Gastroparesis

Violation of the muscular activity of the stomach, which results in a failure in the evacuation function of the stomach, is called gastroparesis. The absence of contractions of the stomach muscles leads to a delay in food in the body, its rotting, the formation of pathogenic flora. All this causes pain in the epigastric region, various disorders in the digestive system. Why does such a state occur?

[1], [2], [3]

Epidemiology

The exact prevalence of the disease is difficult to determine. At the stage of primary care, it is difficult to relate gastric malaises to the rate of emptying the organ. But still there is averaged data that 4% of the world's population suffer from this pathology. According to statistics, women are more likely than men to be ill. In one study, their number was 87% of all observed patients.

[4], [5], [6], [7]

Causes of the gastroparesis

The main causes of gastroparesis are:

• diabetes mellitus;
• diseases of the nervous system ( Parkinson's disease, stroke );
• pancreatitis;
• exposure to drugs;
• chemotherapy and radiation;
• lack of microelements;
• damage to the vagus nerve during surgery.

[8], [9], [10]

Risk factors

Factors that complicate the natural passage of food from the stomach into the duodenum include:

• infection;
• significant weight loss, anorexia;
• binge eating attacks, in which a lot of food is absorbed, and then vomiting is called to get rid of it (bulimia);
• formation of scar tissue inside the organ;
• hypothyroidism of the thyroid gland.

[11], [12], [13]

Pathogenesis

Emptying the stomach is a combination of parallel actions of the tone of the fundus, phase contractions of the antral part of the organ, simultaneous inhibition of contractions of the duodenal and pyloric. Their interaction is carried out by the nervous system and specialized cells. The pathogenesis of gastroparesis is the violation of the links in this chain. The muscles of the stomach become paralyzed and can not cope with the task of mixing food with gastric juice, enzymes of the pancreas, transporting it to the following parts of the digestive system. This leads to poor digestion of nutrients, stagnation within the body.

[14], [15], [16], [17], [18], [19], [20]

Symptoms of the gastroparesis

Paresis of the stomach is manifested by the following symptoms:

• flatulence;
• nausea and vomiting;
• decreased appetite and weight loss;
• eructation;
• heartburn;
• frequent hiccough;
• instability of sugar in the blood.

The first signs consist in unclear stomach sensations during or after a meal. Immediately after the first sips, there comes a feeling of fullness of the stomach.

[21], [22]

Stages

Depending on the severity of the manifestations of the disease, gastroparesis is divided into 3 stages. At the initial stage of the disease, episodic manifestations of pathology occur in the form of rapid supersaturation, short-term pain, nausea. Symptoms are easily amenable to elimination. At the second stage they are more pronounced, partially controlled by drugs, lifestyle and diet. At this time paralysis of the muscles of the stomach is formed, the peristalsis gradually slows down. At a later third gastroparesis gets a chronic course with persistent symptoms of flatulence, nausea, vomiting, weight loss. In the body, food stagnation forms, and putrefactive processes develop.

[23],

Forms

Among the existing types of gastroparesis, there are 3 main etiological:

• Diabetic - is provoked by diabetes (about 30% of all cases). Develops quite a long time against the background of progressive diabetes. It is accompanied by a constant acidic eructation, heaviness in the epigastric region, unstable blood sugar levels. Moreover, in the course of illness the boundary between cause and effect is blurred, one aggravates another;
• idiopathic - occurring without any apparent cause, its origin is unknown (36%);
• postoperative paresis of the stomach - occurs after surgery on the abdominal organs (13%). As a rule, paresis of the intestine is connected to it . These are the most common postoperative complications. The explanation is that the walls of the stomach and intestines have many receptors and during operations because of their trauma the tone of the sympathetic nervous system rises, the catecholomines are released into the blood. Paresis of the abdominal organs is considered a protective reaction of the body to injuries and surgical intervention.

[24]

Complications and consequences

Consequences and complications of gastroparesis are manifested in chronic inflammatory processes, stenoses. The most dangerous consequence for diabetics is hypoglycemia, which threatens human health with coma and even death. This happens due to the fact that not all food consumed is processed in the stomach, and insulin is calculated taking into account all its volume.

