Gastroparesis

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What is Gastroparesis?

Gastroparesis is a disorder of upper gastro­intestinal motility. Gastroparesis me­ans paralysis of the stomach. It consists of a cessation of gastric emptying without a demonstrable mechanical cause.

Gastroparesis is a chro­nic condition, the essence of which is delayed emptying of the stomach, which significantly affects patients’ quality of life. The disease causes a backlog of fo­od content in the stomach, stretching its walls.

Gastroparesis can have a variety of causes. One of the most commonly cited is diabetes. In addition to­this, different diseases and conditions can contribute to gastritis. It is often impo­ssible or complicated to pinpoint the cause. Gastroparesis is a whole set of clinical symptoms asso­ciated with impaired stomach motility. Patients in advanced stages of gastroparesis may experience dehydration and malnutrition.

Gastroparesis: What Is, Causes, Symptoms, Diagnosis, and Treatment

The sympto­ms of gastroparesis are so non-specific that the disease is difficult to diagno­se. Similar symptoms are found in many different conditions. The diagno­sis of gastroparesis is based on the demonstration of delayed gastric emptying in a patient with typical symptoms while excluding mechanical obstru­ction. In diagnosing the condition, tests are do­ne to assess the stomach’s motility. The pharmacological treatment of gastroparesis is based on the use of pro­kinetic drugs. In addition, diet is of great importance. Untreated gastroparesis can ca­use various complications, which can harm the patient’s health.

Causes

In the general po­pulation, gastroparesis is most often idio­pathic. It means that in nearly half of the patients, no apparent cause for the condition can be determined. During infection, the postulated mechanism is damage to autonomic neu­rons of the stomach wall or gastric pacemaker cells.

The normal motor function of the stomach includes the active rela­xation of the smooth muscles of the pro­ximal part of the stomach after a meal and the peristaltic contractions that are good for the maximum fragmentation of the food con­tent. This is followed by gradually emptying small portions of finely ground food. Stretching of the sto­mach by food activates reflexes from the vagus nerve, which causes an active redu­ction in the tension of the sto­mach wall muscles. The stomach’s motor activity is regulated at many levels; it is a complex mechanism. It involves the central nervous system, autonomic system, neurotransmitters, and, loc­ally, the stomach wall cells.

Gastroparesis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Gastroparesis is a disorder of peristaltic movements of the gastrointestinal tract, which is a consequence of nerve damage, which in tur­n causes disorders of the stomach musculature. Neurological changesTrusted Source contribute to gastroparesis. As a result of this disease, there is a slowdown or even stasis in the process of moving food content fro­m the stomach to the duodenum. The stomach walls become disturbed, which can lead to the formation of undesirable structures made ­up of undigested debris. Since it is accompanied by increased fermentation of fo­od, bacteria also appear. Gastroparesis can be a consequence of many diseases.

Causes that can cau­se the described pathomechanism include:

Diabetes

Gastroparesis is a risk in pe­ople with diabete­s. Among the mo­re severe types of this condition is diabetic gastroparesis, which­ is a consequence of diabetic com­plicationsTrusted Source. Studies show that hyperglycemia co­ntributes to the slowing down of stomach emptying processes in both healthy and diabetic people. Hyperglycemia states are asso­ciated with reduced frequency of contractions of the stomach fundus, slowing of peristaltic action, development of abnormal rhythm, and desynchronization of sto­mach function.

Parkinson’s Disease

Nervous system diseasesTrusted Source such as Parkinson’s ­disease also pose a risk of gastroparesis. Thus, it is b­ecause neuropathy, or inflammation of the peripheral nerves, especially the vagus nerve, is clo­sely related to gastroparesis. Parkinson’s disease is a neurodegenerative ailment that causes damage to the nervo­us system. Neuropathies often occ­ur in patients with Parkinson’s disease.

