Inability to eat enough
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Inability to eat enough

Disclaimer: The following explanation is focused on vascular compression syndromes. Of course, and more frequently other explanations may apply. In any case, please turn to your doctor or ask here.

Many patients with vascular compression syndromes suffer from early satiety and cannot eat enough to maintain their normal body weight.

Early satiety may be a consequence of delayed emptying of the stomach and the duodenum. In such a situation the food stays longer within the upper gastrointestinal tract and the patient has a constant feeling of fullness and lack of appetite. Delayed emptying may be due to mechanical reasons or due to a disturbed innervation with a lack of a propulsive peristalsis.

The Wilkie syndrome is one important disorder blocking the passage of food across the horizontal part of the duodenum. In these patients the aorta is lifted up by the strong lordosis thus pressing the horizontal part of the duodenum against the superior mesenteric artery. The aorta and the superior mesenteric artery form a clamp which squeezes the duodenum and the peristalsis constantly runs against this obstacle. Then the food accumulates in a progressively dilating stomach and duodenum, causing there are distension and substantial pain, mostly in the right upper abdomen. In severe cases gulping and vomiting ensues.

One example for a disturbed innervation of stomach and duodenum is the median arcuate ligament syndrome. The pressure of the arcuate ligament onto the nervous plexus surrounding the coeliac artery, the coeliac plexus aka solar plexus, disturbs the normal activity of this important vegetative nervous network. The normal function of the coeliac plexus consists among others to orchestrate the timely action of food uptake, secretion of digestive fluids and enzymes and a useful, propulsive peristalsis. The peristalsis is the motor function of the bowel and stomach. It needs to be slow enough to give the bowel time to absorb nutrients and it needs to be fast enough to transport digested food towards the anus. If the peristalsis is too slow, the stomach remains full, often many hours after a meal and dilates progressively. Sometimes such a development is described as gastroparesis.

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