Gastroparesis

Generality

Gastroparesis is a chronic medical condition, which consists of partial paralysis of the stomach.

Its onset involves the prolonged permanence, at the gastric level, of the ingested food; therefore, the digestive process, in the carriers, is decidedly slowed down.

The state of gastroparesis is usually a damage to the vagus nerve. This nervous structure, in fact, plays a fundamental role in regulating the passage of food from the stomach to the intestine.

The typical symptoms of gastroparesis are: nausea, vomiting, immediate satiety and loss of appetite.

Unfortunately, at the present time, patients can only rely on symptomatic therapy, as there is no specific treatment.

Brief anatomical reference to the stomach

The stomach is the organ of the digestive system within which ingested food is collected and within which the digestion of proteins takes place.

Resides between the esophagus and small intestine (or small intestine): to separate it from the first, is a valve called cardias ; while, to separate it from the second, it is a valve known as the pyloric sphincter . Cardias and pyloric sphincters regulate the passage of food (called more properly bolus) between the compartments that separate, therefore: esophagus-stomach and stomach-small intestine.

From the nervous point of view, it is the muscular contractions induced by the vagus nerve that determine the passage of food (called more properly bolus ) from the stomach to the small intestine.

What is gastroparesis?

Gastroparesis is the medical term for partial paralysis of the stomach; the result is a prolonged stay, at the gastric level, of the ingested food.

In other words, the stomach of people suffering from gastroparesis does not become empty at the same speed as healthy people, but it does it more slowly.

ORIGIN OF THE TERM

The word gastroparesis derives from the union of the terms "gastro" and "paresi".

"Gastro" is a prefix that refers to everything related to the stomach. Many other medical terms contain the "gastro" prefix: think, for example, of gastritis (ie inflammation of the stomach) or gastroscopy (ie the diagnostic procedure for stomach analysis).

"Paresi", on the other hand, means partial paralysis and indicates that only a part of a muscular district has lost its motility.

SYNONYM OF GASTROPARESI

A synonym, little used, of gastroparesis is delayed gastric emptying .

Causes

According to numerous medical studies, at the origin of most cases of gastroparesis there would be damage to the vagus nerve . As stated, the vagus nerve is the nerve structure that, by inducing the contraction of the muscular wall of the stomach, regulates the transit of food from the gastric compartment to the intestine.

A reduced percentage of patients with gastroparesis does not present any alteration on the nervous level: in these situations, the doctors speak of idiopathic gastroparesis .

Note: the vagus nerve also covers other important functions. For example, it stimulates the secretion of bile and slows down the heartbeat as needed.

WHAT CAN DAMAGE THE VAGUE NERVOUS?

Several conditions, morbid and otherwise, also include damage to the vagus nerve among their various complications.

Among these conditions, they deserve a quote:

Type 1 and type 2 diabetes mellitus .
Diabetes mellitus is a metabolic disease caused by a defect in the secretion and / or action of insulin, a hormone essential for the passage of glucose from the blood to the cells. Following failure of insulin secretion and / or malfunction, blood glucose levels (blood glucose) increase, which leads to the onset of a condition known as hyperglycemia. In the long run, hyperglycemia causes the deterioration of blood vessels that supply oxygen and nutrients to certain nerve structures, including nerves such as the vagus. Without oxygen and nutrients, any nerve, tissue or organ in the body undergoes a process of death, more properly referred to as necrosis.
The entire process described above, which culminates in the necrosis of some nerves, is called diabetic neuropathy: "neuropathy" indicates the damage / malfunction of the nerves; while "diabetic" refers to the fact that neuropathy has, as a trigger, diabetes.
Diabetes mellitus is the most common cause of gastroparesis.
Parkinson's disease .
It is a progressive neurological disease that begins with the slow degeneration of neurons in the substantia nigra . The substantia nigra (or Sommering black substance) is an area of the central nervous system, located between the midbrain and the diencephalon, responsible for the production of dopamine. Dopamine is a fundamental transmitter for the harmonic and fast execution of movements.
In people with Parkinson's disease, the degeneration of the cells of the substantia nigra coincides with the reduced presence, in circulation, of dopamine. The reduced production of dopamine entails, first, motor type deficits and, subsequently, other neurological problems, such as the deterioration of the vagus nerve.
Scleroderma .
It is a chronic inflammatory disease of the connective tissue, which mainly affects the skin, but can also extend to the blood vessels, to some internal organs (heart, lungs etc.) and to the nervous system (nerves in particular).
Anorexia nervosa and bulimia nervosa .
They are two eating disorders, resulting from the fear of getting fat.
Self-induced vomiting, which is a typical reaction of people suffering from these disorders, increases vagus nerve activity beyond the limit and this causes it to deteriorate.
Amyloidosis .
It is the medical term for a group of diseases characterized by the accumulation, often in the extracellular area, of the so-called amyloid fibrils. Insoluble, amyloid fibrils compromise the functionality of various tissues and organs of the body, including nerve structures.
Bariatric surgery or gastrectomy operation .
Bariatric surgery is a therapeutic option for people suffering from severe obesity, as they are procedures that promote weight loss.
The gastrectomy operation, instead, is the surgical treatment of total or partial removal of the stomach, reserved for people with a tumor in this fundamental organ of the digestive system.
The administration of opioid drugs and some antidepressants .
Opioid (or opiate) drugs are among the most powerful pain medications (painkillers). They are morphine derivatives, therefore their prolonged use can determine, among the various side effects, a form of dependence.
Antidepressants, on the other hand, are drugs generally used in the case of depression (although, sometimes, they are also useful against some forms of pain).

