Dyspepsia syndrome experts classify as a set clinical symptoms, arising from impaired (slow) gastric emptying due to the patient having not only diseases of the digestive system, but also other body systems.
To the symptoms, united by the term “dyspepsia” traditionally include
- A feeling of heaviness in the abdomen (a feeling of fullness in the stomach), most often occurring after eating (both immediately and several hours after eating) - some patients interpret these sensations as dull aching pain in the epigastric or periumbilical areas
- Feeling of quick satiety
- Nausea (both on an empty stomach in the morning, aggravated by the first meal, and occurring immediately or several hours after eating)
- Vomiting (a possible but optional symptom), if it does occur, then after it comes, even if short-lived, relief (reduction in the manifestations of dyspepsia)
- Bloating (flatulence) with or without belching of air
The named symptoms and severity in each individual patient can vary widely. There may be a combination of dyspepsia with heartburn, chest pain when swallowing, symptoms caused by diseases of the esophagus, most often gastroesophageal reflux disease, as well as a change, often a decrease, in appetite.
Dyspepsia syndrome is a fairly common manifestation various diseases and occurs, according to various sources, in no less than 30-40% of the planet's population. If we take into account single episodes of dyspepsia that occur during acute enteroviral infections or a response to acute toxic damage to the gastric mucosa by a wide variety of factors, including alcohol and drugs, then the indicated figures should at least be doubled.
To better understand the causes of dyspepsia, we should briefly talk about what happens to food in the stomach of a healthy person.
The process of digesting food in the stomach
When food enters the stomach, a change in the configuration of the organ occurs - the muscles of the body of the stomach (1) relax, while the outlet section (antrum - 2) contracts.
In this case, the pyloric canal (3), which is a muscle sphincter, or sphincter, remains practically closed, allowing duodenum(4) only liquid and solid food particles less than 1 mm. In response to food entering the stomach, its cells increase the production of proteins that provide partial chemical digestion of hydrochloric acid and the digestive enzyme pepsin (along with mucus - the main components of gastric juice).
At the same time, activity increases muscle cells stomach, due to which the solid components of food are mechanically crushed and mixed with gastric juice, which facilitates its chemical digestion. This process, with increasing intensity of muscle contractions of the stomach wall, lasts about 2 hours. Then the pyloric canal opens and with several powerful contractions the stomach “expels” the remaining food into the duodenum.
Then comes the phase of restoration (rest) of the functional activity of the stomach.
Causes of dyspepsia
As already mentioned, in most cases, dyspepsia is caused by slow gastric emptying. It can be both functional (without signs of damage to organs and tissues) and organic in nature. In the latter case, dyspepsia occurs as a manifestation of diseases of the stomach and other organs and systems of the body.
- Functional disorders of gastric emptying as a result of irregular nutrition, reduction of time and disturbance of eating conditions (stress, constant distraction by extraneous actions while eating - active and emotional discussion of any issues, reading, doing work, movement, etc.), overeating, regular intake of foods that slow down gastric emptying (primarily fats, especially heat-treated ones), exposure to other factors (so-called non-ulcer dyspepsia)
- Functional disorders of gastric emptying as a result of injury(mismatch) of central (located in the central nervous system) regulatory mechanisms (neurological and mental illness)
- Organic diseases
- Stomach:
- Gastritis (inflammation)
- Acute – acute massive impact on the stomach wall of bacteria and their metabolic products that enter the body from the outside
- Chronic - prolonged exposure to the stomach wall of bacteria and their waste products ( Helicobacter pylori- a microorganism whose presence in the stomach is associated with the occurrence of peptic ulcer, gastritis, tumors), bile (with its regular reflux into the stomach from the duodenum), an autoimmune process affecting the body and/or antrum of the stomach, the influence of other pathogenic factors (see below)
- Benign
- Malignant
- Peptic ulcer, complicated by reversible inflammatory edema (completely disappears after healing of the ulcer) and/or cicatricial deformation of the outlet of the stomach or duodenum (completely irreversible and, with progression, needs to be eliminated surgically)
Nausea, vomiting, sometimes uncontrollable, can be manifestations neurological diseases, accompanied by an increase intracranial pressure, and therefore these symptoms are associated with headaches, sometimes very intense. In such cases, the connection between the manifestations of dyspepsia and food intake is not clearly visible; on the contrary, it is often indicated symptoms appear against a background of high blood pressure
The appearance of dyspepsia forces most people to seek help from a doctor.
