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Gastroparesis is a disorder of the digestive tract. As a result of autonomic neuropathy, gastric emptying is delayed despite the absence of a mechanical obstruction. It is often a complication of diabetes. How is it manifested? How is the treatment going?

Contents:

  1. Gastropareza: symptoms
  2. Gastropareza: research
  3. Gastropareza: differential diagnosis
  4. Gastropareza: treatment

Gastroparesisor disturbance of the perist altic movements of the gastrointestinal tract occurs as a result of nerve damage, which causes abnormalities in the work of the gastric muscles. There is a slowdown or stoppage of food from the stomach to the duodenum. The stomach walls stretch and bezoars, which are abnormal structures made of undigested debris, can form. As a result of the increased fermentation of food, excessive growth of bacteria occurs. Reasons for the occurrence of gastroparesis:

  • idiopathic
  • infections - CMV, EBV and HHV-3 viruses (VZV - varicella zoster virus)
  • diabetes
  • surgery
  • drugs (e.g. opioids, anticholinergics and GLP 1 analogues)
  • Parkinson's disease
  • systemic scleroderma
  • systemic lupus erythematosus
  • paraneoplastic syndromes
  • amyloidosis
  • systemic mastocytosis
  • intestinal ischemia

Gastropareza: symptoms

  • nausea and vomiting with undigested food
  • epigastric fullness after a meal
  • early satiety
  • epigastric pain or discomfort
  • flatulence
  • gastroesophageal reflux
  • heartburn
  • unbalanced blood sugar

In severe cases, we can even observe weight loss, malnutrition, dehydration and dyselectrolithemia.

Symptoms are similar regardless of etiology. It should also be remembered that the clinical picture often does not correlate with the degree of impairment in gastric emptying shown in the studies.

Gastropareza: research

Assessment methods for gastric emptying:

  • the basic method is scintigraphy with a standardized meal labeled with radioactive technetium
  • wireless capsule with pH evaluation function insurrounding environment (the so-called wireless motility capsule - WMC)
  • breath test with the assessment of the concentration of 13CO2in the exhaled air after consumption of food labeled with this isotope

Depending on the clinical situation, the following may be helpful:

  • endoscopy
  • radiological examinations
  • and / or manometry

Diagnostics for diabetes and hypothyroidism should be performed in every patient suspected of having gastroparesis.

Gastropareza: differential diagnosis

Diseases with similar symptoms should be ruled out, they include:

  • peptic ulcer disease and gastroduodenitis
  • duodenogastric reflux
  • regurgitations occurring in the course of various diseases, incl. in chewing syndrome, gastro-oesophageal reflux disease
  • functional dyspepsia
  • anorexia nervosa and bulimia
  • cyclic vomiting syndrome
  • hypothyroidism
  • chronic cannabinoid use

Gastropareza: treatment

  • Nutritional treatment - aims to replenish fluid, electrolyte and caloric deficiencies

Oral nutrition is the best route. Patients should be instructed to eat frequently (4-5 times a day) small portions of foods low in fat and soluble fiber. In case of problems, meals can be crushed, e.g. mixed. Smoking and alcohol are contraindicated as they slow down gastric emptying. Carbonated drinks can make symptoms worse. Sometimes, in severe cases, enteral nutrition or parenteral nutrition is necessary.

  • Pharmacological treatment - supplements dietary treatment

Prokinetic drugs: a. Metoclopramide is the first line treatment, due to serious side effects (acute dystonias and tardive dyskinesias), the lowest possible dose should be administered b. Domperidone - EKG should be taken before starting therapy and monitored during treatment; for cQT prolongation>470 ms in men and>450 ms in women, treatment should be discontinued. Erythromycin - especially in patients requiring intravenous administration of drugs Symptomatic drugs: antiemetic and tricyclic antidepressants

  • Other treatments

- electrical stimulation of the stomach - injection of botulinum toxin into the pylorus - balloon dilation of the pylorus - endoscopic pyloromyotomy - surgical pyloroplasty - acupuncture

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Category:

Gastrology