Neuropathy is made up of two words ‘neuro’ pertaining to nerves and ‘pathy’ pretending to pathology and is defined as the loss or malfunction of the nerves. It can occur in any part of the nerves of the peripheral nervous system.
Can You Have Neuropathy In Your Stomach?
Neuropathy in the stomach occurs when the nerves supplying it are damaged due to do any cause. The stomach contains two layers of nervous tissue in it in the form of plexus formation. One layer is present in submucosa known as Meissner’s plexus and the other layer is present in between the muscular layer known as myenteric plexus or Auerbach plexus. The plexus controls glandular secretions like secretions of parietal cell, chief cell, etc., alters electrolyte and water transport across the luminal membrane, and regulates capillary blood flow of the local vessels and sometimes may also change the configuration of the luminal surface of the stomach. The myenteric plexus controls the muscles of the stomachthe including both circular and longitudinal muscles. It is responsible for the gastric emptying, churning of food, etc.
The most common cause of gastric neuropathy is diabetes mellitus. It causes dysfunction of the autonomic nerves known as autonomic neuropathy. Other causes of gastric neuropathy include HIV, amyloidosis, inherited neuropathies, botulism, autoimmune causes like systemic lupus erythematosus, etc. These causes can affect both the plexuses of the stomach and in turn affect the normal functioning of the stomach. Since diabetes is a modern epidemic and has a very high number of cases, the cases of uncontrolled diabetes are not uncommon which is frequently seen associated with autonomic neuropathy.
The presentation of neuropathy of the stomach depends upon the intensity of involvement of the nerves. The most common presentation appears as delayed gastric emptying known as gastroparesis. It occurs due to less stimulation of the muscular layers by the vagus nerve. The symptoms found in gastric neuropathy are feeling of fullness, nausea, vomiting, poor appetite, abdominal bloating, etc. Acid reflux can also occur because of the reverse movement of the gastric muscles due to non-emptying.
Also, the blood sugar levels become out of control partially because of delayed gastric emptying resulting in the breakdown of carbohydrates for a longer period of time and partially because they are already uncontrollable for a long period of time as the autonomic neuropathy occurs after many years of uncontrolled diabetes mellitus. Gastric autonomic neuropathy starts a vicious cycle of uncontrolled blood sugar levels resulting in an increase in neuropathic symptoms of stomach and the cycle goes on.
Although the damage to the autonomic nerves is permanent and cannot be reversed the gastric symptoms can be managed by medical treatment. First-Line therapy is always based on the control of blood sugar levels. Insulin is the drug of choice for diabetes and its associated complications. Other symptoms like nausea, vomiting, and acid reflux can be managed by a different group of drugs. Surgical treatment for gastric neuropathy has also been introduced in recent times. In this, the stomach of the patient is fitted with an electrical device which gives impulses to the plexus of the stomach at regular intervals and maintains the functioning of the stomach. It is known as gastric electronic stimulation device. Its use is advocated in severe neuropathies and is very costly till now.
It is quite possible to get neuropathy in the stomach associated with dysfunctioning of autonomic nerves supplying the stomach. Diabetes mellitus the topmost cause in the list of gastric neuropathies. Most commonly affected the functioning of the stomach is gastric emptying. Insulin therapy is used to control the high blood sugar levels and medical treatment for diabetes could be used as an adjuvant for it because these cannot be controlled by drugs alone.
Efficient blood sugar control and early detection of the involvement of autonomic and peripheral nerves remains the key to minimize the damage because the already happened dysfunction is permanent and irreversible.
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