A slow
stomach is a common term that is used to describe delayed gastric
emptying. This means that the contents of the stomach are not released into the
duodenum at a normal rate. It may be related to a disorder with the :
- stomach nerves and neurotransmitters
- digestive hormones
- smooth muscle of the stomach wall
- mechanical obstruction
Gastroparesis is delayed gastric emptying
with no mechanical obstruction to the flow of gastric contents. Gastric
outlet obstruction on the other hand is when there is a mechanical
obstruction to the flow of gastric contents out of the stomach.
Causes of Slow Gastric Emptying
It is important
to understand the process of gastric emptying and that factors that promote and
inhibit it.
Gastroparesis,
sometimes called delayed stomach emptying, is caused by nerve damage to the
digestive tract. In addition to causing gastrointestinal distress, gastroparesis
can also have a major impact on blood glucose levels. Symptoms include vomiting,
nausea, reflux, weight loss, heartburn, and early satiety (or feeling of
fullness). Management of gastroparesis in people with diabetes can be difficult,
but there are several drug options and investigational devices available for
treatment.
Gastroparesis
Causes of
gastroparesis include :
- Diabetic neuropathy
- Anorexia nervosa and bulimia (refer to Effects of Eating Disorders)
- GERD (gastroesophageal reflux disease)
- Hypothyroidism
- Sclerodoma
- Amyloidosis of the gastric musculature
- Parkinson’s disease
- Viral infections
- Surgery affecting the vagus nerve
- Chemotherapy
- Drugs
- Opiates
- Calcium channel antagonists
- Anticholinergics like tricyclic antidepressants and phenothiazines
Gastric Outlet Obstruction
The mechanical
obstruction may lie in the duodenum or within the pyloric channel (intrinsic).
Any mass outside of the organs surrounding the stomach and duodenum may also
cause an obstruction to the flow of chyme (extrinsic).
Causes of
gastric outlet obstruction include :
- Pyloric edema due to gastritis or peptic ulcer
- Pyloric stenosis
- Fibrotic stricture of duodenal ulcer
- Adult hypertrophic pyloric stenosis
- Gastric polyps
- Cancer
- pancreas
- stomach
- duodenum
- bile ducts (cholangiocarcinoma)
- Congenital duodenal webs
- Pancreatic pseudocysts
- Gallstone obstruction
Any disruption
in normal gastric emptying causes a build up of undigested food, partially digested food particles, and chyme. Further
eating or drinking may cause a backflow resulting in nausea and
vomiting. The fairly ’stagnant’ gastric contents are prone to bacterial
overgrowth within the stomach resulting in fermentation of food. Partially
digested food can coalesce and harden into solid masses known as bezoars. This
can cause further obstruction of the pyloric canal.
Signs and Symptoms of Gastroparesis and Gastric Outlet Obstruction
Gastroparesis and gastric outlet
obstruction are usually of a gradual onset. However, gastroparesis due
to vagal nerve damage after surgery may result in the sudden onset of the signs and symptoms
of delayed gastric emptying. The most severe symptoms may be noted in
complete gastric outlet obstruction which is rare unless the condition has been
left untreated for a prolonged period of time.
Electrical
Gastrointestinal Pacemaker
In June, surgeons implanted a pacemaker in a
16-year-old patient with gastroparesis, a debilitating stomach condition that
affects the way the body processes food. This is the first time the procedure
has been performed in a child at Nationwide Children’s Hospital, which is now
one of only a handful of institutions across the country offering this type of
treatment in children.
Gastroparesis is a condition where the stomach contracts less often and less powerfully, causing food and liquids to stay in the stomach for a long time. In as many as 60 percent of children with gastroparesis, the cause is not known. The condition often leaves children feeling constantly bloated and nauseated and can result in malnourishment and significant weight loss. In severe cases, symptoms may prevent children from attending school or taking part in other daily activities.
The pacemaker is inserted into the abdomen, with electrical wires leading to the stomach. It sends electrical impulses to stimulate the stomach after eating.
"The pacemaker is surgically implanted under the skin and is connected to two electrodes placed on the stomach wall. It tells the stomach to empty at a certain frequency. The initial settings are fairly low and, as with a pacemaker in the heart, we can change the settings as needed,” explained pediatric surgeon Steven Teich, MD, surgical director of the Bariatric Surgery Program at Nationwide Children’s Hospital and clinical assistant professor of surgery at The Ohio State University College of Medicine. “It empties the stomach, alleviating bloating, vomiting and nausea.”
Gastroenterology, Hepatology and Nutrition at Nationwide Children's Hospital is one of the leading programs in the country in the field of diagnosing and treating gastrointestinal motility problems in children. It is the only children’s hospital in the nation that offers the full spectrum of treatment options for motility disorders, including diagnosis, medications, endoscopic procedures, surgical options, pacemakers and follow up care.
Pacemakers have been used for years in adults with delayed gastric emptying. Nationwide Children’s received IRB approval to implant the device in children as a humanitarian device exemption (HDE), and although this is a new procedure in children and adolescents, doctors at Nationwide Children’s say the early results are promising.