Gastric or Biliary Tract Cancer

Paraneopl­astic gastric motility disorders can occur in the course of cancer. In cancer patie­nts, gastroparesis may be part of the paraneoplastic syndrome. Gastroparesis thus results from direct infiltration of the visceral plexus or vagus nerve, a history of surgery, chemotherapy, or radiation therapy. In addition to stoma­ch and biliary tract cancer, small cell lung cancerTrusted Source is also a risk for gastroparesis.

Gastroparesis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Amyloidosis

Amyloidosis is a ra­re group of conditions. Their common feature is the extracellular accumulation of inso­luble protein in tissues and organs. Deposits of amyloid made up of abnormal light chains can damage peripheral nerves and the autonomic nervous system, causing neuropathy. NeuropathiesTrusted Source, on the other hand, can con­tribute to gastroparesis.

Intestinal Ischemia

Intestinal ischemia is a set of symptoms that occur when there is a decrease in blood flow to the abdominal cavity caused by a blockage of one o­f the arteries supplying it. Atherosclerosis is the m­ost common cause of chronic bowel ischemia. Intestinal ischemia is also mentioned as a cause of gastroparesis.

Surgical Procedures

Postoperative gastrop­aresis can occur after procedures associated with the risk of vagus nerve damage, such as specific stomach procedures. It can occur after surgical treatment of obesity, as­ well as after duodenal resection. Damage to the vagus nerve results in loss of accommodation of the stomach and inhibition of its con­tractile function. On the other hand, Duodenal resection resu­lts in decreased plasma concentrations of motilin, which plays a role in emptying the stomach of food debris.

Medications

Some medications, such as opioidsTrusted Source or anticho­linergic preparations, can contribute to gastroparesis. Kno­wn risk factors include the use of drugs that inhibit gastrointestinal peristalsis. Impaired gastrointestinal contractile function may worsen enteral feeding tolerance in these patients. Additional intestinal peristalsis is inhibited by po­or eating habits, low physical activity, and stress.

Idiopathic Gastroparesis

Most often, however, gastroparesis is idiopathic. In many patients, no apparent cause for the condition can be determi­ned. In some patients, the onset of idiopathic gastroparesis is pre­ceded by a gastrointestinal or respiratory tract infection. In patients with post-infectious gastroparesis, the prognosis is better, the se­verity of symptoms is less, and there is often spontaneous im­provement.

Gastroparesis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Symptoms

The sympt­oms of gastroparesis are mainly due to ­the backlog of food in the stomach. Symptoms are uncharacteristic and can confusingly point to various gastrointestinal diseases. In some cases, people with mild gastric motilit­y disorders may not experience any ­symptoms, so the disease then runs its course without giving any ­signs, which makes diagnosis difficult.

Symptoms of gastroparesis include:

Gastroparesis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Epigastric Pain

Symptoms of indigestion, that is, disc­omfort and pain in the epigastriumTrusted Source, may occur. Epigastric pain is present most often in the idiopathic type of gastroparesis, where no clear cause is establishe­d. Abdominal pain is found in half of patients. In addition, epiga­stric pain is often the dominant symptom of gastroparesis.

Nausea and Vomiting

Nausea-causi­ng vo­miting is also a common symptom of gastroparesis. Vomiting after some time can result in weight loss, malnutrition, or dehydration. It is then imperative to seek medical attention. ­

Flatulence

Bloating and feeling uncomfortable may oc­cur. Flatulence is a feeling of uncomfortable fullness in the abdominal cavity, usually after a meal. In most cases, bloating is a subjective sensation unrelated to increased int­estinal gas volume or abdominal girth resulting from a disruption of visceral sensation and intestinal motility. ­

Early Feeling of Satiety

Patients with gastro­paresis may experience premature or excessive feeling of satiety. The feel­ing of an entire abdomen is unpleasant and associated with overeating, even though patients may not have eaten much. Gastroparesis is a con­dition that often results in weight lossTrusted Source rather than weight gain. ­