IN mandatory need specialist advice who first developed dyspepsia aged 45 years and older, as well as in persons (regardless of age) who have one or more of the following symptoms occur:
- repeated (recurrent) vomiting
- weight loss (if it is not associated with dietary restrictions)
- pain when food passes through the esophagus (dysphagia)
- proven bleeding episodes gastrointestinal bleeding(vomiting “coffee grounds”, loose tarry stools)
- anemia
Of course, the cause of the development of dyspepsia in each specific case must be determined by a doctor. The patient’s task is to clearly state his symptoms so that it is easier for the doctor to understand the cause-and-effect relationships between them.
For this The patient must answer the following questions to the doctor:
- How are the symptoms of dyspepsia related to food intake (occur on an empty stomach in the morning; immediately after a meal, if yes, then is there a connection with the nature (liquid, hard, spicy, fatty, etc.) of food; a few hours after a meal or in the evening; do not depend on the time of eating and its nature)?
- How long does dyspepsia last if nothing is done?
- After what (take liquids, tablets, etc.) and how quickly does dyspepsia go away?
- How long does dyspepsia last without symptoms?
- Is there a connection and, if yes, then what, between the manifestations of dyspepsia and other symptoms that the patient has (for example, dyspepsia is accompanied by abdominal pain, after eliminating dyspepsia the pain disappears or not)
- If vomiting is a manifestation of dyspepsia, it is necessary to clarify what is contained in the vomit (fresh blood, contents resembling coffee grounds, remains of food eaten just or more than 2-3 hours ago, mucus that is colorless or yellow-brown), and whether vomiting brought relief
- How stable has your body weight been over the past 6 months?
- How long ago did dyspepsia appear, is there a connection (according to the patient himself) between its appearance and any events in his life?
- How did the severity of the symptoms of dyspepsia change from the moment of its onset to the visit to the doctor (did not change, increased, decreased, their wavy course was observed)?
It is important for the doctor to know whether the patient has concomitant diseases for which the patient regularly takes medications (which ones, how often, for how long), about possible contact with harmful substances, about the features of the regime and diet.
Then the doctor conducts an objective examination of the patient using “classical” medical methods: examination, tapping (percussion), feeling (palpation) and listening (auscultation). Comparison of data obtained during an objective examination with information obtained during a patient interview allows the doctor in most cases to draw a circle possible diseases and conditions that could cause dyspepsia. In this case, such important factors, such as gender, age, ethnicity of the patient, his heredity (the presence of diseases that occur with dyspepsia in blood relatives), time of year and some other factors.
