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Agastria: Causes, Symptoms and Treatment

Agastria refers to the complete absence of the stomach, most commonly following total surgical removal (gastrectomy). Lifelong nutritional management is essential.

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Agastria refers to the complete absence of the stomach, most commonly following total surgical removal (gastrectomy). Lifelong nutritional management is essential.

What is Agastria?

Agastria is a medical condition defined by the complete absence of the stomach. In most cases, this results from a surgical procedure known as a total gastrectomy, in which the entire stomach is removed. Rarely, agastria may be congenital, meaning the stomach fails to develop before birth, though this is an extremely uncommon anomaly.

Causes

The most common cause of agastria is a medically necessary total gastrectomy. This surgery is typically performed in the following situations:

Gastric cancer (stomach cancer): the primary indication for total gastrectomy.
Severe gastric ulcers or polyps that cannot be managed by other means.
Hereditary diffuse gastric cancer (HDGC), a genetic condition for which prophylactic (preventive) gastrectomy may be recommended.
Severe trauma or injury to the stomach.

Physiological Effects

The stomach plays a central role in digestion. Its complete removal leads to significant physiological changes, including:

Loss of mechanical food breakdown and temporary food storage.
Absence of gastric acid and digestive enzyme secretion.
No production of intrinsic factor, a protein essential for the absorption of vitamin B12.
Altered hormonal regulation, as the stomach normally produces hormones such as ghrelin (the hunger hormone).

Symptoms and Complications

Individuals living with agastria may experience a range of symptoms and complications, including:

Dumping syndrome: food moves too rapidly into the small intestine, causing nausea, dizziness, and diarrhea.
Unintentional weight loss and malnutrition due to reduced food intake capacity.
Vitamin B12 deficiency, potentially leading to megaloblastic anemia.
Deficiencies in iron, calcium, and fat-soluble vitamins (A, D, E, and K).
Bile reflux into the esophagus, causing discomfort and inflammation.

Diagnosis

In most cases, the diagnosis of agastria is established through the patient's medical history, particularly following a documented total gastrectomy. In cases of suspected congenital agastria, the following diagnostic tools are used:

Imaging studies such as ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI).
Endoscopy for direct visualization of the upper gastrointestinal tract.
Laboratory tests to detect nutritional deficiencies.

Treatment and Nutritional Management

Since the stomach is entirely absent, lifelong medical monitoring and nutritional management are required. Key strategies include:

Dietary Adjustments

Eating multiple small meals throughout the day to reduce the risk of dumping syndrome.
Avoiding foods high in sugar or fat.
Eating slowly and chewing food thoroughly.

Supplementation

Lifelong vitamin B12 supplementation, typically via intramuscular injection or high-dose oral supplements.
Supplementation of iron, calcium, vitamin D, and other micronutrients.
Pancreatic enzyme supplements may be recommended to support digestion.

Medical Follow-Up

Regular blood tests to monitor nutritional status.
Guidance from a specialized clinical dietitian.
Psychological support, as altered eating habits can significantly affect quality of life.

Prognosis and Quality of Life

With consistent nutritional therapy and regular medical follow-up, many patients with agastria can achieve a good quality of life. The overall prognosis depends largely on the underlying condition that led to the gastrectomy. Modern surgical reconstruction techniques, such as the creation of a gastric pouch from a section of the intestine, can help improve food intake and digestive comfort.

References

World Health Organization (WHO): Nutrition and Food Safety Guidelines, 2022. Available at: https://www.who.int
Lordick F. et al. - Gastric Cancer: Clinical Guidelines of the German Society of Hematology and Medical Oncology (DGHO), 2023.
Mariette C., Bruyere E. - Total Gastrectomy and Nutritional Management. In: Annals of Surgery, 2020; 271(3): 412-420.

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