesia/Maalox, and Gaviscon, which are available in pill and/or liquid forms. If these remedies help, then acid reflux is likely and other systemic medications may be necessary.
These medications stop stomach acid from being produced, rather than neutralize existing acid. The most commonly available over-the-counter medications include: ranitidine (Zantac), famotidine (Pepcid), and omeprazole (Prilosec). These medications suppress acid production for most of the day. Omeprazole is best taken 30 minutes prior a meal, and many patients take ranitidine or famotidine at night to prevent nighttime heartburn.
Some foods and habits can predispose to acid reflux, such as smoking cigarettes, consuming alcohol, and eating chocolate, caffeine, or spicy foods. Heartburn also tends to be worse in those that have gained a significant amount of weight.
Other interventions include raising the head of the bed up a few inches (using wood blocks), such that at night, even while lying flat relative to the bed, gravity favors the retention of material in the stomach and minimizes reflux.
For unclear reasons, about 10% of MS patients feel persistently nauseated. It is a symptom that should be mentioned to your doctors, who may consider further testing looking for an underlying cause or a change of medications (nausea is often a side effect of medications). For example, the MS disease modifying agent Tecfidera (dimethyl fumerate) often leads to nausea, particularly when the medication is started. At home, there are a few options for nausea relief.
Concentrated ginger has long been used as a medicinal approach to relieve nausea. Ginger is widely available in an extract (pill or capsule) or as a tea. Some people have relief with peppermint oil extract (pill or capsule) or peppermint sucking candies.
If you have a history of motion sickness, or if vertigo, dizziness/imbalance, or ringing in the ears (“tinnitus”) accompanies your nausea, then nausea may be due to a vestibular (or “inner ear”) problem. In this case, over-the-counter medications that target the inner ear can help relieve nausea (as well as vertigo, imbalance, and tinnitus). These medications include: Dimenhydrinate (Dramamine) and meclizine (Antivert).
Dyspepsia is the collective medical term for upper abdominal pain, bloating, and easy sense of fullness that tend to be worse after eating. Some people also feel nauseated in this context. There are innumerable potential causes of dyspeptic symptoms, and you should notify your doctor if there is a sudden development of these symptoms. It would appear that up to 25-30% of all MS patients suffer from dyspepsia, a rate that is about twice that of the general population. If the symptoms are persistent, then a referral to a gastroenterologist may be warranted to look for structural problems with the stomach (such as an ulcer) or irritation of the stomach lining (gastritis).
Iberogast is a liquid mix of herbal extracts with high-quality medical evidence supporting its use for alleviating many dyspeptic symptoms. It is generally taken in 20 drops mixed in a drink twice or three times daily. It is mostly available via online purchase.
Trial of acid suppression:
In some individuals, dyspeptic symptoms diminish with lower stomach acid levels. Therefore, over-the-counter medications to try include: ranitidine (Zantac), famotidine (Pepcid), and omeprazole (Prilosec).
Avoiding fried, fatty, or spicy foods can improve symptoms. In general, eating smaller, more frequent meals (“grazing” or “snacking”) rather than relying on 3 larger meals per day can improve dyspepsia.
Gastroparesis is a long term condition. It leads to inability of the stomach to empty its contents in the intestines. There is usually no blockage but damage to the vagus nerve. The vagus nerve is one of the most important nerves that regulate the muscles of the stomach and intestines and helps in forward propulsion of food.
When this nerve and other important nerves are damaged the muscles of the stomach and intestines do not work properly and the movement of food is slowed.
There are many symptoms of gastroparesis, including:
Heartburn or GERD
Vomiting undigested food
Feeling full quickly when eating
Poor appetite and weight loss
Poor blood sugar control
What Is the Treatment for Gastroparesis?
Gastroparesis is a chronic (long-lasting) condition. This means that treatment usually doesn’t cure the disease. But there are steps you can take to manage and control the condition.
Some patients may benefit from medications, including:
Reglan (metoclopramide): You take this drug before eating and it causes the stomach muscles to contract and move food along. Reglan also decreases the incidence of vomiting and nausea. Side effects include diarrhea, drowsiness, anxiety, and, rarely, a serious neurological disorder.
Erythromycin: This is an antibiotic that also causes stomach contractions and helps move food out. Side effects include diarrhea and development of resistant bacteria from prolonged exposure to the antibiotic.
Antiemetics: These are drugs that help control nausea.
People who have diabetes should try to control their blood sugar levels to minimize the problems of gastroparesis.
Dietary Modifications for Gastroparesis
One of the best ways to help control the symptoms of gastroparesis is to modify your daily eating habits. For instance, instead of three meals a day, eat six small meals. In this way, there is less food in the stomach; you won’t feel as full, and it will be easier for the food to leave your stomach. Another important factor is the consistency of food; liquids and low residue foods are encouraged (for example, applesauce should replace whole apples with intact skins).
You should also avoid foods that are high in fat (which can slow down digestion) and fiber (which is difficult to digest).
Other Treatment Options for Gastroparesis
In a severe case of gastroparesis, a feeding tube, or jejunostomy tube, may be used. The tube is inserted through the abdomen and into the small intestine during surgery. To feed yourself, put nutrients into the tube, which go directly into the small intestine; this way, they bypass the stomach and get into the bloodstream more quickly.
Using an instrument through a small incision, botulinum toxin (such as Botox) can be injected into the pylorus, the valve that leads from the stomach to the small intestine. This can relax the valve, keeping it open for a longer period of time to allow the stomach to empty.
Another treatment option is intravenous or parenteral nutrition. This is a feeding method in which nutrients go directly into the bloodstream through a catheter placed into a vein in your chest. Parenteral nutrition is intended to be a temporary measure for a severe case of gastroparesis.
Electrical stimulation for Gastroparesis
Electrical gastric stimulation for gastroparesis uses electrodes that are attached to the stomach wall and, when stimulated, trigger stomach contractions. Further studies are needed to help determine who will benefit most from this procedure. Currently, only a few centers across the country perform electrical gastric stimulation.
Please speak with your doctor about any gastric symptoms. Other causes must first be ruled out.