Examinations used in diagnosing the causes of dyspepsia and their diagnostic significance
| Examination method | Diagnostic significance |
| Clinical blood test | Detection/exclusion of anemia as a sign of autoimmune gastritis, gastrointestinal bleeding (erosion, ulcer, tumor) |
| Feces for occult blood | |
| Biochemical blood parameters reflecting the functional state of the liver (thymol transaminase test, bilirubin, cholesterol, albumin), kidneys (creatinine), as well as calcium and blood glucose | Grade functional state liver or kidneys, detection/exclusion of metabolic disorders, such as diabetes mellitus |
| Breath test with C13 urea, immunosorbent test to determine specific antibodies in the blood, fecal antigen test | Non-invasive (not requiring intervention in the patient’s body) diagnosis of Helicobacter pylori infection |
| Endoscopic examination of the esophagus, stomach, duodenum with a biopsy (obtaining a piece) of the mucous membrane for histological examination and a quick urease test | Diagnosis of diseases of the esophagus, stomach, duodenum, Helicobacter pylori infections; indirect assessment of gastric emptying process |
| X-ray contrast examination of the esophagus, stomach and duodenum | Diagnosis of diseases of the esophagus, stomach, duodenum; assessment of gastric emptying process |
| Ultrasonography, CT scan, NMR imaging of the liver, gallbladder, biliary tract, pancreas, kidneys | Diagnosis of diseases of these organs as a possible cause of dyspepsia |
In addition to the above research methods, cutaneous and intragastric electrogastrography and radioisotope research using a special isotope breakfast can be used to diagnose gastric emptying disorders. Currently, these methods are used mainly for scientific purposes, while in everyday life clinical practice their use is very limited.
An integral component of the treatment of dyspepsia, regardless of the cause of its development, is the modification of lifestyle and nutrition, and correction of the diet. These recommendations are quite simple and banal in their own way, but the effectiveness largely depends on how well the patient can implement them. drug treatment, and sometimes even its expediency.
Here are the main provisions:
- Meals should be frequent (every 4-5 hours), but in small (fractional) portions. Overeating, especially in the evening and at night, as well as prolonged fasting are completely excluded.
- Eating should take place in calm conditions, without strong external stimuli (for example, emotional conversation) and not combined with activities such as reading, watching TV, etc.
- People suffering from dyspepsia should stop smoking (including passive smoking!!!) or, which is less effective, limit it. You cannot smoke on an empty stomach (the traditional “breakfast” for many socially active people- a cigarette and a cup of coffee are unacceptable).
- If the patient is in a hurry, he should refrain from eating or consume a small amount of liquid food (for example, a glass of kefir and cookies) that does not contain large amounts of fats and proteins.
- Eating quickly, talking while eating, smoking, especially on an empty stomach - all this often causes the accumulation of gas in the stomach (aerophagia) with the appearance of bloating, belching of air, and a feeling of fullness in the stomach.
- Considering that liquid food flows more easily from the stomach into the duodenum (see above), it must be included in the diet (first courses, preferably soups with water or low-fat broth, other liquids). It is not advisable to use food concentrates and other products that contain even approved stabilizers and preservatives when preparing first courses, other foods.
- Food should not be very hot or very cold.
- During the period when symptoms of dyspepsia appear, dishes made with the addition of tomato pastes are excluded from the diet or significantly limited, including borscht, pizza, products made from butter dough, rice, primarily pilaf, sweet compotes and juices, chocolate and other sweets, vegetables and raw fruits, strong tea, coffee, especially instant coffee, carbonated drinks.
- If the diet included meat products, especially fatty ones, the patient should not consume dairy products, especially whole milk, at this meal.
The presented rules cannot be perceived as dogma; deviations are possible both in the direction of tightening them and softening them. The main task is to reduce the irritating/damaging effect (mechanical or thermal) on the gastric mucosa of the food itself, hydrochloric acid, bile thrown from the duodenum into the stomach during long breaks between meals, medications, etc. The last remark is especially important, and therefore, before starting treatment for dyspepsia, the patient should consult with the doctor about the possibility of linking the appearance of this syndrome with taking medications.
If dyspepsia is based on functional disorders the process of evacuation of food from the stomach, in most cases, it is enough to correct the lifestyle and diet, diet to eliminate the manifestations of this syndrome. Not only that, medications(for example, antacids, H2 receptor antagonists), which are designed to reduce/eliminate dyspepsia, can, if unjustifiably prescribed and irrationally used, increase its manifestations.
Drug Therapy Options dyspepsia largely depends on the disease that caused its occurrence.