[25], [26], [27]

Diagnostics of the gastroparesis

Diagnosis of gastroparesis is based on the history of the disease, the results of the examination, tests, in particular blood tests for sugar in the blood. But the most informative for suspicion of gastroparesis is instrumental diagnosis.

Instrumental diagnostics consists of such studies:

• Ultrasound of the stomach - gives an opportunity to examine the contours of the stomach on the screen;
• Radiography - with the help of contrast agent shows the state of the esophagus, stomach and 12-intestine;
• gastric manometry - measures pressure in different parts of the gastrointestinal tract;
• endoscopy of the stomach - an optical method for determining the condition of the organ from the inside;
• electrogastroenterography - determines the motor-evacuation function of the stomach by recording the biopotentials of different departments;
• respiratory gastric emptying test.

Differential diagnosis

Differential diagnosis excludes obstruction of the gastrointestinal tract - obstruction caused by various internal or external tumors, strictures; peptic ulcer; stenosis of the antrum of the stomach, duodenum, pylorus.

Treatment of the gastroparesis

Treatment of gastric paresis depends on the patient's condition and ranges from a special diet and diet regime to surgical treatment.

Food should include a minimum of fat and fiber, portions are not abundant, but the eating habits are frequent. Essential to the body, but heavy for digestion in crushed, liquid form. Also used drugs that increase the contractile activity of the stomach. For diabetics it is important to maintain the level of sugar at the desired level. In special cases resort to parenteral or intravenous nutrition, but this is a temporary measure.

Medications

The drugs used for paresis of the stomach include:

Cerucal - tablets, solution for injections. Has anti-nausea and antiemetic effect, normalizes the muscle tone of the gastrointestinal tract. Tablets take half an hour before meals. The dose for children after 3 years is determined from the calculation of 0.1 mg per kilogram of body weight, older than this age - 10ml four times a day. Solutions are administered in the form of short-term infusions or long-term intravenously. To prepare the injection, alkaline solutions are not used. The drug is contraindicated in pregnancy, during lactation, children under 3 years. It is not prescribed for intestinal obstruction, bronchial asthma, gastrointestinal bleeding, hypersensitivity to sulfites. Tserukal can cause side effects: headache, tachycardia, stool, tinnitus.

Domperidone - is available in tablets, granules, suspensions, solutions, candles. Eliminates nausea, hiccups, regulates the motor activity of the stomach. The dose for children weighing 20-30 kg is half the tablets twice a day, with a larger mass - one tablet. Suspension and 1% solution - a more convenient form of the drug for young children. The dose for the suspension: 2.5ml per 10kg of the child's weight; solution: 1 drop per kilogram three times a day. Adults appoint 10 mg (1 piece) 3-4 times, with strong vomiting, an increase of up to 20 mg with the same periodicity is possible. The drug can provoke an allergic reaction, dry mouth, diarrhea. Contraindicated in patients with perforation of the stomach, intestinal obstruction, allergy to components, pregnant, lactating mothers, children weighing up to 20 kg.

Erythromycin - tablets, antibiotic, accelerates the evacuation of food from the stomach. For children under 14 years, the daily dose is 20-40 mg / kg, divided into 4 receptions. After this age, 0.25 mg is taken every 4 to 6 hours for 1-1.5 hours before meals. Do not prescribe with hypersensitivity to the drug, severe violations of the liver. Side effects are observed rarely as nausea, vomiting, diarrhea.

Metoclopramide is produced in tablets and ampoules, speeds up the digestion of food, eliminates nausea, hiccups, and the urge to vomit. Dose for adults - a tablet before meals three times a day, in severe cases, inject one ampoule intramuscularly or intravenously. Children from 6 years of age are prescribed a pill or tablet. The drug may cause drowsiness, rarely tremor and impaired coordination of motion. Not recommended when driving a car.

