Cambio de modalidad dialítica motivada por la implantación de un marcapasos gástrico

Abstract

Gastroparesis is a chronic alteration of gastric motility in which there is a delay in emptying in the absence of mechanical obstruction. Disruption of antral peristalsis can be the consequence of any disorder that induces neuromuscular dysfunction of the gastrointestinal tract, as gastric emptying reflects the coordination of different regions of the stomach and duodenum, as well as the extrinsic modulation of the central nervous system¹. The most frequent aetiologies are idiopathic, diabetic and post-surgical, although other less common aetiologies are also considered, including those resulting from eating disorders. Common symptoms include postprandial fullness, early satiety, nausea, vomiting, abdominal discomfort and bloating. The diagnosis of certainty, after excluding other causes such as intestinal obstruction, is based on evidence of slow gastric emptying, the gold standard being scintigraphy^1,2. The objectives of treatment are to ensure adequate nutritional intake which is threatened in this context, to treat the underlying disease if it is recognizable and to alleviate the symptoms. As an initial approach, changes in diet and therapy with antiemetic and prokinetic drugs are basic; when these measures fail, vomiting is unconscious and leads to electrolyte disturbances, hospital admission is necessary for more invasive therapeutic manoeuvres. In extreme cases, enteral or parenteral nutrition is initiated. For pharmacological treatment, the intravenous route is used.