Delay Emptying and Rapid Emptying: Disorder of Gastric Motility
Disorder of gastric motility can be divided into the broad categories of delay and rapid emptying. The generalized symptoms of both disorder overlap.
Delayed gastric emptying is common is diabetes mellitus and may be related to disorder of the vagus nerves, as part of a spectrum of autonomic neuropathy. Surgical vagotomy results in a rapid emptying of liquid and delayed emptying of solids. As mentioned later, vagotomy impairs adaptive relaxation and results in increased contractile tone in the reservoir. Increased pressure in the gastric antral pump. Paralysis with a loss of propulsive motility in the antrum occurs after a vagotomy. The result in gastroparesis, which can account for the delayed emptying of solids after a vagotomy. When selective vagotomy is performed as a treatment for peptic ulcer disease, the pylorus is enlarged surgically (pyloroplasty) to compensate for postvagotomy gastroparesis.
Delayed gastric emptying with no demonstrable underlying condition is common. Up to 80% of patients with anorexia nervosa have delayed gastric emptying of solids. Another such condition is idiopathic gastric stasis, in which no evidence of an underlying condition can be found. Motility-stimulating drugs are used successfully in treating these patients. In children, hypertrophic pyloric stenosis impedes gastric emptying. This is a thickening of the muscles of the pyloric canal associated with a loss of enteric neurons. The absence of inhibitory motor neurons and the failure of the circular muscles to relax account for the obstruction stenosis.
Rapid gastric emptying often occurs in patients who have had both vagotomy and gastric antrectomy for the treatment of peptic ulcer disease. These individuals have rapid emptying of solids and liquids. The pathological effects are referred to the dumping syndrome, which results form the dumping of large osmotic loads into the proximal small intestine.
References:
- Sabiston textbook of surgery 18th edition
- Bailey and love, surgery 25th edition
- The Washington manual of surgery, 5th edition.
- emedicine.medscape.com
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