Vitamins

To maintain the muscle tone of the stomach, vitamins of the B group are necessary. Nuts, cereals, cereals, cabbage, beans (B1), wheat bread, tomatoes, meat, milk (B2), asparagus, green peas, kidneys, liver, garlic must be included in the diet (B3), poultry, meat, pepper, potatoes (B6), lettuce, beets, bananas, avocado (B9), soybeans, sea kale, heart (B12). Carotenes and vitamin A contribute to the production of glycoproteins, which protect the gastric mucosa from the aggressive action of hydrochloric acid. They are in food such as liver, eggs, butter, fish, fish oil.

Physiotherapeutic treatment

Developed physical exercises during and after meals that promote the removal of food from the stomach. These are the inclinations back and forth, alternating retraction and inflation of the abdomen. Accelerate the process of digesting food walking and walking leisurely. Physiotherapeutic treatment includes electrostimulation, when impulse currents affect the muscles and nerves of the organ. This procedure increases blood circulation, metabolism, contractile function of the muscles of the stomach.

Alternative treatment

For the treatment of gastroparesis, those alternative recipes are used that help in digestion of food, improve digestion. Promotes its absorption of simple water with lemon juice, soaking before eating. It is recommended that food intake be preceded by a decoction of corn stigmas. Stimulates the motility of the gastrointestinal tract and bee colonies. They are bees seal honeycomb with honey. It is a mixture of bee saliva, wax, perga, pollen, propolis. To get the healing effect, you just chew it.

Treatment with herbs will help to reduce the feeling of heaviness in the stomach (coriander, dill, chamomile), flatulence (fennel, cumin, anise), improve digestion (dandelion, buckthorn, artichoke leaves, oregano, gold ore). Do not resort to the means that have a sedative effect: valerian, mint, motherwort.

[28], [29], [30]

Homeopathy

The drugs that normalize the stomach tone and eliminate the symptoms associated with this include:

Iberogast is a multi-component herbal preparation in the form of drops. The recommended dose is 20 drops for a small amount of water before or after meals three times a day. The course of treatment is a month. It is not assigned until 18 years, because children did not undergo clinical studies, pregnant women, during lactation, with a diagnosis of calculous cholecystitis. Side effects are manifested as allergies, shortness of breath, nausea. In this case, you should cancel the treatment.

Hepazine - oral drops, supporting the drug for diabetics, reducing nausea, overfilling the stomach, flatulence, belching. Applied to children after 11 years in a dose of 15 drops, drenched in a small amount of water 3 times a day, for adults - 30 drops. Duration of treatment 2 weeks. Contraindicated in hypersensitivity to components.

The sodium phosphoricum salt of Dr. Schuessler No. 9 - tablets, promotes the digestion of fatty foods, reduces flatulence. For all ages, the dose applied is 1 tablet, but with different frequency of reception: children under 5 years of age per day, 6-11 years - 2 times, over 12 years - 3 times (chronic condition). In acute manifestations, the frequency increases. Side effects are associated with the presence of wheat starch and occur in people with allergies to cereals.

Amarin - drops for ingestion, are used for violations of the contractile activity of the stomach. We admit for admission from 11 years. Recommended for 10 drops three times a day for children, the maximum dose, if necessary, can be increased to 30 drops. The adult dose is 10-20 drops, maximum 60. Contraindicated in children under 11 years of age, people with high acidity of the stomach, hypertension, peptic ulcer of the gastrointestinal tract.

Surgery

Surgical treatment is used in case of severe conditions of patients and is to expand the passage between the stomach and duodenum. Such a method promotes faster gastric emptying and improvement of the general condition. Another method is to place the food tube in the small intestine. Nutrients are fed through the stomach to bypass the stomach. It is also possible to implant the electrostimulator of the stomach, the electrodes are connected to the organ, stimulating the contractions.

Prevention

Preventive measures include monitoring the level of sugar in patients with diabetes mellitus and mandatory familiarization with the instructions of the medication taken, as well. Anesthetics, calcium channel blockers, individual antidepressants provoke the development of gastroparesis. The main preventive measures should be aimed at preventing the occurrence of a cause that led to a decrease in gastric motility.

[31], [32], [33]

Forecast

If the cause that led to the disease is reversible, then the prognosis is favorable. Diabetic gastroparesis while maintaining the sugar at a normal level and renewing the functions of the vagus nerve is also reversible. In other cases, pathology is not cured, but only gets worse with time.