SMALL STOMACH SYNDROME

Small stomach syndrome consists of:

• Epigastric discomfort (dyspepsia) after food (gastric distention)

• Retrosternal discomfort (heartburn) after food (reflux)

• Nausea, hiccup

• Flatulence

• Early satiety

It is due to inability of the stomach to distend, usually because of:

• Gastric carcinoma

• Partial gastrectomy

• Hepatomegaly (possibly)

«  The pain does not respond to opioid analgesics.

Many patients with massive hepatomegaly have no gastric symptoms. Symptoms are exacerbated by anxiety (and air swallowing), irritant drugs (iron, NSAIDs, steroids), delayed gastric emptying (opioids, anti- cholinergics), or decreased tone in the lower esophageal sphincter (alcohol, diazepam, nitrites, verapamil, nifedipine). An esophageal tube for dysphagia causes reflux and gas.

Management options include:

• Explanation

• Review of drugs

• Small frequent meals

• Simethicone after meals

• Metoclopramide after meals

• H₂-receptor antagonist

• Remember anxiety (air swallowing)

Simethicone (silica activated dimethicone) is a defoaming agent available in a number of antacids (Mylanta, Riopan Plus, etc.). It clears gas bubbles by allowing bubbles to coalesce, and by facilitating eructation (belching) which reduces gastric distention.

Metoclopramide is a gastro-kinetic anti-emetic. (The usual dose is 10mg to 20mg after meals.) It increases gastric emptying by increasing the tone of the lower esophageal sphincter, decreasing the tone of the pylorus and increasing gastric and small bowel peristalsis.

Ranitidine 150mg 2 times a day should be added for severe or persistent symptoms.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.