My 17-year-old son recently had a GI endoscopic exam. We were told that he has an unusual, J-shaped stomach with compartments that make it difficult for food to travel through the stomach at a normal rate. Doctors recommended that he be placed on Prilosec and Propulsid. Is it safe to take these two medications on a long-term basis? Also, my son has Type I diabetes and intermittently suffers from depression. Does either of these medications affect diabetes or exacerbate depression?

D.L.

Doctors use the term "J-shaped stomach" to describe an unusually round, sharply curving stomach that is often difficult to navigate with an endoscope. Most people with J-shaped stomachs have no symptoms, and there is no evidence that this type of stomach has any significant effect on digestion.

In your son's case, I'd be interested to know why the endoscopy was done. Did he have symptoms of delayed emptying of the stomach, known as gastroparesis? Such symptoms include bloating, early fullness after eating, nausea/vomiting and reflux/regurgitation. I can imagine that if this diagnosis was being considered, then it would be tempting to blame a J-shaped stomach for the symptoms.

However, gastroparesis is very common as a complication of diabetes. I suspect that if your son has the symptoms mentioned, he may have this condition. This diagnosis is made via a radiologic test in which a special meal is consumed (the food contains a slight amount of radioactive marker), and X-ray pictures are taken of the stomach over the next few hours to see how slowly it empties.

The treatment for gastroparesis usually begins with medications such as cisapride (Propulsid), which works by increasing the rate at which the stomach empties. Some doctors also add omeprazole (Prilosec) or lansoprazole (Prevacid). Although these medications suppress acid production and do not have a specific effect on the stomach muscle, they are often effective in alleviating some of the symptoms of gastroparesis, such as those associated with reflux.

Prilosec and Propulsid are safe when taken together. They are not known to cause problems in diabetics. However, these medications, especially Propulsid, may have significant interactions affecting the heart when used with other medications. For Propulsid, these medications include certain drugs used for depression or psychosis, certain antibiotics or antifungal medications, and certain drugs used for abnormal heart rhythms [Editor's note: Because of such side effects, Propulsid's manufacturer decided to remove the drug from the market in July 2000. For more information, see the article Substitutes for Propulsid?].