So the reason chronic gastritis with the localization of inflammation in the outlet (antrum) of the stomach (most often Helicobacter pylori or bile reflux) determines the options for drug treatment.
If proven (see above) bacterial nature gastritis, according to international standards(Maastricht Consensus 2, 2000), a patient with dyspepsia can be prescribed (for at least 7 days) antimicrobial therapy with two antibacterial drugs(in various combinations of clarithromycin, amoxicillin, metronidazole, tetracycline, less often some others) and one of the proton pump blockers (omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole). The same scheme is used in the treatment of peptic ulcers.
Despite the high probability of Helicobacter pylori disappearing from the stomach after such treatment, manifestations of dyspepsia may persist, which will require continued treatment, but only with a proton pump blocker or its combination with sucralfate or antacids (Maalox, Almagel, Phospholugel, etc.) situationally - after 2 hours after eating, if next appointment there won't be any food soon before bedtime.
A prerequisite for prescribing a proton pump blocker is to take it 30 minutes before your first meal!
It is possible, but not always necessary, to take a second dose of the drug (usually in the afternoon, after 12 hours, and also on an empty stomach). H2 receptor antagonists (cimetidine, ranitidine, famotidine, nizatidine, roxatidine) have a less pronounced blocking effect on the secretion of hydrochloric acid in the stomach. They are also capable of eliminating the manifestations of dyspepsia as hydrogen pump blockers.
For reflux gastritis, the same proton pump blockers are prescribed in combination with antacids or sucralfate. Antacids or sucralfate are taken as for chronic Helicobacter pylori-induced gastritis: situationally - 2 hours after meals, if the next meal is not soon and always before bedtime (protecting the gastric mucosa from the damaging effects of bile, the likelihood of which entering the stomach at night is higher).
Ursodioxycholic acid (2-3 capsules before bedtime) or so-called prokinetics (metoclopramide, domperidone, cisapride), drugs that enhance contractility muscles of the digestive tract, including the pyloric sphincter. Thanks to this effect, prokinetics not only facilitate gastric emptying, but also reduce the likelihood of bile entering the stomach. They are prescribed 30 minutes before meals and before bedtime. Their use is undesirable for people whose work is related to traffic safety; it requires precise coordinated actions, since there is a possibility of an inhibitory effect on brain activity. The ability of cisapride to negatively affect cardiac activity (increases the likelihood of developing unsafe cardiac arrhythmias) requires careful use of this drug, and possibly other prokinetics in cardiac patients (an ECG must first be taken - if there are signs of prolongation of the QT interval), cisapride is contraindicated.
Another drug that is used to eliminate such manifestations of dyspepsia as bloating is simethicone (espumisan). His therapeutic effect is achieved by reducing the surface tension of the liquid in the digestive tract. The drug can be used either alone or in combination with antacids.
In those cases when dyspepsia occurs in a patient with diabetes mellitus, renal or liver failure- the main goal is to reduce the manifestations of these diseases and conditions.
Thus, in diabetes mellitus, dyspepsia mainly appears with poor control of blood glucose levels (on an empty stomach and 2 hours after meals). Therefore, to eliminate dyspepsia, treatment should be adjusted hypoglycemic drugs. To do this, you should consult a doctor. There are several options, which one should be chosen - the patient and the doctor decide locally.
If the patient takes insulin, there is no problem; under the control of the glycemic profile (determination of glucose levels several times during the day), an adequate dose of insulin is selected so that the fasting blood glucose level does not exceed 7.0 mmol/l, and preferably below 6.0 mmol /l. It is somewhat more complicated with tableted drugs that lower blood glucose. Many of them themselves can cause dyspepsia, so such patients should agree with their doctor about the advisability of changing the drug, or, even temporarily, until glucose normalizes, switch to insulin. After reaching the target glucose level, a reverse transition (again under the control of the glycemic profile) to tablet drugs is possible.
