Disturbance of motility of a stomach
- Symptoms of Disturbance of motility of a stomach
- Causes of infringement of motility of a stomach
- Treatment of Disturbance of motility of a stomach
Disturbances of a tone of MMC of a muscular coat of a stomach (including muscular sphincters), a vermicular movement of a stomach and evacuation of contents of a stomach belong to disorders of motility of a stomach.
- Disturbances of a tone of a muscular coat of a stomach: excess increase (hyper tone), excessive decrease (hypotone) and an atony — lack of a muscle tone. Changes of a muscle tone lead to disturbances of a peristole — embracing of food masses a wall of a stomach and formation of a portion of food for intragastric digestion, and also its evacuation in a duodenum.
- Disorders of activity of muscular sphincters of a stomach in the form of decrease (up to their atony; causes long opening — "gaping" of cardial and/or peloric sphincters) and increases in a tone and a spasm of muscles of sphincters (lead to a cardiospasm and/or a pylorospasm).
- Disturbances of a vermicular movement of a stomach in the form of its acceleration (hyperkinesia) and delays (hypokinesis).
- Disorders of evacuation. The combined and/or separate frustration of a tone and vermicular movement of a wall of a stomach lead either to acceleration, or to delay of evacuation of food from a stomach.
Symptoms of Disturbance of motility of a stomach:
As a result of disturbances of motility of a stomach development of a syndrome of early saturation, heartburn, nausea, vomiting and a dumping syndrome is possible.
- Syndrome of early (bystry) saturation. Is result of decrease in a tone and motility of antral department of a stomach. Reception of a small amount of food causes feeling of weight and overflow of a stomach. It creates subjective feelings of saturation.
- Heartburn — a burning sensation in the field of the lower part of a gullet (result of decrease in a tone of a cardial sphincter of a stomach, the lower sphincter of a gullet and throwing in it acid gastric contents).
- Nausea. At subthreshold excitement of the emetic center nausea — the unpleasant, painless subjective feeling preceding vomiting develops.
Causes of infringement of motility of a stomach:
- Disturbances of nervous control of motive function of a stomach: strengthening of influences of a vagus nerve stimulates its motor function, and activation of effects of a sympathetic nervous system suppresses it.
- Disorders of humoral regulation of a stomach. For example, high concentration in gastric cavities of hydrochloric acid, and also secretin, cholecystokinin brake motility of a stomach. On the contrary, gastrin, мотилин, the reduced content of hydrochloric acid stimulate motility in a stomach.
- Pathological processes in a stomach (erosion, ulcers, hems, tumors can weaken or increase its motility depending on their localization or expressiveness of process).
Treatment of Disturbance of motility of a stomach:
Medicamentous therapy of the diseases which are followed by weakening of a tone and vermicular movement of various departments of digestive tract (a gastroesophageal reflux disease and a reflux esophagitis, reflyuksopodobny and diskinetichesky options of functional dyspepsia, hypomotor dyskinesia of a duodenum and biliary tract, hypomotor option of a syndrome of the angry intestines, etc.), includes use of the drugs increasing motility of a digestive tract.
The medicines which are appointed for this purpose (these drugs
received the name of prokinetics), have the effect or by means of stimulation of holinoretseptor (Carbacholinum, cholinesterase inhibitors), or due to blockade of dopamine receptors. Attempts of use of pro-kinetic properties of an antibiotic of erythromycin which are made in recent years face with high frequency its side effects caused by the main (antibacterial) activity of drug and remain for the present at a stage of pilot studies. Also were not beyond still experimental works
researches of pro-kinetic activity of other groups of drugs: antagonists of 5-HT3-retseptorov (tropizetron, ondansetron), somatostatin and its synthetic analogs (oktreotid), antagonists of cholecystokinin (asperlitsin, loksiglumid), agonists kappa receptors (fedototsina), etc.
As for Carbacholinum and inhibitors of cholinesterase, because of the system nature of their cholinergic action (increase in production of saliva, increase in secretion of hydrochloric acid, a bronchospasm) these drugs are used in modern clinical practice also rather seldom.
Long time Metoclopramidum remained the only drug from group of blockers of dopamine receptors. Experience of its use showed, however, that pro-kinetic properties of Metoclopramidum are combined with its central side effect (development of ektrapiramidny reactions) and the giperprolaktinemichesky effect leading to emergence of a galactorrhoea and amenorrhea, and also gynecomastia.
Domperidon is also a blocker of dopamine receptors, however, unlike Metoclopramidum, it does not get through a blood-brain barrier and does not give, thus, the central collateral manifestations.
Pharmakodinamichesky action of a domperidon is connected with its blocking influence on the peripheral dopamine receptors localized in a wall of a stomach and duodenum.
Domperidon raises a tone of the lower esophageal sphincter, increases sokratitelny ability of a stomach, improves co-ordination of reductions of antral department of a stomach and duodenum, prevents emergence of a duodenogastralny reflux.
