How Do I Choose the Best Gastroparesis Treatment?

Gastroparesis syndrome refers to a group of clinical symptoms characterized by delayed gastric emptying, which is mainly manifested by early satiety, epigastric bloating, nausea, paroxysmal nausea, vomiting, weight loss, etc. Stomach weakness and so on. Gastroparesis syndrome occurs not only after gastric surgery, but also after other abdominal surgery. According to the etiology can be divided into two types of primary and secondary. Primary, also known as idiopathic gastroparesis, occurs in young women. Gastroparesis can be divided into acute and chronic according to the onset and duration of the disease. Chronic is more common clinically, and the symptoms last for several months or even more than 10 years.

Basic Information

nickname

Gastric paralysis, stomach weakness

English name

gastroparesis syndrome

Visiting department

Basic surgery

Multiple groups

Young women

Common locations

stomach

Common causes

Old age, malignant tumors, water electrolyte and nutrition disorders, vagus nerve resection, long-term use of drugs that affect gastrointestinal motility, etc.

Common symptoms

Early satiety, epigastric bloating, nausea, paroxysmal nausea, vomiting, weight loss, etc.

Causes of gastroparesis syndrome

Postoperative gastroparesis is caused by many factors, such as old age, mental stress, malignant tumors, anastomotic edema, water electrolyte and nutritional disorders, vagus nerve resection, and long-term application of drugs that affect gastrointestinal motility. They are more common in young women and may be related to Gastroesophageal reflux disease is closely related to gastrointestinal disorders such as irritable bowel syndrome. Secondary gastroparesis is common in: diabetes; connective tissue diseases such as progressive systemic sclerosis; gastric surgery or vagus nerve cut; infection or metabolic abnormalities; central nervous system diseases; certain drugs Applications. In addition, reduced tonicity of the vagus nerve and intestinal hormones and peptides may also play a role. Motilin levels and motilin receptor function may be abnormal during gastroparesis.

Clinical manifestations of gastroparesis syndrome

Most patients present with early satiety, epigastric fullness, heating, nausea, vomiting, and weight loss, and may also have symptoms such as diarrhea and constipation; a few patients with chronic gastroparesis are concealed by drugs or metabolism, and their symptoms persist. Or recurrent attacks range from months to years, and very few patients may be asymptomatic. The patient's vomiting is mostly delayed vomiting, but the appetite of the patient is not affected. Patients with secondary gastroparesis are also accompanied by the clinical manifestations of the primary disease.

Physical examination is non-specific. Patients with long-term loss of appetite and vomiting may experience weight loss and malnutrition, resulting in a significant reduction in patient weight and even cachexia.

Gastroparesis syndrome

Determination of gastric emptying function

There are many methods for checking gastric emptying function. Currently, radionuclide gastric emptying test should be preferred. For any unexplained dyspepsia, radionuclide-labeled solid and liquid gastric emptying tests should be routinely performed. This test is of great value in confirming the diagnosis. Impedance technology can measure gastric fluid emptying and may be widely used in the future.

2. Gastric manometry

This test is performed only if the gastric emptying test is abnormal. Intragastric manometry in patients with gastroparesis can show abnormal gastric movements, with low gastric antrum movement as the most common after meal. In patients with gastroparesis after major gastrectomy, the measurement of proximal gastric static pressure shows low basal tension.

3. Electrogastrogram

Body surface electrocardiogram is a non-invasive examination method. It has been found that various types of gastroparesis can occur with abnormal electrical rhythms, such as tachycardia, bradycardia, and electrical rhythm disorders.

Diagnosis of gastroparesis syndrome

At present, the diagnostic criteria for postoperative acute gastroparesis are not uniform. With reference to recent literature reports, the more commonly accepted criteria are:

1. One or more examinations suggest no mechanical obstruction of gastric outflow tract;

2. Gastrointestinal decompression drainage 800 ml / day, lasting more than 10 days;

3. No obvious imbalance of water and electrolyte balance;

4. No underlying diseases that cause gastroparesis, such as diabetes, connective tissue disease, etc .;

5. No drugs affecting smooth muscle contraction were applied.

Differential diagnosis of gastroparesis syndrome

The main difference from gastroparesis after gastric surgery is mechanical obstruction. Both mechanical obstruction and gastric paresis after gastrointestinal surgery occur in Billroth , so it is necessary to distinguish between them.

Gastroparesis syndrome complications

Easily complicated by chronic mesenteric artery occlusion, diabetes, anorexia nervosa, progressive systemic sclerosis and cancer.

Treatment of gastroparesis syndrome

General treatment

Patients with gastroparesis syndrome should be given a low-fat, low-fiber diet, eat less frequently and eat more fluid, mainly to facilitate gastric emptying. Because smoking can slow gastric emptying, quit smoking. Try to avoid drugs that delay gastric emptying.

2. Treatment of primary disease

Diabetic gastroparesis should be controlled as much as possible. Anorexia nervosa patients with adequate calories can improve gastric emptying and correct the complete recovery of symptoms from mental disorders. Ischemic gastroparesis caused by chronic mesenteric artery occlusion can completely return to normal after vascular reconstruction.

3. Prokinetic drugs

Prokinetic drugs are currently the most effective treatment for most patients with gastroparesis syndrome.

(1) Metoprolol, domperidone, and cisapride are commonly used as prokinetic drugs. The long-term effects of metoclopramide and domperidone are irrelevant, and long-term application of cisapride still has good results.

(2) Another concern is the promotive effect of erythromycin. Erythromycin as a motilin receptor agonist improves the coordination of gastric and duodenal contractions and promotes the emptying of solid food.

(3) Motilin, after intravenous infusion, significantly accelerates gastric fluid and solid emptying, which may provide a new method for the treatment of gastroparesis in the future.

4. Surgery

For a few patients with refractory gastroparesis, surgery can be used. Some patients with idiopathic gastroparesis have reported a significant reduction in symptoms after major gastrectomy and gastrojejunostomy.

5. Other therapies

Gastric pacing can restore the disordered electrical slow-wave rhythm of the stomach to normal, thereby restoring normal gastric movement. Some people have tried to treat patients with gastroparesis associated with electrical-wave rhythm disorders after surgery, which has a certain effect.