Gastric dyskinesia is a functional disorder of the contractile activity of the organ, which can occur in hyperkinetic and hypokinetic types (up to complete atony). The main signs of pathology are abdominal pain of varying intensity without a clear localization, unrelated to food intake, as well as dyspeptic phenomena. Diagnosis is based on a characteristic clinical picture, X-ray determination of motor disorders and the absence of histological signs of organic pathology. The treatment is complex, aimed at correcting neuropsychic disorders and gastric motility; physiotherapy is effective.
Meaning
Gastric dyskinesia is a functional disorder characterized by impaired gastric motility; it can occur with dyspeptic phenomena and pain syndrome, however, gastroscopy does not reveal organic changes. In modern gastroenterology, dyskinesia is a fairly common disease: in about a third of patients complaining from the gastrointestinal tract, it is not possible to detect morphological changes.
This pathology is common in young people, as well as in patients with functional or organic diseases of the central nervous system. Many experts believe that such a diagnosis is often mistakenly made at the initial stages of diseases of the digestive, endocrine, urinary, and nervous systems, and this is associated with the problem of overdiagnosis. Therefore, at present, the diagnosis of dyskinesia is valid only after the exclusion of organic changes in the stomach using all available diagnostic methods.
Causes of gastric dyskinesia
The most common causes of gastric dyskinesia are alimentary factors: irrational nutrition (especially the lack of a regular rhythm), frequent dry food, too fast food intake without sufficient mechanical and enzymatic processing in the oral cavity; predominance of carbohydrate products in the diet, deficiency of vitamins and trace elements, protein; abuse of spicy and fatty. Violation of gastric motility can be a manifestation of an allergic reaction of the body to food products, most often cow’s milk proteins, eggs, fish.
Dyskinesia also occurs as a result of the toxic effects of chemicals, alcohol, nicotine. When exposed to such exogenous factors, irritation of the chemo- and baroreceptors of the stomach occurs. An important role in the etiology of dyskinesia is assigned to diseases of the nervous system: both frequent neuropsychiatric stresses and severe organic changes (stroke, intracerebral tumors, encephalitis).
Common exogenous etiological factors of gastric dyskinesia are high ambient temperature, the effect of ionizing radiation and vibration, burns. Possible violation of the motor function of the stomach when taking certain medications that affect the autonomic nervous system, hypothalamus, endocrine organs.
Of the endogenous factors, other diseases of the digestive system most often lead to disorders of gastric motility: cholecystitis, pancreatitis, enteritis. Pathology can be provoked by viral hepatitis. Sometimes gastric dyskinesia up to atony is one of the symptoms of heart and vascular diseases, in particular, myocardial infarction. It is possible to reduce motor skills and with hypertension, rheumatism.
Functional changes in the stomach can develop in any diseases accompanied by intoxication. Quite often, dyskinesia accompanies purulent-inflammatory lung diseases (including tuberculosis), kidney pathology, as well as the endocrine system. In the development of functional disorders in somatic pathology, the main role is assigned to viscero-visceral reflexes and the effects of neurohumoral mechanisms (disruption of the production of gastrointestinal hormones, digestive enzymes and other substances).
Classification
Depending on the type of motor disorders, hypertonic (with increased motor function), hypotonic (with reduced) and atonic gastric dyskinesia are distinguished. According to the prevailing clinical syndrome, the disease is classified into painful, dyspeptic and mixed types. Dyskinesia is also divided into exogenous, in which functional disorders of the stomach are caused by external factors (more often alimentary), and endogenous, arising from the pathology of other organs and systems. Some authors distinguish the following variants of the course of pathology:
- Achalasia of the cardia is a spastic contraction of the stomach cardia, characterized by difficulty swallowing, pronounced pain behind the sternum.
- Pylorospasm is a spasm of the pyloric department, accompanied by a violation of the evacuation of stomach contents and acid belching, pain in the epigastrium.
- Tetany – convulsive stomach cramps with intense pain and gastrocardium syndrome.
- Acute gastric dilation – occurs with chronic overeating and in the postoperative period, when the tone of the stomach is significantly reduced.
