The function of the digestive system is consumption and digestion, absorption, and elimination. Mechanical digestion happens when a person starts chewing on their food and their saliva breaks down the food; created by the salivary glands. Mucus is also secreted from the salivary glands to help guide food down when swallow. The food is then pass through the pharynx into the esophagus. “Peristalsis is a wavelike series of involuntarily muscular contractions that propel solid and semisolid materials through the tubular alimentary canal”(Bontrager, Lampignano, & Kendrick, 2018). The stomach is located in between the esophagus and small intestine; it joins the esophagus at the esophagogastric junction which is close to the diaphragm.
As the stomach holds fluid and food it enlarges. Within the stomach rugae are present, these rugae are also known as mucosal folds. On the medial side of the stomach, the rugae guide fluids down to the distal part of the stomach, the pylorus. Rugae is found in the stomach as an aid for mechanical digestion (Bontrager, Lampignano, & Kendrick, 2018).
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According to Picco (2018), on average a healthy individual takes about six to eight hours for food to pass to the stomach into the small intestine. Gastroparesis is when the stomach is not able to process the food content out at the usual rate of emptying. With gastroparesis the motility of the stomach decrease. This could cause medical health problems due to the stomach retaining the food and fluids in the stomach. There is no mechanical obstruction within the stomach or the small intestine to cause gastroparesis.
Some symptoms that correlate with gastroparesis is malnutrition, extreme weight loss, feeling full with only a small meal, bloating, nausea, vomiting, and abdominal pain (Liu & Abell, 2017). There are three categories of gastroparesis: idiopathic, diabetic, and postsurgical. Idiopathic is defined as an unknown cause of a condition; this category is most commonly seen.
Postsurgical gastroparesis has also become common in patient that has gone through with a bariatric surgery and fundoplication surgery. The patient experiences gastroparesis symptoms within the first 3 months after surgery. However, within a year the patient no longer have the symptoms. “The other rare causes of gastroparesis include diseases such as Parkinsonism, amyloidosis, paraneoplastic disease, scleroderma and mesenteric ischemia” (Liu & Abell, 2017). There are certain disease or condition such as diabetes that may be a reason for a patient experiencing gastroparesis. Therefore, the patient should be tested for a health assessment to rule out any possibility of contributing to gastroparesis (Liu & Abell).
Gastroparesis occurs more in young women than in men. A study mentioned that due to the small amount of neuronal nitric oxide synthase(nNOS) which “control the muscle tone of the lower esophageal sphincter, the pylorus, the sphincter of Oddi, and the anus…It also modulates the accommodative reflex of the fundus and the peristaltic reflex of the small intestine” (Oh & Parsricha, 2013). With the depletion of nNOS, interstitial cells of Cajal (ICC) are also reduced which causes gastroparesis specifically in the distal part of the stomach. Studies have shown that diabetic gastroparesis is particularly affected by the nNOS and ICC.
ICC function is to signal for motility in the stomach (Oh & Parsricha). To ensure if someone has gastroparesis a full history of symptoms should be attained and see if it is related to gastroparesis. By doing so, this eliminates the possibility of gastric obstruction as the reason. Furthermore, an emptying exam should be in place to see if there is a loss of contraction or movement in the stomach. Due to unknown causes of gastroparesis patient care plan or treatment is different and there is no specific cure for gastroparesis.
Diet plays a big role to decrease the symptoms related to gastroparesis. Incorporating multiple meals a day, but in smaller portion with specific types of food content is advise. While consuming a meal it should be thoroughly chewed into little pieces. This all contributes to decreasing the symptoms of gastroparesis. Other possible intakes of “alcoholic beverages, carbonated drinks, and cigarette smoking should be avoided as modifiable factors that affect emptying. Heavy lipid containing foods should also be avoided since they potentially also slow down emptying” (Liu & Abell, 2017).
Another way for nutrition is a nasojejunal tube if patient struggle with swallowing or any oral intake. The patient should also monitor blood sugar levels since studies have indicated a relation between high glucose resulting gastroparesis symptoms. For medication, prokinetic is widely used for gastroparesis.
Metoclopramide is a type of prokinetic medications that could be administrated “intravenous, intramuscular, oral, and liquid form” (Liu & Abell, 2017). However, a lot of medications treatment has a side effect which could cause complications. Besides medication a gastric electrical stimulator is a device that is placed in the stomach; this is considered a therapeutic choice. The gastric electrical stimulator has a pulse generator with electrodes implanted in the wall of the stomach.
A patient who has this device has shown a significant decrease in gastroparesis symptoms. Surgery is another option for treating gastroparesis. Either there is a surgical repair of the pylorus by widening the pylorus section or removal of the stomach which could be a section or the whole stomach. This is usually considered if the patient is leading up to renal failure. Other treatment should be done first before resorting to surgical procedure due to limited cases of long-term outcomes (Liu & Abell).
The status of a patient health have related certain condition that may lead up to the patient experiencing gastroparesis but, in some case, there are no findings as to why. Gastroparesis has no definite cause which makes it hard to find the underlying of gastroparesis. However, with the continue and researching on gastroparesis new understanding concludes to better improvements in treatment and in diagnosis.