“In patients who have received this type of treatment, nearly all symptoms were resolved within two weeks,” said pediatric gastroenterologist Hayat Mousa, MD, medical director of the Motility Center at Nationwide Children’s Hospital and associate professor of Clinical Pediatrics at The Ohio State University College of Medicine. “Previous treatment options, including medications, have been much less effective.”
Thought to Be An Eating Disorder Not eating, throwing up and losing weight are all clear signs of an eating disorder. So it was no wonder when family members, friends and doctors thought that 14-year-old Gentrie Hansen had one after she lost 30 pounds in seven months.
The difference with Gentrie's symptoms is that she wanted to eat. "I would gladly take some weight and then be healthy and be happy," Gentrie told TODAY's Ann Curry in an interview. But even a small bite of food or beverage would make her throw up.
She was experiencing what doctors later found out was gastroparesis -- a rare neurological disease where the stomach doesn't empty properly. "The nerves and the muscles aren't coordinated so food goes into the stomach and can't get out, so the only way to get it out is through vomiting," said NBC's chief medical examiner, Dr Nancy Snyderman.
After dozens of failed therapies and medications doctors inserted a pacemaker into Gentrie's stomach. "It works like a pacemaker for the heart sending signals to nerves so the muscles will work normally," says Dr. Snyderman.
"It was really frustrating having people tell me I had an eating disorder when I knew I had a disease," says Gentrie. "It was the worst part of the sickness."
Having an actual diagnoses was a blessing and a curse for the Hansens. "You're so glad there's something to go forward with and try to understand, but at the same time you realize it's a lifelong disease without a cure," says Gentrie's mom.
Gastroparesis is a condition where the stomach contracts less often and less powerfully, causing food and liquids to stay in the stomach for a long time. In as many as 60 percent of children with gastroparesis, the cause is not known. The condition often leaves children feeling constantly bloated and nauseated and can result in malnourishment and significant weight loss. In severe cases, symptoms may prevent children from attending school or taking part in other daily activities.
The pacemaker is inserted into the abdomen, with electrical wires leading to the stomach. It sends electrical impulses to stimulate the stomach after eating.
"The pacemaker is surgically implanted under the skin and is connected to two electrodes placed on the stomach wall. It tells the stomach to empty at a certain frequency. The initial settings are fairly low and, as with a pacemaker in the heart, we can change the settings as needed,” explained pediatric surgeon Steven Teich, MD, surgical director of the Bariatric Surgery Program at Nationwide Children’s Hospital and clinical assistant professor of surgery at The Ohio State University College of Medicine. “It empties the stomach, alleviating bloating, vomiting and nausea.”
Gastroenterology, Hepatology and Nutrition at Nationwide Children's Hospital is one of the leading programs in the country in the field of diagnosing and treating gastrointestinal motility problems in children. It is the only children’s hospital in the nation that offers the full spectrum of treatment options for motility disorders, including diagnosis, medications, endoscopic procedures, surgical options, pacemakers and follow up care.
Pacemakers have been used for years in adults with delayed gastric emptying. Nationwide Children’s received IRB approval to implant the device in children as a humanitarian device exemption (HDE), and although this is a new procedure in children and adolescents, doctors at Nationwide Children’s say the early results are promising.
“In patients who have received this type of treatment, nearly all symptoms were resolved within two weeks,” said pediatric gastroenterologist Hayat Mousa, MD, medical director of the Motility Center at Nationwide Children’s Hospital and associate professor of Clinical Pediatrics at The Ohio State University College of Medicine. “Previous treatment options, including medications, have been much less effective.”
Thought to Be An Eating Disorder Not eating, throwing up and losing weight are all clear signs of an eating disorder. So it was no wonder when family members, friends and doctors thought that 14-year-old Gentrie Hansen had one after she lost 30 pounds in seven months.
The difference with Gentrie's symptoms is that she wanted to eat. "I would gladly take some weight and then be healthy and be happy," Gentrie told TODAY's Ann Curry in an interview. But even a small bite of food or beverage would make her throw up.
She was experiencing what doctors later found out was gastroparesis -- a rare neurological disease where the stomach doesn't empty properly. "The nerves and the muscles aren't coordinated so food goes into the stomach and can't get out, so the only way to get it out is through vomiting," said NBC's chief medical examiner, Dr Nancy Snyderman.
After dozens of failed therapies and medications doctors inserted a pacemaker into Gentrie's stomach. "It works like a pacemaker for the heart sending signals to nerves so the muscles will work normally," says Dr. Snyderman.
"It was really frustrating having people tell me I had an eating disorder when I knew I had a disease," says Gentrie. "It was the worst part of the sickness."
Having an actual diagnoses was a blessing and a curse for the Hansens. "You're so glad there's something to go forward with and try to understand, but at the same time you realize it's a lifelong disease without a cure," says Gentrie's mom.
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