Stomach paralysis

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In the case of gastric paralysis , the mobility of the stomach (gaster, ventriculus) is reduced or, in extreme cases, abolished, leading to gastric emptying disorders. Synonyms in medical terminology are gastric atony ( atony means something like "flaccidity") and gastroparesis ( paresis is incomplete paralysis).

pathology

Stomach paralysis can have various causes. Most often, damage to the autonomic and enteric nervous systems is responsible for gastric paralysis. This is also known as autonomic neuropathy . Both nervous systems are involved in the innervation of the stomach and control both mobility and functional tasks such as gastric acid secretion . These nerves can be damaged, especially in the context of diabetes mellitus (diabetes). Surgical complications and chronic alcohol and nicotine abuse are less common causes .

Gastroparesis can also occur as an accompanying symptom of a migraine attack.

In addition to the nerves, the smooth muscles of the stomach can also be responsible. There are numerous muscle diseases that can lead to gastric paralysis, such as progressive muscular dystrophy .

Symptoms

Stomach paralysis can lead to a wide range of disorders, impairment of quality of life and, rarely, serious complications. The main symptoms are nausea, bloating, loss of appetite, vomiting of undigested food, and weight loss. A common complication is the development of reflux esophagitis , which can cause heartburn, bleeding, and carcinoma.

diagnosis

The diagnosis can be made by determining the gastric emptying time, which is prolonged in gastric paralysis. The gastric emptying time can be determined by 99m Tc-labeled protein particles. Older substances are 13 C octanoic acid or with 13 C sodium acetate. These are rarely used in clinical practice.

therapy

Nutritional advice

The initial treatment is often provided with nutritional advice and changes. The change in diet is intended to alleviate symptoms and ensure an adequate supply of fluids and nutrients. The transition typically involves increasing fluid intake, reducing the fat and fiber content of the food, and splitting up into many small meals.

Medication

The following drugs are commonly used to treat gastroparesis or its symptoms:

  • Prokinetics - These drugs stimulate the peristalsis of the gastrointestinal tract, making the stomach empty more quickly.
  • Antiemetics - These drugs suppress nausea and vomiting but do not affect gastric emptying.

Artificial nutrition

In the form of artificial nutrition , nutrients are supplied in liquid form directly through a tube inserted into the stomach or small intestine. Feeding tubes are usually only used temporarily and only in the case of severe gastroparesis.

Parenteral nutrition

With parenteral nutrition , nutrients are supplied directly into the bloodstream in the form of an intravenously administered solution. Parenteral nutrition is only used if enteral nutrition cannot be tolerated or if sufficient energy can not be supplied in this way .

surgery

Surgical treatment of gastroparesis is only an option as a last resort. In pyloroplasty - one of these possible surgical interventions - the doorman (ie the transition between the stomach and the duodenum) is widened.

Electrical gastrostimulation (gastric pacemaker)

This surgical form of treatment is suitable for patients with gastroparesis-related chronic, drug-refractory (ie not responding to drugs) nausea and vomiting. The gastric pacemaker is implanted under the skin and connected to two electrodes inserted into the muscles of the stomach. It emits weak electrical impulses through the electrodes to stimulate the nerves and smooth muscles of the lower stomach area. This can help suppress gastrointestinal nausea and vomiting.

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  1. ↑ further information

literature