It is much more difficult to combat dyspepsia in patients with kidney or liver failure, since these are irreversible conditions. Along with measures to slow their progression, the maximum possible stomach-friendly lifestyle and diet (see above) is ensured, reducing the likelihood of damage to it.
If the basis for the violation of the evacuation of food from the stomach is a narrowing of the outlet section by a tumor or scar tissue formed during the healing of ulcers of the pyloric canal or duodenal bulb, drug therapy not effective. In such cases, surgical treatment should be performed.
Gastric emptying and passage of food into the intestines are regulated by the humoral and nervous systems. Contractions of the stomach and small intestine are coordinated with each other. This process can be represented as following diagram. Swallowed food, previously crushed into oral cavity and mixed with saliva, enters the cardiac part of the stomach. Due to constant peristaltic movements, the food bolus moves to the distal section. The distal part of the stomach grinds food into small particles and acts as a gate, allowing only liquid and small particles to enter the duodenum, and preventing the return of food. Peristaltic contractions of the proximal and distal parts
stomach fish are under control vagus nerve, the main neurotransmitter of which is acetylcholine. Acetylcholine interacts with the receptors of smooth muscle cells of the stomach, thereby stimulating their contraction and relaxation during the act of swallowing. In addition, a number of hormones also influence stomach contractions, strengthening or weakening them. For example, cholecystokinin reduces proximal gastric motility while stimulating contractions distal section, and secretin and somatostatin weaken the contractions of both sections.
Gastric evacuation It takes the time during which the stomach is freed from its contents, which then enter the duodenum. Deviation from the normal time of gastric evacuation in the direction of increase contributes to the development of a delay in the onset of action of certain xenobiotics and/or various dosage forms drugs. According to the theory of the dependence of absorption capacity on the dissociation constant, weakly basic drugs awaiting transition to an ionized form in the stomach, with a slow rate of gastric evacuation, could delay the onset of action of the main drugs. The speed of gastric evacuation is influenced by the following factors.
Drugs that block acetylcholine receptors of gastric smooth muscle cells, delaying the evacuation of gastric contents (for example, propantheline ¤).
The high acidity of gastric chyme also delays the evacuation of stomach contents.
The chemical composition of the chyme within the stomach determines the time of gastric evacuation. In humans, liquids are cleared in approximately 12 minutes and solids in approximately 2 hours, depending on chemical composition chyme. Carbohydrates are evacuated faster than proteins, and proteins faster than fats.
Gastric emptying corresponds to the caloric content of the stomach contents so that the number of calories transferred to the small intestine remains constant for different nutrients for a long time, but the evacuation of contents from the stomach is slower, the richer the food in calories.
The rate of gastric evacuation depends on the amount of food consumed. For example, changing the amount of solid food from 300 to 1692 g increases the gastric emptying time from 77 to 277 minutes. The size of food particles also matters because
large food particles put pressure on the walls of the stomach, thereby stimulating the evacuation of stomach contents.
Receptor modeling small intestine(for example, duodenal receptors sensitive to osmotic pressure) hypertonic or hypotonic solution slows down gastric evacuation.
The temperature of solid or liquid foods can affect the rate of gastric emptying. Temperature is higher or lower physiological norm(37 °C) can proportionally reduce the evacuation of gastric contents.
Other factors such as anger or agitation may increase the rate of gastric emptying, while depression or trauma appear to decrease it. Body position also matters. For example, standing or lying on your right side can make it easier for content to pass through small intestine due to increased pressure in the proximal part of the stomach.
