Rare Disease Day: An Introduction to Gastroparesis


Please note that this article is intended for general educational purposes only. Please seek nutritional advice from a Registered Dietitian. Full disclaimer here.

The term gastroparesis describes the partial paralysis of the stomach. It's also medically referred to as "Delayed Gastric Emptying" (1).


In a person with gastroparesis, muscular damage or ill-functioning nerves result in the muscles of the stomach not functioning as they typically would.


This means that partially-digested food stays in the stomach for longer than it normally would, which can cause a number of symptoms, all of which vary in severity.


Gastroparesis is a long-term chronic illness which has the potential to impact considerably on a person’s quality of life.


This article will provide a brief overview of gastroparesis as well as discussing the dietary management of patients with gastroparesis.



Symptoms


The symptoms of gastroparesis can include:

  • Nausea

  • Vomiting

  • Bloating

  • Abdominal pain

  • Feeling full after eating small amounts of food

  • Heartburn

  • Loss of appetite


The severity and frequency of these symptoms can vary considerably; some people may experience a few mild symptoms, whereas others may be severely affected.


As well as the primary symptoms, serious complications can arise from untreated gastroparesis, such as:

  • Dehydration as a result of vomiting

  • Malnutrition due to the poor absorption of nutrients from food

  • Poorly regulated blood sugar levels

  • Gastro-oesophageal reflux disease

  • Development of bezoars (blockages) in the stomach

  • Excess weight loss

Diagnosis


In order to diagnose gastroparesis, a doctor will review the patient’s symptoms, examine their medical history, and complete a physical examination, which often includes blood tests.



If gastroparesis is suspected, the doctor will then order further tests in order to rule out other diagnoses. This is important as gastroparesis can present with similar symptoms to other conditions such as Irritable Bowel Syndrome (IBS) or coeliac disease (2).


These tests may include (2):

  • An ultrasound or barium X-ray – these procedures are used to determine if there are any alternative physical abnormalities that may be causing the symptoms

  • An upper endoscopy – a camera and light are guided down the oesophagus and used to look into the upper digestive tract to check for blockages

  • Gastric emptying scintigraphy – a small amount of food containing a harmless radioactive substance is eaten, and the stomach scanned to determine how long it takes the food to empty. A diagnosis of gastroparesis is usually confirmed if more than 10% of the food remains in the stomach after four hours.

  • A wireless capsule test - a small, electronic device is ingested. This is tracked to see how fast it moves through the digestive tract.

Prevalence and risk factors


The true prevalence of gastroparesis is unknown, although it's estimated to affect around 4% of the population (3).


Some groups of people are at higher risk, including:

  • People who have diabetes, especially poorly controlled diabetes, as prolonged high blood sugar can cause damage to nerves over time

  • People who have sustained damage to the vagus nerve, as a result of surgery, mineral deficiencies, certain medications, or illnesses such as autoimmune disorders, viral infections, or Parkinson’s disease

Around 36% of cases of gastroparesis are described as ‘idiopathic’, meaning they have no known cause (3).


It would appear that gastroparesis is becoming increasingly common amongst people with Ehlers-Danlos Syndrome (EDS) hyper mobility subtype, a group or rare inherited conditions that affect the connective tissue (4). However we need more research to confirm this.


Diet and symptom management (5)


Unfortunately, there is not (yet) a cure for gastroparesis, and whilst some medications can be prescribed, and less commonly a gastric pacemaker may be fitted, making dietary changes is often the first method used to control symptoms.


If you suffer with gastroparesis, your doctor and/or dietitian may offer the following tips in order to manage your symptoms.


  • Eat little and often – consume smaller meals more frequently rather than three square meals, as the stomach will find it easier to empty a smaller bulk of food

  • Eat soft or liquid foods – consume a large proportion of foods in liquid form, such as soups, smoothies, or yoghurts. These are easier to digest, and people with gastroparesis sometimes have normal liquid digestion

  • Avoid fizzy drinks as these can aggravate bloating

  • Limiting high fibre and high fat foodsthese foods take the longest and are the hardest to digest, and so are likely to remain in the stomach longer and exacerbate symptoms. Carbohydrate and protein-rich foods pass through quicker (5). Foods which contain 17.5g of fat per 100g or more are considered high in fat, and those which contain 6g of fibre per 100g or more are considered high in fibre. Familiarise yourself with how to read food labels and choose foods that are low fibre and low fat

  • Take oral nutrition supplementsthis may be necessary for some people to ensure adequate nutrition and hydration is achieved. Ensure that all supplements are discussed with a dietitian before taking them

  • Avoid alcoholalcohol can slow the gastric emptying process further, so avoid where possible


Alcohol may need to be avoided in people with gastroparesis

For those with milder gastroparesis, making these changes may help with symptom control.


However, those with more severe gastroparesis may require medication, surgery, or enteral or parenteral nutrition (feeding tubes). The condition can affect different people in different ways.


Foods to aim for and avoid


With gastroparesis, the focus should be on choosing nutrient-rich foods that are easy to digest. Your Registered Dietitian will be able to advise you on which foods to avoid, and suitable substitutions.


As an example, patients may be advised by their dietitian to avoid:


  • Raw vegetables and those that are high in fibre (e.g. squash, green leafy vegetables, potatoes with the skin on)

  • Fizzy drinks and alcohol

  • High-fibre foods such as wholegrain cereals and breads

  • Whole nuts and seeds

  • Beans and pulses

  • Deep fried foods

  • Fatty meats

Pulses and beans may need to be avoided in some people with gastroparesis

Instead, you may be advised to have:


  • Energy-dense soups, smoothies, and juices

  • Soft, well-cooked vegetables

  • Low-fat dairy products such as yoghurt, cheese, and milk

  • Lean meat, poultry and fish

  • Softer versions of solid foods, such as nut and seed butters

  • Lower fibre breads and cereals such as white bread and cornflakes


It's important to be aware that finding a diet to alleviate symptoms may require some trial and error. Always ensure that you work with a Registered Dietitian to ensure safe implementation of dietary changes.

Written by Harriet Smith, RD. Assisted by Heather Deering, RNutr


Further information on gastroparesis here

Surrey Dietitian

United Kingdom

©2018 by Surrey Dietitian.