- Aerophagia is a functional disorder caused by rapid ingestion of food with a large amount of air.
Symptoms of gastric dyskinesia
The main manifestation of pathology is a pain syndrome in the abdominal area without a clear localization. Pain can occur in the epigastrium, hypochondria, and the umbilical region, while the duration of the attack varies from several minutes and hours to weeks. The nature of sensations may also differ: some patients describe intense cramping pains, others – aching, pressing (this depends on the nature and degree of motor impairment). The occurrence of such signs is not associated with food intake or its absence, but more often with a neuropsychic factor.
In the presence of antiperistaltic contractions of the muscular layer of the stomach and the throwing of acidic contents into the esophagus, patients are concerned about heartburn, acid belching. A marked decrease in the contractile activity of the stomach leads to stagnation of its contents, the appearance of rotten belching. Dyskinesia, which has developed against the background of central nervous system pathology and irritation of the emetic center, is accompanied by copious repeated vomiting, which does not bring relief.
All the above-described signs of impaired gastric motility may have different intensity and are not specific – patients make such complaints with a variety of other diseases. But gastric dyskinesia is characterized by the association of the development of symptoms with mental trauma and stress, the presence of common manifestations of neurosis, the variability of complaints and their reduction at night, as well as the absence of signs of organic pathology during endoscopic and histological examination.
Diagnostics
The basis for the diagnosis of gastric dyskinesia is the exclusion of organic pathology in the presence of a characteristic clinical picture. During the consultation of a gastroenterologist, the type of motor changes and the probable etiological factor (neuropsychiatric changes, irrational diet, work and rest, existing diseases) are presumably established. During palpation of the abdomen, it is possible to detect soreness, with atony of the stomach, a percussion specialist can determine the expansion of the boundaries of the organ.
Disorders of gastric motility can be detected by electrogastrography – a method of registering electrical potentials during the contraction of the muscular layer of the organ. Gastric dyskinesia is characterized by high variability of the results of electrophysiological examination in the time interval. Stomach fluoroscopy is highly informative, which makes it possible to determine spasm or hypotension of the organ, peristalsis disorders, gastroesophageal reflux, organ prolapse, pylorospasm or cardiospasm.
Mandatory diagnostic methods include gastroscopy: a characteristic endoscopic picture is the thickening of the folds of the gastric mucosa without its macroscopic changes. During the study, spastic contractions of the stomach may occur when even a small amount of air is injected. In the process of esophagogastroduodenoscopy, a biopsy is necessarily performed, since it is the absence of histological changes that is the most important differential diagnostic criterion for dyskinesia.
Treatment of gastric dyskinesia
Treatment of this pathology is usually carried out on an outpatient basis, hospitalization may be required with severe pain syndrome in order to perform diagnostic procedures. A mandatory measure is the correction of nutrition: compliance with the regime, the volume of portions of food. In order to normalize the nervous regulation of motor skills, neurotropic and psychotropic drugs, sedatives are prescribed. Correction of the contractile activity of the stomach with hyperkinesia is carried out by M-cholinolytics, with hypokinesia, caffeine, euphyllin are prescribed, in the case of atonia – neostigmine.
Most often, dyskinesia is combined with pathology of the secretory function of the stomach, therefore, a mandatory component of treatment is replacement therapy (natural gastric juice, pepsin, preparations of pancreatic enzymes). Physiotherapy is highly effective in gastric dyskinesia: electrophoresis with novocaine, warming procedures, mud applications, diathermy, paraffin treatment and ozokeritotherapy. The choice of the technique is determined by the type of motor impairment and the leading clinical syndrome.
Prognosis and prevention
The prognosis for gastric dyskinesia is favorable: the disease lends itself well to correction, the ability to work is preserved. Patients are subject to medical examination, since with inadequate treatment of the disease and its long course, pronounced destructive changes in the gastric mucosa are possible. Prevention consists in timely and effective treatment of pathology of the gastrointestinal tract and other systems. In order to reduce the frequency of exacerbations, sanatorium treatment, correction of work and rest, nutrition are recommended.