Gastroparesis

Clinic

• Also called delayed gastric emptying, is an entity belonged to category of GI motility disorders
• Weak peristalsis of stomach, resulting in prolonged food and liquid remaining in stomach
• This can result in irregular absorption of nutrients, inadequate nutrition, and poor glycemic control.
• Probable mechanism is autonomic neuropathy (Vagus nerve)
• Uncontrolled diabetes mellitus is its major causation.
• Other causes include post-infectious and trauma to the vagus nerve.
• Idiopathic gastroparesis (33% of all chronic cases); Due to an autoimmune response triggered by an acute viral infection:
  1. Gastroenteritis
  2. Mononucleosis

Signs / Symptoms

• Symptoms include Nausea (Esp Morning), Vomiting, Abdominal pain, Early satiety, Abdominal bloating and Heartburn.

• Other symptoms:
  • Myalgia
  • Erratic blood glucose levels
  • Lack of appetite
  • Muscle weakness
  • Night sweats
  • Palpitations
  • Spasms of the stomach wall
  • Constipation or infrequent bowel movements
  • Weight loss, malnutrition
  • Dysphagia

Miasms

PLV

Fantastically, many accompanied Sign / Symptoms of Gasteroparesis are similar to PLV such as muscular weakness, Dyspahgia

Related entities

• GERD
• Ileus
• Achalasia
• Gastritis

Related Disease

• Connective tissue diseases such as scleroderma
• Ehlers–Danlos syndrome
• Parkinson's disease
• Multiple system atrophy. It may occur as part of a mitochondrial disease.
• Opioids and anticholinergic medications can cause medication-induced gastroparesis.
• Damage to the vagus nerve, such as abdominal surgery
• Heavy cigarette smoking

Mechanism

• On the molecular level, it is thought that gastroparesis can be caused by the loss of neuronal nitric oxide expression
• Other important components of the stomach are the interstitial cells of Cajal (ICC) which act as a pacemaker since they transduce signals from motor neurons to produce an electrical rhythm

Pathogenesis of symptoms in diabetic gastroparesis include:

• Loss of gastric neurons containing nitric oxide synthase (NOS) is responsible for defective accommodation reflex, which leads to early satiety and postprandial fullness.
• Impaired electromechanical activity in the myenteric plexus is responsible for delayed gastric emptying, resulting in nausea and vomiting.
• Sensory neuropathy in the gastric wall may be responsible for epigastric pain.
• Abnormal pacemaker activity (tachybradyarrhythmia) may generate a noxious signal transmitted to the CNS to evoke nausea and vomiting.

Gastroparesis black box

Entities	Miasms	Remedies
Gastric Dilation	PLV	GELS PLB, LACH, BELL Caust, Sil Op, Hell, Cocc, Alum, Sulph, Phos, Merc, Agar

Remedies

Abdominal Bloating	Lyc	The bloating is noted even after eating a little bit of food. Constrictive pains in the stomach that are relieved by rubbing the stomach. (Maybe) There may be a gnawing and gripping sensation in the stomach, and clothes around the stomach may cause uneasiness. Loss of appetite Coldness in the stomach Violent hiccoughs.
Vomiting of Food	Hydr	Sensation of a lump in the stomach followed by regurgitation that causes vomiting of the food eaten Distressing and cutting pain in the stomach (Maybe) Weakness and weight loss.
Stomach Pain after Eating	Puls	Pain usually begins an hour after eating. Chilly Tightness in the stomach (Maybe) Stomach is sensitive to the least pressure. Belching that tastes like food may be present Symptoms tend to get work after eating fatty food and fruits. Dry mouth, bitter taste in the mouth and a lack of thirst.
Weight in Stomach	Chin	Weak and slow digestion Belching of bitter taste is present Food may be regurgitated Rumbling and pulsating sensation at pit of stomach.
Hard Knot in Stomach	Nux-v	Stomach area is sensitive to touch Nausea or vomiting, and retching. (Maybe) The vomit contains undigested food or greenish matter. Vomiting relieves nausea. Sour taste in the mouth. (Chin ₳ Nux-v)
Fetid Belchings	Bism	Food lies in the stomach for several days due to weak digestion. Pressure / Sensation of a load in the stomach after eating, which is followed by vomiting Stomach pain amel by bending backward
Heartburn/ Acid Reflux	Carb-v	Sour belchings / Water brash after eating + Fullness and a tensed sensation in stomach. Epigastric region is sensitive and tender to touch. Contractive pain in stomach extending to the chest Even eating the simplest kind of food agg him