Gastroparesis

With a stomach paralysis gastric motility ( Gaster, ventriculus) is repealed or diminished so that there is a gastric emptying disorder. The stomach paralysis in medical terminology as gastroparesis or gastric atony ( atonia: from Greek -energized ) referred to as the paralysis paresis (from Greek sagging ).

Pathology

A paralysis of the stomach can have various causes. The most common damage to the autonomic and enteric nervous system for a stomach paralysis is responsible. This is also referred to as an autonomous neuropathy. Both nervous systems are involved in the innervation of the stomach and control both the mobility and the functional tasks, such as the secretion of gastric acid. To damage to these nerves can occur, especially in the context of diabetes mellitus ( sugar diabetes ). Less common causes include surgical complications as well as chronic alcohol and nicotine abuse.

Also, gastroparesis can occur as an accompanying symptom of a migraine attack.

Adjacent to the nerve and the smooth muscle of the stomach may also be responsible. There are numerous muscle diseases that can lead to stomach paralysis, such as progressive muscular dystrophy.

Symptoms

As a result of stomach paralysis can lead to various disorders, impairment of quality of life and rarely come to serious complications. The main symptoms are nausea, bloating, loss of appetite, vomiting of undigested food components and weight loss. A common complication is the development of reflux oesophagitis, which can cause heartburn, bleeding and carcinomas.

Diagnosis

The diagnosis can be made by determining the gastric emptying time is prolonged in a gastric paralysis. The gastric emptying time can be determined with 13C - octanoic acid or 13C - sodium acetate.

Therapy

Nutrition counseling

The initial treatment is often done through nutrition counseling and nutrition. Due to the change in diet, the symptoms are alleviated and an adequate supply of fluid and nutrients to be ensured. The conversion typically includes an increased fluid intake, a reduction in fat and fiber content of the food and the sharing of many small meals.

Drugs

For the treatment of gastroparesis and its symptoms usually the following drugs are used:

  • Prokinetic agents - These drugs stimulate the peristalsis of the gastrointestinal tract and thereby cause the stomach empties faster.
  • Antiemetics - These drugs suppress nausea and vomiting, but have no effect on gastric emptying.

Artificial nutrition

In the treatment form of artificial nutrition, the supply of nutrients in liquid form directly by an introduced into the stomach or into the small intestine probe. Feeding tubes are usually used only temporarily and only when strongly pronounced gastroparesis.

Parenteral Nutrition

In parenteral nutrition, the supply of nutrients takes place in the form of an intravenous solution administered directly into the bloodstream. Parenteral nutrition is only applied when enteral nutrition is not tolerated or enough calories can not be supplied in this way.

Operation

Surgical treatment of gastroparesis comes only as a last resort in question. When pyloroplasty - one of these possible surgical interventions - the gatekeeper ( ie the transition between the stomach and duodenum) is expanded.

Electrical gastric stimulation (stomach pacemaker )

This form of surgical treatment is suitable for patients with chronic gastroparesis, drug-refractory (ie, not on medication appealing ) nausea and vomiting. The gastric pacemaker is implanted under the skin and connected to two inserted into the muscles of the stomach electrodes. It is over the electrode from weak electrical pulses to stimulate the nerves and smooth muscle of the lower stomach area. This can help to suppress the gastroparesebedingte nausea and vomiting.

Swell

  • K. Poeck, W. Hacke: Neurology. Springer - Verlag 2006, 12th edition. ISBN 3-540-29997-1
  • Classen, Diehl, Kochsiek: Internal Medicine. 5th edition. Urban & Fischer Verlag, Munich, 2006. ISBN 3-437-44405-0
  • New treatment of gastroparesis ( Aerzteblatt 97 ) (PDF, 94 kB)
  • Medtronic, Inc. ( manufacturer of the stomach pacemaker )
  • Disease in gastroenterology
  • Disease in neurology
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