The slow transit: Nutrition for gastroparesis

With gastrointestinal (GI) disease, nausea, vomiting, early satiety and abdominal pain or bloating can be significant concerns and barriers to nutrition in our patient population. In the case of gastroparesis, diet and medication can play an integral role in helping to alleviate these symptoms. 

What is gastroparesis?

Gastroparesis is a rare condition in which food is delayed or unable to pass from the stomach into the small intestine. While many GI conditions can present with similar symptoms, only about 50 out of 100,000 individuals are actually diagnosed with this disorder. The vagus nerve is a large cranial nerve responsible for peristalsis or smooth muscle contraction in the GI tract that supports digestion.

In gastroparesis, the vagus nerve is damaged and the result is slow stomach emptying. Common causes of gastroparesis included poorly-controlled diabetes, prior gastric surgery, viral infection, idiopathic causes, Parkinson’s disease or pseudo-obstructions. There is no cure for gastroparesis; rather, the focus is on treatment for GI symptoms. 

Gastroparesis treatment: Diet, medications and surgical intervention

Modifying a patient’s diet with guidance from a registered dietitian is one of the first steps in treating gastroparesis. In an acute gastroparesis exacerbation, the diet needs to be patient–driven and provided based on symptoms and diet tolerance. Small, frequent meals or a liquid diet may be recommended until GI symptoms improve.

Long-term, the patient may consider reducing dietary fat and fiber, as each slows gastric emptying. Additional nutrition recommendations include blood glucose management in diabetic patients, avoiding alcohol, supplementing with a multivitamin, modifying food consistency based on the patient’s best tolerance and encouraging the patient to avoid laying flat for at least 60 minutes after a meal. 

Medication therapy has also been shown as an effective treatment in the gastroparesis population. Prokinetic drugs, including metoclopramide (Reglan®), domperidone (Motilium®) and erythromycin, act to stimulate peristalsis.

Anti-nausea medications can be used in combination with prokinetic agents to help with symptom management. In addition, use of narcotics and certain anti-depressants, anti-cholinergics and calcium channel blockers should be monitored, as the side effects of these medications can slow gastric emptying rate. 

Surgical interventions for the gastroparesis patient are offered on an individual basis for more severe cases in which the use of diet and medication for symptom management is unsuccessful. Potential procedures for gastroparesis include the placement of a gastric electric simulator device, a surgical pyroplasty, and a gastrectomy or jejunal feeding tube placement with a possible gastric port used for stomach decompression. 

Role of the RD 

Dietitians can play a supportive role in managing the gastroparesis patient. Preventing dehydration and correcting electrolyte abnormalities are necessary in the patient who is actively experiencing nausea and vomiting. 

When more stable, individualizing patient recommendations for fluid, foods, and vitamin or mineral supplementation can help to prevent malnutrition. If nutritional status is unable to be maintained on an oral diet alone, the RD can identify if the gastroparesis patient would benefit from a feeding tube and enteral nutrition support and advocate for those interventions.   

If you have more questions about gastroparesis, it’s always a great idea to speak with a registered dietitian. Registered dietitians are the only credentialed experts qualified to address your unique health questions.

References:

Escott-Stump S, ed. Gastroparesis and Gastric Retention. In: Nutrition and Diagnosis-Related Care. 7th edition. Lippincott Williams & Wilkins. Baltimore, MD; 2012:403-405. 

Cleveland Clinic: Gastroparesis. Available at: https://my.clevelandclinic.org/health/diseases/15522-gastroparesis. Accessed December 8, 2019. 

National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/definition-facts#gastroparesis. Accessed December 8, 2019. 

Shada A. Diagnosis and Treatment Options for Gastroparesis. https://www.surgery.wisc.edu/2017/12/01/diagnosis-and-treatment-options-for-gastroparesis/.  Accessed December 8, 2019. 

Cleveland Clinic: Diet for Gastroparesis: https://my.clevelandclinic.org/-/scassets/files/org/digestive/gastroparesis-clinic/diet-for-gastroparesis.ashx?la=en.  Accessed December 8, 2019.