Motility disorders of the esophagus and stomach
The International Foundation for Functional Gastrointestinal Disorders (IFFGD) has produced a range of resources for patients and their families regarding functional gastrointestinal disorders. This article is devoted to disorders caused by abnormal motility of the gastrointestinal tract (GERD, dysphagia, functional chest pain, gastroparesis, dyspepsia and others) and their characteristic symptoms, such as difficulty swallowing, chest pain, heartburn, nausea and vomiting.Motor skills and functioning gastric tract fine. The term motility is used to describe muscle contractions in the gastrointestinal tract. Although gastrointestinal tract is a round tube, but when its muscles contract, they block this tube or make its internal lumen smaller. These muscles can contract synchronously, moving food in a certain direction - usually downwards, but sometimes up short distances. This is called peristalsis. Some contractions may push the contents of the digestive tube forward. In other cases, the muscles contract more or less independently of each other, mixing the contents but not moving them up or down the digestive tract. Both types of contractions are called motility.
The gastrointestinal tract is divided into four sections: the esophagus, stomach, small intestine, and large intestine. They are separated from each other by special muscles called sphincters, which regulate the flow of food from one section to another and which are tightly closed most of the time. Each section of the gastrointestinal tract performs various functions V general process digestion and therefore each department has its own types of contractions and sensitivity. Contractions and sensitivity that do not correspond to the functions performed by this department can cause various unpleasant symptoms. This article describes the normal contractions and sensitivity of the esophagus and stomach, and the symptoms that may occur as a result of abnormalities.
Esophagus
. The function of the esophagus is to transport food from the mouth to the stomach. To accomplish this task, each swallow is accompanied by powerful, synchronized (peristaltic) contractions. The esophagus usually does not contract between swallows. The sphincter muscles that separate the esophagus from the stomach (called the lower esophageal sphincter, or LES) usually remain tightly closed, preventing acid from the stomach from flowing into the esophagus. However, when we swallow, this sphincter opens (relaxes) and the food we swallow enters the stomach.Gastroesophageal reflux disease (GERD). The most common symptom of GERD is heartburn, which occurs when, as a result of gastroesophageal reflux, acid from the stomach periodically flows into the esophagus and irritates its mucous membrane. This occurs when the lower esophageal sphincter, which separates the stomach from the esophagus, does not work properly. The main function of this sphincter is to prevent reflux from contracting the stomach. The causes of this reflux may be: weak muscles sphincter, too frequent spontaneous relaxation of the sphincter, hiatal hernia. For hernia hiatus diaphragm, the stomach extends partially up into the chest above the muscle that separates abdominal cavity from chest(this muscle is called the diaphragm). A hiatal hernia weakens the lower esophageal sphincter. Gastroesophageal reflux disease can be diagnosed on an outpatient basis through a test called intragastric pH-metry, during which the frequency with which acid is thrown into the esophagus (reflux frequency) is recorded. To do this, a small, soft tube with one or two sensors is inserted through the nose into the esophagus. It connects to a battery-powered computing unit. To study the effects of acid on the esophagus, recordings are made over a period of 18-24 hours. All this time, the patient lives in his usual mode and is engaged in daily activities. Endoscopy is also used, in which the esophagus is viewed using a thin fiber-optic tube and esophageal manometry , which measures the pressure in the esophagus and lower esophageal sphincter and thus determines whether they are functioning properly.
Dysphagia. Dysphagia is a condition in which there are problems with swallowing. This can happen if the muscles in the tongue and neck that push food down the esophagus do not work properly due to a stroke or other condition that affects the nerves or muscles. Food may also be retained because the lower esophageal sphincter does not relax enough to prevent it from entering the stomach (a disorder called achalasia), or due to a mismatch in the contractions of the esophageal muscles ( esophageal spasm). Dysphagia may cause backflow of food into the esophagus and vomiting. There may also be a sensation of something stuck in the esophagus or pain. Diagnostic test with dysphagia is esophageal manometry
, in which a small tube with pressure sensors is inserted through the nose into the esophagus and is used to detect and record contractions of the esophagus and relaxation of the lower esophageal sphincter. The duration of such a study is approximately 30 minutes.
