A case report recently published in Cureus describes the treatment for a teenage patient with Duchenne muscular dystrophy (DMD) who developed acute gastric dilation, which is the sudden, abnormal widening of the stomach.
The lack of functional dystrophin caused by DMD can lead to the stomach muscles moving food through the gastrointestinal system too slowly, which in this case caused the rare complication of stomach dilation. “Acute gastric dilatation is a consequence of refractory gastroparesis due to the absence of dystrophin in the smooth muscle of the digestive tract, manifested as delayed gastric emptying, increased diameter of the stomach and small bowel, and the absence of evacuations,” said the case report’s authors.
What is dystrophin?
Dystrophin is the protein that mutates and leads to DMD. It is found in small quantities in muscle cells, where its role is to protect the cell from daily damage.
When it mutates, it causes muscle cell degeneration and inflammation, leading to damage in the tissue of the bones, lungs and heart.
The report described a 16-year-old boy with DMD who came to the emergency department with generalized abdominal pain, vomiting and the absence of bowel evacuations for the previous 72 hours. When he was physically examined, it was clear that he was in pain and malnourished, with a low body mass index.
An abdominal imaging scan showed that the patient’s stomach had dilated to the point of enlarging the first part of the small intestine. These findings prompted doctors to administer intravenous fluids to the patient and insert a nasogastric tube, which drained 2,000 mL of gastric content out of his digestive system. The patient was then administered central parenteral nutrition, which is the delivery of nutrition via a central vein.
An endoscopy examination showed significant changes in the patient’s stomach and the first part of his small intestine. The patient was given cisapride, a gastroprokinetic agent meant to stimulate movement in the upper gastrointestinal tract. This resulted in peristaltic movements of the gut 12 hours later.
Read more about DMD treatment and care
Following this breakthrough, the patient was started on a carefully managed oral diet. An imaging scan showed reduced dilation of the stomach and the affected part of the small intestine. After 10 days in the hospital, the patient was well enough to be discharged. In subsequent follow-ups, there was no recurrence of this condition.
While it most commonly affects the muscular system, Duchenne can also affect other systems, including the gut. Cases of acute gastric dilation are rarely seen but can potentially be fatal if it results in the absence of movement in the stomach muscles.
“The gastrointestinal issues associated with DMD encompass a broad range of conditions, which can vary in severity and significantly affect patients’ quality of life,” the report’s authors said.
Sign up here to get the latest news, perspectives, and information about DMD sent directly to your inbox. Registration is free and only takes a minute.
