Free of Pain, Full of Hope: DeAnn’s G-POEM Story

 DeAnn Washington

Food is a major source of joy for DeAnn Washington. Whether it’s cooking a big dinner for her husband and five kids, or larger family outings to the park for summer Sunday baseball games or even special occasions at Brazilian steakhouses, eating together is closely tied to fond memories and time spent with loved ones.

But for years, the food she ate was also a major source of unexplained pain for Washington.

“It was a constant feeling of a big rock just sitting in my stomach,” Washington said. “I would wake up and almost be in tears every morning because whatever I ate the day before that did not digest very well was still with me. It sat like a boulder in my stomach, and I just could not do anything.”

Heat pads would help, but medicine for pain and digestion did not. On the good mornings, Washington would have to drag herself to work and be a parent while dealing with extreme discomfort and low energy. On the bad mornings, she couldn’t get out of bed.

Washington had stomach issues growing up, and as an adult was hospitalized for diverticular disease caused by inflamed and infected pouches that formed on the wall of her large intestine.

“The moment of understanding that something was really wrong was those doctors telling me, at 36, that I had the stomach of a 60-year-old man,” Washington said.

But treating those conditions wasn’t addressing the root cause, and each doctor she went to had no answer for why she felt this way.

Washington spent years finding ways to cope, narrowing her diet down to the bare minimum of shredded chicken and seafood. She started cooking less for holidays like Thanksgiving and Christmas, discouraged by the idea she couldn’t eat what she’d cook.

“Those big family events weren’t fun for me anymore,” Washington said. “I exempted myself from them, otherwise I'd be in a bad mood because I couldn’t eat what I wanted to eat. It was depressing. It was like a downpour to watch everybody have fun but me. And part of that depression was feeling like I couldn’t be the mom or the wife that I want to be because it affects me mentally to have to cook this food and not be able to eat it.”

Ghassan Hammoud, MD
Ghassan Hammoud, MD

Then her primary care doctor referred her to Ghassan Hammoud, MD, a gastroenterologist and the director of advanced therapeutic endoscopy at MU Health Care. In the summer of 2023, Hammoud diagnosed Washington with severe gastroparesis, a condition in which the stomach is paralyzed and struggles to empty food down to the small bowel even though there are no structural blockages.

The cause of gastroparesis is neurological, and can arise because of diabetes, previous abdominal surgery or from unknown causes. The nerves that control the opening between the bottom of the stomach and the small intestine, called the pyloric sphincter, do not properly allow food to pass through the digestive system.

“DeAnn truly was suffering with this disorder for a long time, despite seeing multiple providers in the past,” Hammoud said. “Although the condition can be easily diagnosed, the treatment is challenging. She had gone many years without a clear, satisfying answer, and we were very excited to offer a possible solution.”

Hammoud needed to do some tests to determine if Washington was a candidate for a newer procedure called gastric per-oral endoscopic myotomy, or G-POEM for short. Washington underwent a gastric emptying scan (GES), a test that uses a tiny amount of radiation to give Hammoud a picture of how well her stomach emptied itself. Four hours after eating, Washington’s stomach had emptied less than 30% of her meal: A healthy stomach empties more than 90% in the same time. Her test indicated severe gastroparesis and Hammoud suggested G-POEM.

During this minimally invasive procedure, the endoscopist inserts a small, flexible endoscope into the patient’s mouth and cuts the pyloric sphincter muscle to loosen it and allow food to easily exit the stomach.

Washington was overjoyed to hear she was an ideal candidate for the procedure, amazed and grateful she had an answer to her problem. And Hammoud was able to complete her minimally invasive endoscopic procedure in time for Christmas and her birthday.

“When he offered the surgery, I think I was on cloud nine after that,” Washington said. “My whole spirit actually changed after I met with him because I had something to look forward to finally.”

They talked about the side effects and potential complications together and agreed the endoscopic procedure would give Washington the best chance to improve her quality of life.

“Even though DeAnn had changed her diet, we confirmed her symptoms with a gastric emptying scan, or GES,” Hammoud said. “Her initial GES showed she had a severe form of gastroparesis. I told her she was a good candidate for G-POEM, and she wanted to go into the endoscopy suite that minute.”

Hammoud is one of very few therapeutic endoscopists in mid-Missouri who offers the procedure to his patients with moderate to severe gastroparesis, so he understood DeAnn’s excitement to regain her enjoyment of food. He outlined the steps DeAnn needed to take before G-POEM, including dietary modification, and scheduled her procedure.

“At MU Health Care, we are fortunate to work with a comprehensive team of gastroenterologists, surgeons, interventional radiologists, nutritionists and other experts to offer Missourians therapies that are personalized to their needs,” Hammoud said.

While gastroparesis is not life-threatening, it causes food-related discomfort and can lead to other health issues for people who can’t eat complete diets. Symptoms like bloating, nausea, vomiting or feeling full after eating small meals can all be signs of gastroparesis.

Like other endoscopic procedures, G-POEM is not risk-free, and some people may have their symptoms return if their diet includes high fat and high residue foods. But for doctors like Hammoud, it’s gratifying to offer a procedure for his patients that has a high success rate, improves quality of life and is not a life-long medication.

“I feel it’s important for people to know that there are solutions for what you’re experiencing,” Hammoud said. “If you have any of these symptoms, talk to your primary care physician about seeing a gastroenterologist, or call a clinic like our Digestive Health Center to schedule an evaluation.”

Like other G-POEM patients at MU Health Care, Washington’s was done under general anesthesia. She recovered at University Hospital, eating a clear liquid diet and then a mechanical soft diet to promote healing.

“A few days after my procedure, I got to have lean steak in the hospital, and a little bit of salad, and I was able to eat a burger,” Washington said. “Those were the three things I missed the most. And the salad was the scariest, because the fiber used to cause me the most pain. But after a few bites I called my mom, I was that excited.”

Follow-up scans confirmed Washington’s feeling: Three months after her G-POEM, a GES showed Washington’s stomach was emptying 90% of its contents after two hours.

When her birthday came around a few weeks later, the Washingtons celebrated at a Brazilian steakhouse. DeAnn had her appetite ready, sampling everything the waiters would bring by their table. And although there are some foods she eats selectively or not at all — popcorn and vegetables high in fiber are the main ones — Washington has never felt better.

“It was such a relief to finally get to a doctor who didn’t think I was crazy, because that’s how you feel when so many doctors don’t have an answer,” Washington said. “Dr. Hammoud is so great, he’s positive and confident. I was almost in tears to hear him say I was a candidate. That was the aha moment, and I thought, ‘I’m finally going to feel better. I’m going to be able to eat again.’”

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