How the stomach works and what is disrupted
Normally, the stomach accepts food, relaxes, then grinds it with rhythmic contractions and pushes it in portions into the duodenum. This is controlled by pacemakers in the stomach wall, smooth muscles and the vagus nerve. With gastroparesis, consistency is disrupted: contractions of the antrum weaken, the pylorus spasms, and the stomach stops relaxing under a portion of food. Food stagnates, sometimes forming dense lumps. The walls are stretched, and the brain perceives this stretching as nausea and fullness.
- Weakening contractions of the gastric outlet
- Damage to the vagus nerve
- Disruption of pacemaker cells
- Pyloric spasm
- Food retention and formation of dense lumps
Reasons
In about a third of patients, the cause cannot be found - this type of gastroparesis is called idiopathic, and it is more common in women, sometimes starting after a viral infection. The second major group is diabetes mellitus: long-term elevated glucose damages nerve fibers. Another reason is surgery on the stomach and esophagus with damage to the vagus nerve. Medicines that can slow down bowel movements include opioid painkillers, some diabetes medications, antidepressants, and anticholinergic medications.
- Idiopathic gastroparesis, including after infection
- Diabetes mellitus with long-term decompensation
- Operations on the stomach and esophagus
- Parkinson's disease and other neurological diseases
- Opioid analgesics and anticholinergics
- Hypothyroidism and systemic connective tissue diseases
Symptoms
The most typical complaints are rapid satiety after just a few spoons, heaviness and fullness after eating, nausea and vomiting. Distinctive detail: vomit may contain food eaten many hours ago, almost unchanged. I am concerned about bloating, belching, and sometimes pain in the upper abdomen. In patients with diabetes, sugar becomes unpredictable: insulin acts before food is absorbed. Due to dietary restrictions, weight loss and vitamin deficiency develop.
- Early satiation with small portions
- Heaviness and fullness after eating
- Nausea and vomiting of undigested food
- Bloating and belching
- Weight loss and nutritional deficiencies
- Unpredictable glucose fluctuations in diabetes
Diagnostics
First, a mechanical obstacle is excluded: endoscopy allows you to see an ulcer, cicatricial narrowing or tumor of the gastric outlet. An indirect but indicative sign is the remains of food in the stomach on an empty stomach with proper preparation. Gastric emptying is assessed by scintigraphy with a standard breakfast, where available, or by fluoroscopy with contrast and ultrasound techniques. Be sure to check glycated hemoglobin, thyroid function and electrolytes, and also review the list of medications taken.
- Endoscopy of the stomach to exclude obstruction
- X-ray of the stomach with contrast
- Ultrasound of the stomach and abdominal cavity
- Gastric emptying study when available
- Glycated hemoglobin, TSH, electrolytes
- Review of medications taken
Nutrition and treatment
Nutrition is the basis of help. Eat often and in small portions, 5-6 times a day, limiting fat and coarse fiber, which delay bowel movements. Food is crushed, preference is given to soft and liquid dishes, soups, purees, and liquids are drunk in small sips throughout the day. After eating, it is useful not to lie down, but to sit or walk quietly. Among the medications, the doctor may prescribe prokinetics that improve motor skills and antiemetics; In diabetes, normalizing glucose is key. In severe cases, the introduction of botulinum toxin into the pylorus, the installation of a probe or a feeding stoma are discussed. The doctor selects the treatment.
- 5–6 small meals a day
- Limiting fatty and fiber-rich foods
- Soft, crushed and liquid food
- Stay up after eating, take a light walk
- Prokinetics and antiemetics as prescribed by a doctor
- Strict glucose control in diabetes
- Quitting smoking and alcohol