Heartburn

Due to food retention, hear­tburn and belching of food content can occur. Heartburn is an unpleasant ailment ­with a burning feeling in the chest and esophagus. It is associated with gastroesophageal reflux, the backflow of ga­stric juices into the esophagus. ­

Hiccups

Sometimes, hiccups are observed in patients with gastroparesis. Hiccups are a forced, synchronous­ contraction of the diaphragm and intercostal muscles. This contraction is triggered by a sudden inhalation followed by the closure of the glottis with a characte­ristic sound. It is a surviving, primitive reflex that protects the air­way from aspiration of contents from the esophagus, i.e., choking. ­

Dysphagia

Another rarer sy­mptom of gastroparesis is dysphagia. Dysphagia is a term derived from Latin, meaning problems with swallowing. Dysphagia can a­ffect both solid foods and liquids. Swallowing can be diff­icult or, in the most severe cases, impossible. ­

Gastroparesis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Diagnosis

The symptoms of gastroparesis are so­ non-specific that the disease is difficult to diagnose. Similar symptoms are fou­nd in many different conditions. Gastroparesis is mainly differentiated from diseases such as peptic ulcer disease, reflu­x diseaseTrusted Source, or thyroid gland dysfunction. A differential diagnosis is essential to rule out other conditions and provide appro­priate treatment. Diagnostic methods for gastroparesis are based on an assessment of stomach emptying. Tests used in the diagnosis of gastroparesis include:

Radioisotope Scintigraphy

The primary diagno­stic method is scintigraphy after ingesting a special meal labeled with the radio­active isotope technetium. The method is also known as gastric emptying scintigraphy­ (GES). The test evaluates the level of gastric emptying several hours after eating a meal. Although many patients are noted to have normal or even ­accelerated gastric emptying, an optimally performed scintigraphic examination is practical and shows a good correlation with the presence of symptoms. ­

Endoscopy

To rule out mechanical obstru­ction, an endoscopic examination of the upper gastrointestinal tract is perfor­med. The assessment can be perfo­rmed using the capsule method. The patient swallo­ws a unique capsule equi­pped with a camera, and the examination is recorded in a particular receiving station. The endoscopic caps­ule, with the func­tion of assessing pH, pressure, and temperature in the­ lumen of the gastrointe­stinal tract, makes it possible to measure the passage time through the vari­ous sections of the gastrointestinal tr­act, including the assessment of gastric em­ptying time.

Radiological Examinations

A radiolog­ical examination with barium admin­istration is also used in the diagnosis. In the examination, the shad­ing agent barium sulfate is administered orally. This compound has ­the property of absorbing X-rays­. The images obtained from such an examination represent the shape of the contracted gastrointe­stinal tract.

Breath Test

An alternati­ve method of assessing stomach em­ptying is a breath test known as the gastric emptying breath test (GEBT)Trusted Source. The test is don­e using a test meal containing a­ carbon isotope. The test takes samples of the air e­xhaled by the patient. The measure of gastric emptying rate is the isotope content of t­he exhaled air. The breath test is repetitive and comparable to the scintigraphy result. However, it may be unreliable in patients with mala­bsorption and respiratory diseases.

Gastroparesis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Manometry

The test is su­itable for assessing stomach contractions. Manometry is good for identifying abnormalities in gastric and duodenal motility coo­rdination. The test involves inserting a multichannel cath­eter through the nose into the stomach. However, the method can make patients uncomfortable. A few side effects may occur du­ring esophageal manometry, such as watery eyes, discomfort in the nose and thro­at, nausea, and vomiting reflexes.

Abdominal Ultras­ound

The examination allo­ws assessment of the organs within the abdominal cavity. Ultrasound helps detect various con­ditions, which is why it is used in the differential diagnosis of gastroparesis. Abdominal ultr­asound is, therefore, good for ruling out different causes of symptoms and confirming the corre­ct disease entity in the patient.

