The famous Mayo Clinic has good pages on this subject at http://www.mayoclinic.com/health/gastroparesis/DS00612
I looked up ‘weak stomach’ at Google, and found the word ‘Gastroparesis’, and a very informative site on gasterointenstinal physiology. This article is a result of my reading there.
How It Functions:
Like The Heart
According to Jackson Siegelbaum Gastroenterology, the stomach is like the heart. Why? Well, each has a pacemaker. From the pacemaker, electric pulses fan out across both the heart, and the stomach. This makes muscles contract (close in on themselves, or squeeze). The regulator of this impulse in the stomach is the vagus nerve.
Two Parts
The stomach’s two parts are the upper part, or the fundus, where swallowed food and liquid are stored, and the lower part, or the antrum, where food is ground up and turned into chyme, a milky, thick, amalgum of what you have eaten, which is then “squirted” into the duodenum (/doo-AH-din-um/), the beginning of the small intestine, or the small bowel.
As we just mentioned, the antrum, where food is ground up, contracts to do this, and the normal rate for these contractions is roughly three times in a minute; much slower than the heart, but frequent enough for the task of making food into a chyme.
Gastroparesis
Also called ‘delayed gastric emptying’, this condition describes a stomach that contracts at a lower than normal rate, or too infrequently to empty the stomach properly. This slowing down, or stoppage is also caled paralysis, thus the ‘paresis’ in the name of the disorder.’ This retarded or stopped stomach contraction problem is due to a less frequent, or stppped electric pulse from the stomach’s pace maker, the vagus nerve. When gastroparesis is present, the stomach will have to depend more on its digestive acids and enzymes to break down food inside, and less on the physical action of grinding it up with normal contractions. In essence, as the doctors in my source material say, your food ‘just lies there’, waiting for ‘gravity’ to bring it to the bowels. Gastroparesis may occur when the vagus nerve is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.
Gastroparesis can be caused by damage to the vagus nerve . This causes the muscles of the stomach and intestines to not work normally. Food then moves slowly or stops moving through the digestive tract. (paraphrased from Wikipedia). Damage to the vagus nerve may be caused by high levels of blood glucose over many years.
Symptoms
(This portion of my article is copied directly from the site mentioned above, with thanks and apologies to the authors:)
The usual symptoms of gastroparesis are:
- a feeling of fullness after only a few bites of food,
- bloating,
- excessive belching, and,
- nausea.
- At times there will be a vague, nagging ache in the upper abdomen, but usually the pain is not sharp or crampy as might occur with ulcers or a gallbladder attack.
- There may be vomiting,
- heartburn, or
- regurgitation of stomach fluid into the mouth.
Medications that reduce or eliminate stomach acid usually don’t help much. (emphasis, mine)
Causes
(This portion of my article is copied directly from the site mentioned above, with thanks and apologies to the authors:)
- Diabetes is the most common known cause. Adrenal and thyroid gland problems can also be a cause although these are infrequent
- Scars and fibrous tissue from ulcers and tumors can block the outlet of the stomach and mimic gastroparesis
- Certain drugs weaken the stomach (tricyclic antidepressants such as Elavil, calcium blockers such as Cardizem and Procardia, L-dopa, hyoscyamine, Bentyl, Levsin, narcotics)
- Previous stomach surgery
- Anorexia and bulimia
- Neurologic or brain disorders such as Parkinson’s disease, strokes and brain injury
- Certain diseases such as lupus erythematosus and scleroderma
- In up to 40% of cases the cause of gastroparesis is not known
It should be noted that not all of these disorders affect the pacemaker of the stomach. Some disorders weaken the stomach muscle itself so it can’t respond to the pacemaker. In either case, the result is the same, gastroparesis.
Diagnosis
(Portions of this part of my article are copied directly from the site mentioned above, with thanks and apologies to the authors:)
|
| The diagnosis of gastroparesis starts with taking the information about the patient’s medical history when he suspects symptoms. In severe cases, the physical exam and blood tests may show evidence of malnutrition, but usually the exam is normal.An upper GI (gastro-intentestinal) barium x-ray measures how liquid barium leaves the stomach. This exam is to show how quickly or slowly material leaves the stomach. Often this exam is normal.Upper endoscopy is a visual exam of the stomach using a lighted flexible tube. Mild sedation is usually given for this procedure. This exam should always be done to be certain there is not a blockage in the stomach.A gastric or stomach emptying test is presently the best method of making the diagnosis. In this test, a food, such as scrambled eggs, is labeled with a marker (radioactive? [question; mine]) which can be seen by a scanner. Following ingestion, the scanner tracks the time it takes for the food to leave the stomach. In general, half the stomach contents should leave within about 90 minutes. A final test, which is not available everywhere, is the electrogastrogram (EGG). This test, like the EKG on the heart, measures the electrical waves that normally sweep over the stomach and precede each contraction.
|
Treatment
(This portion of my article, including ‘Medication’, is copied directly from the site mentioned above. I manipulated and changed it for clarity. With thanks and apologies to the authors:)
|
First, if there is an underlying disorder, it needs to be treated effectively. Examples are good blood sugar control in the diabetic patient or thyroid medicine for someone with an underactive thyroid.Second, there may be a need to address diet and nutrition. When gastroparesis is mild, there are usually few food problems. However, if there is marked delay in stomach emptying, then attention to the diet is necessary.