Functional chest pain. Sometimes patients experience chest pain that is different from heartburn (no burning sensation), and it can be confused with pain of cardiac origin. The doctor always finds out whether the patient has heart problems, especially if the patient is over 50 years old, but in many cases he does not find such problems. Many patients with chest pain do not have heart disease; the pain arises either from spasmodic contractions of the esophagus or from hypersensitivity nerve endings in the esophagus, or from a combination muscle spasms and increased sensitivity. Diagnostic test What is done in this case is esophageal manometry, described above. To make sure that gastroesophageal reflux is not the cause of chest pain, an outpatient daily pH-metry
esophagus.
Stomach
Normal motor skills and functions. One of the functions of the stomach is to grind food and mix it with digestive juices so that when the food reaches the small intestine it is absorbed. The stomach usually moves its contents into the intestines at a controlled rate. There are three types of contractions in the stomach:- Peristaltic contractions of the lower part of the stomach, creating waves of food particles mixed to varying degrees with gastric juice. They occur when the pyloric sphincter is closed. The purpose of these contractions is to crush pieces of food, the frequency of these contractions is 3 times per minute.
- Slow contractions of the upper stomach, lasting a minute or more, that follow each swallow and which allow food to enter the stomach; in other cases, the upper part of the stomach occurs slow contractions, helping to cleanse the stomach.
- Very strong, synchronized random contractions occur between meals, when digested food has already left the stomach. They are accompanied by the opening of the pyloric sphincter and are “cleansing waves”, their function is to remove any indigestible particles from the stomach. In the physiology of digestion, they are called “migrating motor complex”.
- The outlet of the stomach (the pylorus) may be blocked by an ulcer, tumor, or something swallowed and undigested.
- The pyloric sphincter at the outlet of the stomach does not open enough or at the right time to allow food to pass through it. This sphincter is controlled by neurological reflexes that ensure that only very small particles leave the stomach and that not too much acid or sugar comes out of the stomach, which could irritate or injure the small intestine. These reflexes depend on nerves, which are sometimes damaged.
- The peristaltic, three-minute contractions of the lower stomach may become out of sync and stop moving stomach contents toward the pyloric sphincter. It usually also has a neurological basis, the most common cause being perennial diabetes, but in many patients the cause of delayed gastric emptying is unknown, so they are diagnosed idiopathic(that is, with an unknown cause) gastroparesis.
Conclusion
The gastrointestinal tract consists of four sections separated by sphincter muscles. These four departments perform different functions and to perform these functions they have Various types muscle contractions. One of these sections is the esophagus, which transports food to the stomach, where it mixes with digestive enzymes and turns into a more or less liquid form. Abnormal motility or sensation in any part of the gastrointestinal tract may cause characteristic symptoms, such as food stuck, pain, heartburn, nausea and vomiting. To determine how adequate the motility of each part of the gastrointestinal tract is, certain studies are performed, based on the results of which physicians, gastroenterologists or surgeons make decisions regarding best option treatment.________________________________________________________________________________
The views of the authors do not necessarily reflect the position of the International Foundation for Functional Gastrointestinal Diseases (IFFGD). IFFGD does not warrant or endorse any product in this publication or any claims made by the author and does not accept any liability regarding such matters.
This article is not intended to replace consultation with a physician. We recommend visiting a doctor if your health problem requires an expert opinion.
The rate of evacuation of liquid and solid food from the stomach can be measured in many ways. With gastroparesis, it is more informative to determine the rate of evacuation of solid food from the stomach, since this process requires vigorous contraction of the antrum of the stomach to mix and push food, while evacuation of liquid can occur under the influence of gravity or due to pressure differences due to contraction bottom of the stomach.
