Gastric dysmotility is a condition where the stomach’s muscles do not contract and relax in a coordinated manner. This disrupts the normal movement of food, preventing it from moving into the small intestine at the appropriate rate and leading to various uncomfortable digestive issues.
What Gastric Dysmotility Means
The digestive system relies on motility, the coordinated contractions of muscles that move food along the gastrointestinal tract. In the stomach, these muscles churn food, mixing it with digestive juices to break it down into chyme. This semi-liquid substance is then gradually released into the small intestine for further digestion and nutrient absorption. Normally, a solid meal largely empties from the stomach within about 2 hours.
In gastric dysmotility, the stomach muscles do not function correctly, leading to delayed or uncoordinated emptying. This dysfunction can stem from issues with the muscles themselves or the nerves that control them. Gastroparesis, often called delayed gastric emptying, is a common form where food remains in the stomach for an extended period. This delay disrupts the digestive process, affecting nutrient absorption.
Common Causes
Gastric dysmotility can arise from various underlying conditions. Diabetes is a common cause, particularly in long-standing cases of both Type 1 and Type 2 diabetes, leading to diabetic gastroparesis. High blood sugar levels can damage the vagus nerve, which regulates stomach muscle contractions, impairing its ability to send signals for proper food movement. This damage is known as autonomic neuropathy.
Certain medications can also induce or worsen gastric dysmotility. Opioid pain relievers, some antidepressants, and specific drugs for high blood pressure or weight loss are known to slow stomach emptying. Post-surgical complications are another factor, especially after procedures involving the esophagus, stomach, or duodenum, which can inadvertently injure the vagus nerve.
Neurological disorders like Parkinson’s disease and multiple sclerosis can affect the nerves controlling stomach motility, contributing to the condition. Autoimmune diseases, where the body’s immune system mistakenly attacks its own tissues, can also target nerves and muscles in the digestive tract, leading to dysmotility. In a significant number of cases, however, no clear cause is identified, and these are referred to as idiopathic gastroparesis.
Identifying the Symptoms
The symptoms of gastric dysmotility are directly linked to the impaired movement and delayed emptying of food from the stomach. Nausea is a common symptom, often accompanied by vomiting, which can sometimes include undigested food eaten hours earlier. This occurs because food remains in the stomach, causing irritation and a feeling of sickness.
Individuals experience early satiety, meaning they feel full after eating only a small amount of food. This sensation can be so pronounced that it discourages further eating, leading to reduced food intake. Bloating and abdominal pain or discomfort are also common symptoms, resulting from the prolonged presence of food and gas in the stomach.
Loss of appetite and unintentional weight loss can occur as a direct consequence of chronic nausea, vomiting, and early satiety. When the stomach doesn’t empty properly, the body may not absorb enough calories or nutrients, potentially leading to malnutrition. Fluctuations in blood sugar levels can also be observed, particularly in diabetic patients, as the inconsistent emptying of food affects glucose absorption.
Diagnosis and Evaluation
Diagnosis of gastric dysmotility begins with a review of medical history and a physical examination to understand the patient’s symptoms and overall health. Imaging tests, such as an upper endoscopy, upper GI series, CT scan, MRI, or abdominal ultrasound, are performed first to rule out any physical obstruction that could be causing similar symptoms. These tests ensure there is no blockage preventing food from leaving the stomach.
If no obstruction is found, specialized gastric emptying studies assess stomach muscle activity and the rate at which food leaves the stomach. The Gastric Emptying Scintigraphy (GES) is considered the gold standard diagnostic test. In this test, a patient consumes a meal containing a small amount of radioactive material. A scanner then tracks the movement of this material over several hours to measure how quickly food empties from the stomach.
Other tests may also be used to provide additional information or to rule out other conditions. A gastric motility breath test (GEBT) involves consuming a substance that is absorbed and later measured in breath samples to determine emptying rates. In some cases, an electrogastrogram (EGG) might be performed to measure the electrical activity of stomach muscles, providing insights into their function.
Treatment and Management
Managing gastric dysmotility involves a multi-faceted approach, combining dietary adjustments with medical interventions. Dietary modifications are the first step, focusing on eating small, frequent meals throughout the day instead of large ones. This helps prevent the stomach from becoming overly full and reduces symptom severity. Patients are advised to consume low-fat and low-fiber foods, as these are easier for the stomach to digest and empty. Liquid supplements can also be used to ensure adequate nutrition and hydration.
Medications are prescribed to alleviate symptoms and improve stomach emptying. Prokinetics, such as metoclopramide or motilin agonists like erythromycin, stimulate muscle contractions in the stomach and accelerate food movement into the small intestine. Antiemetics are used to control nausea and vomiting.
For severe cases where dietary changes and medications are insufficient, other interventions may be considered. Gastric electrical stimulation (GES) involves surgically implanting a device that delivers mild electrical impulses to the stomach muscles to help improve emptying and reduce symptoms like nausea and vomiting. In instances of severe malnutrition or persistent vomiting, feeding tubes, such as a percutaneous endoscopic gastrostomy with jejunal extension (PEG-J), might be necessary to deliver nutrients directly into the small intestine, bypassing the stomach.