- Fats, including vegetable oils, normally cause delay in emptying of the stomach, so foods that are high in fat need to be avoided.
- High fiber foods such as broccoli and cabbage tend to stay in the stomach, so these foods should be restricted when symptoms are severe.
- Liquids always leave the stomach faster than solid food so liquid type foods such as low-fat milkshakes should be used.
- Finally, frequent small feedings, 4-6 times a day, are usually more effective than larger meals, 2 or 3 times a day.
- A registered dietitian can be very helpful in providing advice in severe cases.
Medications
|
| Several medications are now available to stimulate the stomach to contract more normally. These drugs should be taken 20-40 minutes before eating to allow enough time for the drug to get into the blood stream where they can then act on the stomach. They all cause the stomach to contract more often and, hopefully, more vigorously thereby emptying the stomach and reducing symptoms. |
Metoclopramide (trade name: Reglan)
|
| This is an effective drug although it may have side effects such as restlessness, fatigue, agitation and depression. The dose is 5-20 mg. This drug is available in generic form. |
Domperidome (trade name: Motilin)
|
| This drug is available in Canada and Europe but not in the U.S. as of January 2001. |
Bethanechol (trade name: Urecholine)
|
| and erythromycin, an old antibiotic are occasionally used but generally are not effective or even desirable long-term. |
Summary
|
| Gastroparesis is a fairly frequent medical problem. While causing distressing symptoms in some patients, it rarely causes serious medical problems. The diagnosis is now straightforward. Treatment consists of treating any underlying problem, diet and medications. By working with the physician, most patients are able to reach a satisfactory treatment program. |
| Learn how the new prebiotic soluble fibers benefit bowel health and many GI disorders |
|
More about the disease, from Wikepedia:
Causes
Gastroparesis may be chronic or transient; transient gastroparesis may arise in acute illness of any kind, with the use of certain cancer treatments or other drugs which affect digestive action, or due to anorexia nervosa, bulimia and other abnormal eating patterns.
Chronic gastroparesis is frequently due to autonomic neuropathy. This may occur in people with type 1 diabetes or type 2 diabetes. The vagus nerve becomes damaged by years of high blood glucose, resulting in gastroparesis. Gastroparesis has also been associated with various autoimmune diseases and syndromes, such as fibromyalgia and Parkinson’s disease, and may occur as part of a mitochondrial disorder.
Chronic gastroparesis can also be caused by other types of damage to the vagus nerve, such as abdominal surgery.[1]
Idiopathic gastroparesis (gastroparesis with no known cause) accounts for a third of all chronic cases; it is thought that many of these cases are due to an autoimmune response triggered by an acute viral infection. “Stomach flu”, mononucleosis, and others have been anecdotally linked to the onset of the condition, but no systematic study has proven a link.
Signs and Symptoms
The most common symptoms of gastroparesis are[2]
- Chronic nausea
- Vomiting (especially of undigested food)
- Early satiety
Other symptoms include
- Heartburn
- Weight loss
- Abdominal bloating
- Erratic blood glucose levels
- Lack of appetite
- Gastroesophageal reflux
- Spasms of the stomach wall
Morning nausea may also indicate gastroparesis. It is important to note that vomiting may not occur in all cases, as sufferers may learn to adjust their diets to include only small amounts of food.[3]
Diagnosis and Treatment
Gastroparesis can be diagnosed with tests such as x rays, manometry, and gastric emptying scans. The clinical definition for gastroparesis is based solely on the emptying time of the stomach and not on other symptoms, and severity of symptoms does not necessarily correlate with the severity of gastroparesis. Therefore, some patients may have marked gastroparesis with few, if any, serious complications.
Treatment includes dietary changes (low-fiber and low-residue diets, and in some cases, restrictions on fat and/or solids), oral medications such as Metoclopramide (Reglan, Maxolon, Clopra), Cisapride (Propulsid), Erythromycin (E-Mycin, Erythrocin, Ery-Tab, EES) and Domperidone (Motilium); adjustments in insulin dosage for those with diabetes, a jejunostomy tube, parenteral nutrition, implanted gastric neurostimulators (“stomach pacemakers“), or botulinum toxin.
Viagra, which increases blood flow to the genital area, is also being used by some practitioners to stimulate the GI tract in diabetic gastroparesis.
The antidepressant Mirtazapine has also proven effective in the treatment of gastroparesis unresponsive to conventional treatment. This is due to its anti-emetic and appetite stimulant properties. Mirtazapine acts on the same serotonin receptor (5-HT3) as the popular anti-emetic Ondansetron[4].
Complications
Primary complications of gastroparesis include:
- Fluctuations in blood glucose due to unpredictable digestion times (in diabetic patients)
- General malnutrition due to the symptoms of the disease (which frequently include vomiting and reduced appetite) as well as the dietary changes necessary to manage it
- Severe fatigue and weight loss due to calorie deficit
- Intestinal obstruction due to the formation of bezoars (solid masses of undigested food)
- Bacterial infection due to overgrowth in undigested food
Carlo Atteniese
Like this:
Like Loading...