Abdominal bloating is a common symptom of the digestive system. Many people often self-administer metoclopramide (domperidone) to promote gastrointestinal motility and alleviate bloating. However, when experiencing bloating, patients should first seek medical diagnosis at a hospital to determine the underlying cause. Using metoclopramide without understanding the cause can sometimes worsen the condition.
There are many causes of bloating. Some are physiological, such as overeating or poor dietary habits that lead to excessive gas in the intestines. More commonly, there are pathological causes, such as chronic gastritis, gastric ulcers, gastric prolapse, gastric mucosal prolapse, pyloric obstruction, intestinal obstruction, acute and chronic hepatitis, liver cirrhosis, chronic cholecystitis, acute peritonitis, hypokalemia, heart failure, ascites due to various reasons, and abdominal tumors. Bloating caused by the aforementioned reasons can be alleviated by enhancing gastrointestinal motility, which is achieved by taking prokinetic drugs. However, some conditions causing bloating cannot be treated with these drugs, such as one type of gastric mucosal prolapse called gastroesophageal prolapse.
Gastroesophageal prolapse occurs when the abnormally relaxed gastric mucosa protrudes into the esophagus (gastroesophageal prolapse) or passes forward through the pyloric canal into the duodenal bulb (gastrointestinal prolapse), with the latter being more common clinically. Gastrointestinal prolapse presents with varying degrees of epigastric pain, bloating discomfort, belching, and poor appetite. Since one of the pathogenic mechanisms of gastrointestinal prolapse is factors that can cause intense gastric motility, the principle of treatment is to reduce gastric motility and avoid gastric fundus mucosal prolapse into the pyloric canal. Sedatives and anticholinergic drugs such as dicyclomine, atropine, and propranolol can be used. On the other hand, commonly used prokinetic drugs in clinical practice include metoclopramide (Gufuan), domperidone (Motilium), cisapride, and mosapride. These drugs increase gastrointestinal motility and tension, promote gastric emptying, increase gastric and duodenal movement, coordinate pyloric contraction, and accelerate intestinal propulsion. They also enhance the tone of the lower esophageal sphincter, reducing gastric-oesophageal reflux. However, these effects contradict the treatment principles of gastrointestinal prolapse. If prokinetic drugs are mistakenly used for gastrointestinal prolapse, it will only worsen the degree of prolapse.
It is worth noting that another type of gastric mucosal prolapse is gastroesophageal prolapse, where the gastric mucosa retrogrades into the esophagus. In this type, prokinetic drugs can be used to alleviate the degree of retrograde prolapse. Therefore, when experiencing bloating symptoms, patients should not self-administer prokinetic drugs such as metoclopramide and should instead seek medical diagnosis at a hospital.