IDIOPATHIC GATROPARES

In medicine, the idiopathic term associated with a pathology indicates that the latter has made its appearance without obvious and demonstrable reasons.

Symptoms and Complications

The symptoms and signs that characterize the gastroparesis are:

Sense of immediate satiety, even after small meals
Nausea and vomit
Loss of appetite
Weight loss
Sense of stomach swelling
Abdominal pain and discomfort
Stomach ache.

The intensity of the symptoms varies from patient to patient. In fact, some individuals with gastroparesis complain of unbearable disorders, while others experience decidedly less acute discomforts and with which they manage to live together.

Furthermore, it is quite frequent that the aforementioned events are inconstant, that is, they are present at certain times of the day and absent in others.

COMPLICATIONS

In the absence of any treatment and in more serious patients, gastroparesis can lead to the appearance of various complications, some of which are also very dangerous.

Possible complications include:

Dehydration . It is due to continuous episodes of vomiting.
Gastroesophageal reflux disease . It is when the acidic contents of the stomach rise chronically into the esophagus and damages it progressively.
Malnutrition . It is a consequence of poor appetite, repeated vomiting, feeling full even after small meals and frequent heartburn.
Abnormal fluctuations in blood glucose levels . They are the result of slowing down digestion. They represent an important danger for people with diabetes.
Fatigue and weight loss
Intestinal obstruction . It is a very dangerous condition that requires immediate medical intervention.
Bacterial type infections . They are consequent to the long permanence of the food inside the stomach.

Diagnosis

The diagnostic procedure for the detection of gastroparesis and its triggering causes generally begins with a thorough physical examination combined with the evaluation of clinical history (NB: they are often held on the same occasion, one after the other).

Then, he continues with blood tests and ends with a series of instrumental tests, such as:

Radiography of the digestive system .
Through an X-ray instrument, the doctor observes the progression, along the digestive tract, of a radiopaque contrast agent (usually barium sulfate), previously ingested by the patient.
Gastrointestinal scintigraphy .
It involves measuring how much radioactive tracer previously taken with food or a drink remains in the stomach. For the vision of the radioactive tracer, a special detection instrument called gamma-camera is required.
The wireless capsule tests .
It involves the ingestion by the patient of an electronic instrument that records the speed with which the food passes into the digestive system.
Endoscopy of the digestive system .
It consists of inserting an endoscope along the digestive system, that is a probe equipped with a camera and connected to an external monitor.

EXAMINATION OBJECTIVE AND CLINICAL HISTORY

A thorough physical examination requires the doctor to visit the patient and ask about the symptomatology. In general, the questions focus on the present clinical signs, when the latter appeared, if and when there are deteriorations in the symptom picture, etc.

At the end of this important questionnaire, the evaluation of the clinical history begins. This consists of a conversation between doctor and patient, during which the first asks the second:

If you suffer from particular diseases.
If you take certain drugs.
If you have had surgery in the past on the digestive tract, especially the stomach.
Etc.

The aforementioned questions and the previous physical examination can provide the doctor with very important diagnostic information, so much so that, sometimes, the instrumental examinations serve only as confirmation.

Treatment

Unfortunately, at present, patients with gastroparesis cannot rely on any specific therapy, but only on symptomatic treatments . Symptomatic treatments are those treatments that improve symptoms and signs and try to prevent (or delay) the most serious complications.

Entering specifically, among the treatments aimed at improving the symptomatology, there are:

Adoption of dietary ad hoc behavior . Doctors recommend soft or liquid foods, small but frequent meals, careful chewing, giving up carbonated drinks and, finally, giving up hard-to-digest foods.
The administration of certain drugs, including domperidone, erythromycin and antiemetics . The first two favor the movement of food inside the digestive system, while the third serve to control nausea.
Unfortunately, taking these drugs is often linked to the appearance of several side effects.
Gastric electrical stimulation (GES) . It consists in stimulating, through a special tool, the stomach muscles that regulate the passage of food from the gastric compartment to the intestine. Doctors generally use them when dietary remedies and drugs have not produced the desired results.
Artificial nutrition . Doctors can adopt various methods of artificial nutrition: the one using a nose-jejunal tube, jejunostomy and so-called parenteral nutrition.
Gastroenterostomy or gastrodigiunostomy surgery . They are two rather invasive surgical procedures, which doctors only resort to in extreme cases.