Domperidon is one of the main drugs for treatment of functional dyspepsia now. Its efficiency at this disease was confirmed with data of the big multicenter researches conducted in Germany, Japan and other countries. Besides, drug can be used for treatment of patients about a reflux esophagitis, patients with the secondary gastroparez which arose against the background of a diabetes mellitus, a system scleroderma and also after stomach operations. Domperidon is appointed in a dose on 10 mg 3 – 4 times a day to food. Collateral manifestations at its use (usually a headache, the general weakness) meet seldom, and extrapyramidal disturbances and endocrine effects – only in isolated cases.
Tsizaprid who was widely adopted now as pro-kinetic drug on the mechanism of the action significantly differs from other medicines stimulating motive function of digestive tract.
Exact mechanisms of action of a tsizaprid a long time remained not clear though their implementation through cholinergic system was assumed. In recent years it was shown what цизаприд promotes release of acetylcholine due to activation of recently found new type of serotoninovy receptors (5-HT4-retseptorov) localized in neural textures of a muscular coat of a gullet, stomach, intestines.
Tsizaprid has the expressed promoting effect on motility of a gullet, raising and more than Metoclopramidum, a tone
the lower esophageal sphincter and significantly reducing total number of episodes of a gastroesophageal reflux and their total duration. Besides, цизаприд exponentiates also propulsive motility of a gullet,
improving, thus, esophageal clearance.
Tsizaprid increases sokratitelny activity of a stomach and duodenum, improves evacuation from a stomach, reduces a duodenogastralny reflux of bile and normalizes antroduodenal coordination. Tsizaprid stimulates sokratitelny function of a gall bladder, and, increasing motility of a small and large intestine, accelerates a passage of intestinal contents.
Tsizaprid is one of the main drugs now,
the patients who are applied at treatment from gastroesophageal reflux
disease. At the initial and moderately expressed stages укзаприд it is possible to appoint a reflux esophagitis in the form of monotherapy, and at severe forms of damage of a mucous membrane – in a combination with anti-secretory drugs (H2 blockers or blockers of the proton pump). In
the present experience of the long supporting reception of a tsizaprid for prevention of a recurrence of a disease is accumulated.
Multicenter and metaanalytical researches confirmed good results of use of a tsizaprid at treatment of patients with functional
dyspepsia. Besides, drug was effective at treatment
patients with an idiopathic, diabetic and postvagotomichesky gastroparez, patients with the dispepsichesky frustration, a duodenogastralny reflux and dysfunction of a sphincter of Oddi which arose after operation of a cholecystectomia.
Tsizaprid gives good clinical effect at treatment of patients with the irritable colon proceeding with a picture of persistent locks, resistant to therapy by other drugs and also patients with
the syndrome of intestinal pseudo-obstruction (developing, in particular, against the background of diabetic neuropathy, a system scleroderma, muscular dystrophy, etc.).
Tsizaprid is appointed in a dose of 5 - 10 mg 3 – 4 times a day to food. Drug, as a rule, is well transferred by patients. The most frequent collateral manifestation is the diarrhea which is found at 3 – 11% of patients, usually not demanding the treatment termination.
In the presence at sick signs of the increased motility of these or those departments of a digestive tract drugs with the spasmolytic mechanism of action are appointed. Traditionally in our country spasmolysants of a myotropic row are for this purpose used: papaverine, Nospanum, Halidorum. Abroad preference is given to butylscopolaminum, anticholinergic drug with the spasmolytic activity exceeding that at myotropic spasmolysants in similar situations. Butylscopolaminum is applied at various options of an esophagism,
hyper motor forms of dyskinesia of a duodenum and biliary tract, the syndrome of the angry intestines proceeding with a clinical picture of intestinal gripes. Drug is appointed in a dose of 10 - 20 mg 3 – 4 times a day. The by-effects inherent to all anticholinergic drugs (tachycardia, a lowering of arterial pressure, disorders of accommodation), are expressed at treatment
butylscopolaminum in much smaller degree, than at therapy by atropine, also meet, mainly, at its parenteral use.
At manifestations of an esophagism a certain clinical effect can give use of nitrates (for example, Nitrosorbidum) and blockers of the calcium channels (nifedipine) having moderate spasmolytic effect on walls of a gullet and a tone of the lower esophageal sphincter.
At hyper motor options of a syndrome of the angry intestines, so-called functional diarrhea which, unlike organic (for example, infectious) diarrheas, is observed preferential in the morning it is connected with psychoemotional factors and is not followed
pathological changes in analyses the calla, drug of the choice is loperamide. Contacting opiate receptors of a large intestine, loperamide suppresses release of acetylcholine and prostaglandins in a wall thick
guts also reduces its peristaltic activity. The dose of loperamide is selected individually and makes (depending on a chair consistence) from 1 to 6 capsules on 2 mg a day.
Thus, as show data of numerous researches, disturbances of motility of various departments of a digestive tract act as an important pathogenetic factor of many gastroenterological diseases and often define their clinical picture. By means of special methods of tool diagnosis and use of the adequate drugs normalizing gastrointestinal motility results of treatment of such patients allow to improve early detection of motive disturbances of digestive tract considerably.