Gamma scintigraphic study is the most informative method for assessing the evacuation function of the stomach. The injected fluids contain chelated particles labeled with technetium or indium isotopes, which prevents the radioactive tracer from binding to solid food or the gastric mucosa. The nature of the evacuation of solid food from the stomach is determined using colloidal sulfur with technetium ("""Te), which binds well to proteins. The first such studies were carried out using chicken liver, into which colloidal sulfur was introduced with 99m Tc. In modern research centers, colloidal a mixture of the drug with chicken eggs or with butter. The degree of gastric emptying is determined by successive measurements of radioactivity in the stomach area, usually over a period of two hours.
There are other ways to study the evacuation function of the stomach. These include ultrasound and real-time nuclear magnetic resonance. Regardless of the research method, many factors can affect the results, such as the composition and amount of food, time of day, body position, gender, age or medications taken, and the subject’s addiction to alcohol and smoking. Even in healthy people different days The results of a study conducted using the same method may differ by 30%. These factors, plus errors in the performance of the study, explain why so often patients with nausea and vomiting have normal results when assessing gastric emptying function.
Manometry
Manometry is the measurement of pressure in the intestinal lumen using either a semi-rigid or water-perfused catheter. In both cases, changes in pressure are transmitted to the recording device. Manometry is indicated more for assessing phasic motor activity than for measuring the actual pressure in the intestinal lumen. Manometry becomes less informative as the diameter of the intestine increases, since small changes in pressure in the lumen are not detected by sensors. Manometry is traditionally performed in “stationary” conditions, where the patient is constantly in the same position throughout the study. Modern technologies make it possible to study motor activity on an “outpatient basis” (although the study becomes longer in time). This allows for a better assessment of both normal and “altered” motor skills in various physiological conditions, not only in a special laboratory.
Delayed gastric emptying refers to the inability of the stomach to properly grind and break down food before it reaches the intestines. In almost all cases, the condition occurs due to damage to the nerve that controls the abdominal muscles, called the vagus nerve. The stomach muscles remain partially or completely paralyzed when the vagus nerve is inactive, greatly affecting digestion. This condition is difficult to treat, but maintaining a specialized diet and taking prescription medications can help relieve bloating, cramping, nausea and other symptoms.
When food is ingested, muscles in the stomach churn the contents and grind the solids into small, soft pieces. The contents are then released into the intestines to extract nutrients and waste from the process. If the vagus nerve is damaged or torn, the muscles cannot help destroy solids. Food is very slowly broken down by stomach acids, which results in delayed gastric emptying.
Doctors have identified several potential risk factors for delayed gastric emptying. Long-term diabetes is the most common cause, as the disease slowly deteriorates the vagus nerve and other nerves in the body. Some people have trouble emptying their stomach after gastric or esophageal surgery due to unintentional damage to the vagus nerve. Patients who are taking drugs that suppress nervous systems, for other disorders are at risk. Rarely, severe bacterial or viral infection stomach problems can deplete your abdominal muscles for a long time.
The most common symptoms of delayed gastric emptying are frequent bouts of bloating, abdominal cramps, nausea and vomiting that begin after eating and can last for several hours. Because solids cannot be processed immediately, people often feel full after eating very small portions of food. If the condition is not treated, a person may experience significant weight loss and malnutrition.
A doctor can diagnose this condition by performing a series of specialized tests. A common test called a gastric emptying study involves taking a radioactive marker that can be tracked as it passes through the gastrointestinal tract. Endoscopy may also be useful to check for undigested solids in the stomach. The doctor usually performs an abdominal x-ray and also rules out other possible reasons, such as cancer tumor or birth defect.
Treatment for delayed gastric emptying depends on the severity of the digestive problems and accompanying symptoms. Most patients turn to clinical nutritionists to develop individual plans diets. Soft products, nutritional supplements, vitamins and plenty of fluids are usually recommended to prevent malnutrition and ease digestion. If diabetes appears to be a major factor, the patient may need to initiate or adjust insulin treatment measures. In addition, doctors usually prescribe medications to combat nausea and vomiting. Surgery to widen the opening of the stomach is considered a definitive option if conservative methods treatments are ineffective.
