Gastric atony is a loss of stomach muscle tone resulting from damage to nerve fibers or general severe asthenia. The cause of pathology can be any serious disease: peritonitis, infectious diseases, myocardial infarction, surgery, trauma, sudden weight loss, severe stress. It is manifested by pain in the epigastrium, belching, nausea, worsening of symptoms after eating. A diagnosis can be made with the help of gastrography or EGD. Surgical treatment of gastric atony is ineffective, medications that improve gastric motility, diet and physiotherapy are prescribed.
K31.8 Other specified diseases of the stomach and duodenum
Gastric atony – loss of tone by the walls of the stomach, weakening of its peristalsis. The condition is quite rare, occurring against the background of severe diseases, after complex operations or severe stress. Signs of gastric atony are similar to the symptoms of many other pathologies of the gastrointestinal tract. Since this pathology has no specific symptoms, it can be quite difficult to make a diagnosis. According to the observations of specialists in the field of clinical gastroenterology, the disease develops more often in asthenic, emaciated people. Also, constant overeating, the use of a meager amount of fiber predisposes to the loss of stomach tone. Modern methods of treatment are aimed at treating the underlying pathology, restoring gastric motility. Surgery in this situation is not indicated, since atony in most cases recurs after surgical treatment.
Causes of gastric atony
Acute atony of the stomach occurs when the innervation of its walls is disturbed as a result of damage to the nervous system or the influence of certain factors. This condition may occur against the background of myocardial infarction, diffuse peritonitis, severe pneumonia. Also, the formation of blood clots in the vessels of the stomach, stenosis of the pyloric department can lead to atony. In surgical practice, this pathology can develop with injury to the stomach, injury to the spinal cord during surgery, in the postoperative period. Severe infectious diseases (typhoid fever, Lyme disease, legionellosis, botulism, brucellosis, etc.) can also provoke depression of the tone of the gastric walls.
Pathological organ enlargement occurs more often in emaciated and too thin people (with anorexia, alimentary dystrophy, etc.). In this case, the tone of the anterior abdominal wall is reduced, the abdominal muscles are flabby and stretched. If the patient has a congenital elongation of the stomach or its acquired omission (gastroptosis), the probability of developing atonia is very high.
The mechanism of development of gastric atony in case of eating disorders consists in constant irritation of the receptors of the pyloric part of the stomach with coarse, insufficiently crushed food, toxins and extractive substances. The development of the pathological process in severe general diseases is complex, usually includes a violation of both secretory and motor function, which leads to stomach paresis as a result. Pathology of the central nervous system and the endocrine system can lead to disruption of the production of hormones that regulate the functioning of the gastrointestinal tract.
Symptoms of gastric atony
The symptoms of pathology are nonspecific, inherent in most other diseases of the stomach and intestines. Patients complain of a feeling of pressure and heaviness in the epigastric region, swelling in the stomach. Abdominal pain may occur. Heartburn, nausea, belching with a lot of air and food, bad breath are characteristic. Vomiting is periodically noted with a large amount of liquid contents with an admixture of greenery. Characterized by rapid saturation after the first portions of food. With acute expansion of the stomach, the patient is pale, covered with cold sweat, he has tachycardia and arterial hypotension.
When examining the patient, attention is drawn to the bulging in the projection of the stomach, the noise of splashing during its palpation. With percussion (tapping) a characteristic “drumming” sound (tympanitis) is heard above the stomach. The boundaries of the stomach are significantly expanded to the right and down. When a gastric tube is inserted, the liquid contents are evacuated very quickly from the stomach, bringing significant relief to the patient. If the patient is not helped in time, circulatory disorders begin in the stomach wall, its rupture may occur. Stagnation of the contents in the stomach often leads to gastritis.
The main method of diagnosing gastric atony is gastrography or endoscopic examination of the gastrointestinal tract (esophagogastroduodenoscopy). On radiography with contrast, a pattern characteristic of this disease is noted: the contrast, getting from the esophagus into the stomach, is immediately sent to the bottom of the stomach. The peristalsis of the stomach walls is usually significantly reduced. Due to atony, the stomach acquires an elongated vertical shape with a significantly lowered bottom and a characteristic “waist”. The evacuation of contrast is slowed down, its remnants can be detected in the stomach more than six hours after the start of the study.
With EGD, a significantly expanded stomach cavity is visible, filled with a huge amount of stagnant contents. Mucosal folds are preserved, but peristalsis is significantly weakened. During EGD, intragastric manometry is possible, which helps to identify paresis of the gastric muscles. Low waves with large intervals are recorded on electrogastrography. Any functional disorders are characterized by a wide variety and variability of the electrogastrographic picture over a short period of time.
The disease should be differentiated from other gastrointestinal pathology. If nausea and vomiting are accompanied by dizziness, hearing loss and tinnitus, Meniere’s syndrome should be excluded. Repeated vomiting without weight loss and deterioration of the general condition can be psychogenic. If after vomiting, abdominal pain significantly weakens or passes, this may be a sign of stomach ulcers. Acidity in gastric atony is usually normal or moderately elevated. With a significant increase or decrease in the pH of gastric juice, you should think about other diseases.
Treatment for gastric atony
Patients with this rare pathology should be closely treated by a gastroenterologist, a specialized specialist (treating the underlying disease), a psychotherapist, a nutritionist and a physiotherapist. First of all, after the diagnosis is made, a thick gastric tube should be placed and all its contents evacuated to prevent stomach rupture. Active attention should be directed to the treatment of the underlying disease. The patient is prescribed a therapeutic diet (table No. 2): the food should be liquid and easily digestible, divided into 7-10 meals a day in fractional portions. The diet includes a large amount of fiber, vitamins. You should also drink a little in small portions.
Medical treatment includes drugs that improve the motility of the stomach, vitamins and general tonic. If the disease has developed against the background of severe asthenia, anabolic steroids and hydrolyzed proteins are prescribed. Drugs that stimulate tissue repair are also shown. With moderate hypotension, potassium and calcium preparations can be prescribed, and with severe – neostigmine.
Prognosis and prevention
The course of gastric atony is usually prolonged, recurrent. Acute gastric dilation in myocardial infarction, pancreatitis, peritonitis and thrombosis of gastric vessels can lead to death. For the prevention of the disease and its relapses, spa treatment in a sea or mountain climate, moderate physical activity to increase the overall tone and strengthen the anterior abdominal wall, treatment with mineral waters is recommended. Failure to observe the correct daily routine and nutrition, smoking, alcohol intake aggravate the course of the disease and provoke its relapses.