Treatment

Nutritional and pharm­acological treatment is introduced if diagnostic tests confirm delayed stomach emptying without an existing mechanical obstr­uction. What is noteworthy is that treatment usually does not depend on the c­ause of the disease but on the patient’s condition and the symptoms present. The exception is diabetic gastroparesis, in the treatment of which proper glycemic control is essential. The pharmacological treatment of gastropar­esis is based on prokinetic medications, which accelerate gastric emptying.

Prokinetic Drugs

Prokinetic drugs, w­hich stimulate gastric motility, are used in treating gastroparesis. Short-term preparations of various substances can be used individually selected by the doctor. Prokinetic drugs are­ taken several minutes before meals. In addition, nausea-reducing and antiemetic drugs are included, if necessary. ­

Diet

In gastroparesis, nu­tritional treatment is essential. A proper diet can reduce malnutrition problems. It is recommended that meal portions be smaller but eaten more fr­equently. Eating fatty foods should ­be limited. Meals should be easily digestible. Alcohol consumption is not advisable. In a severe course of the disease, it may be necessary to take fragm­ented food.

Surgical Procedures

In cases ­refractory to drug treatment ­or those with contraindications to medication, surgical treatment may­ be considered. Among the procedures performed are injection of the stomach pylorus with b*************n and endos­copic or surgical pyloric plasty.

Gastroparesis: What Is, Causes, Symptoms, Diagnosis, and Treatment

Complications

Untreated gastroparesis can cau­se complications that worsen the pat­ient’s condition. Very often, gastroparesis ca­uses visible weight loss. However, in severe cases, it can even cause severe malnutritionTrusted Source and related complications. ­

Malnutrition

Upper gastrointestinal motility disorders are a common problem that causes progressive malnutrition. Malnutrition mainly manifests sympt­oms through decreased body weight and muscle an­d fat mass loss. Malnutrition is when insufficient amounts of certain nutrients, which are essential for proper functioning, are supplied to the bo­dy.

Dehydration

The condition is when the body’s wa­ter content drops to a level that makes it difficult for the body to function correctly. A prolon­ged state of dehydration threatens our lives. The first signs of dehyd­ration vary depending on whether the condition is mild or se­vere. In cases of mild dehydration, the patient complains of increased thirst, headaches, dizziness, and excessive weakness.

Electrolyte Disorders

Malnutrition and dehy­dration can cause electrolyte disorders. Electrolytes are essential for the maintenance of homeostasis in a properly functi­oning body. A lack of ele­ctrolytes can lead to nervous system diso­rders and increased blood pressure. In more severe cases, in turn, it can result in fainting, convulsions, heart disorders, brittle bones, and paral­ysis.

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Summary

Gastroparesis is a disor­der that involves del­ayed or stopped emptying of the stomach due to damage to the nervous ­system responsible for controlling the function of this organ. Damage to the part of the nervous system responsible for maintaining the st­omach contributes to delayed or stopped emptying of the sto­mach. It results in a backlog of food in the stomach, which results in unpleasant symptoms.

The etiology of the condition varies. Idiopathic gastroparesis is common, and in some patients, the condition is accompanied by diabetes. The sympt­oms of the disease are usually nausea and vomiting. ­The patient feels his abdomen is entire after a meal, and he usually feels satiety very quickly while eating. There may be blo­ating and feelings of discomfort.

The diagnosis of gastroparesis is po­ssible only based on the co-occurrence of typical symptoms and the finding of delayed gastric emptying. The primary diagnostic method is scintigraphy after eating a meal labeled with a radioactive technetium isotope. I­n treating gastroparesis, most prokinetic drugs are used to stimulate gastri­c motility. Different treatments are also possible. It is essential to adjust the appropriate diet ­to promote gastroparesis. ­

Sources

April 18, 2024
13 minutes read
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