La gastroparésie

Definition

Gastroparesis is a stomach disorder that is defined as delayed gastric emptying. Gastroparesis is a motility disorder, which means that the flow of stomach contents to the small intestine is not delayed by physical obstruction, but rather by dysfunction of muscle contractions allowing food to move through the body. digestive tract.

Etiology

Gastroparesis is usually associated with damage or removal of the vagus nerve, which provides an important connection between the brain and the intestines. In particular, it transmits information to the muscles of the stomach to contract so that food can progress to the small intestine. When this nerve is damaged, food stays in the stomach longer.

There are different factors that can cause damage to the vagus nerve. The most common include diabetes, gastrointestinal surgeries, infections, neurological disease, hypothyroidism, chronic kidney disease, and certain medications. Finally, gastroparesis can also be idiopathic, which means that its cause is unknown.

Symptoms

Symptoms of gastroparesis usually include decreased appetite which can lead to anorexia, nausea, vomiting, bloating, abdominal pain, gastric reflux, feeling of fullness, early satiety, bad breath (halitosis) , hypoglycemia after meals or fluctuating blood sugar in individuals with generally well-controlled diabetes.

Diagnostic

When the doctor suspects gastroparesis, here are the different methods used to make the diagnosis:

  • Scintigraphy, which measures the speed at which food is digested. A tiny radioactive substance is consumed with a light meal. The radiation emitted can be monitored by medical imaging and can monitor the rate at which food passes through the digestive system.
  • The œso-gastro-duodenal transit consists of drinking a barium drink on an empty stomach, while being placed in front of an X-ray machine. Barium is a chalky liquid visible on x-rays, allowing details to be seen in the gastrointestinal tract.

  • Abdominal ultrasound which assesses changes in the surface area of the stomach lining over time after a meal and also helps determine if there are other physical abnormalities that could be causing the symptoms attributed to gastroparesis.

  • Gastroscopy to view with a camera the inner wall of the stomach, esophagus and duodenum

  • Peptic manometry, which involves inserting a long, thin tube that measures muscle pressure and contractions from the digestive tract to the stomach.

Nutritional intervention

Symptoms of gastroparesis can cause various nutritional complications, such as dehydration, due to vomiting, and malnutrition (eg: nutritional deficiencies), due to decreased appetite. The goal of nutritional intervention is therefore to restore hydration, maintain an adequate intake of calories and protein, and restore levels of electrolytes, vitamins and minerals.

Dietary recommendations

Dietary recommendations for gastroparesis typically include:

  • Eat small, frequent meals. Too large meals can slow down gastric emptying.
  • Consume foods in liquid or mashed form. Foods may be better tolerated in these forms depending on the severity of the gastroparesis.
  • Reduce fat and fiber intake, as these nutrients are more difficult to digest.
  • Avoid drinks or carbonated liquids.
  • Monitor iron and vitamin B deficiencies12, vitamin D and calcium, and take supplements if necessary.
  • Have adequate hydration.
  • Eat slowly and chew food well to aid digestion.
  • Be well seated when eating and remain seated for one to two hours afterwards.
  • Have good dental hygiene to prevent corrosion from vomiting.
  • Check blood glucose level if gastroparesis is related to diabetes.

Finally, in the case of severe gastroparesis, where individuals cannot tolerate any food or liquid, dietary recommendations may also include the use of enteral nutrition. The feeding tube is usually placed in the jejunum, a segment of the small intestine, to bypass the paralyzed stomach.

Note that some medications can help alleviate symptoms, but do not treat the underlying disease. Also, people struggling with this disease who are unable to relieve their symptoms by changing their eating habits or taking medication, also have access to various surgical options.

 

References

  1. Bouthillier, Lise. January 2019. Diseases of the digestive tract. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
  2. https://cdhf.ca/fr/digestive-disorders/gastroparesie/
  3. https://badgut.org/centre-information/sujets-de-a-a-z/gastroparesie/lang=frr

 

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