Gastroparesis

Gastroparesis

What is gastroparesis?

Gastroparesis is also often referred to as delayed gastric emptying. The term “gastric” refers to the stomach. Usually, the stomach voids its contents in a disciplined fashion into the small intestine. In gastroparesis, the muscle contractions that allow the food to move along the digestive tract do not function normally and the stomach does not empty quickly enough. Gastroparesis is defined by long-term symptoms combined with postponed stomach emptying in the absence of any observable obstruction or blockage. The delayed stomach emptying is confirmed by a test.

What causes gastroparesis?

The cause of gastroparesis is often unclear. However, it has been observed that in many cases, gastroparesis is caused by damage to the vagus nerve (an important link from the gut to the brain.)

The vagus nerve is responsible for managing the intricate mechanisms in your digestive tract, including communicating to the muscles in your stomach when to contract and move food into the small intestine. An impaired vagus nerve cannot signal normally to your stomach muscles. This causes food to remain in your stomach for a longer period of time, rather than pushing into your small intestine to continue the digestion process.

Factors that cause vagus nerve damage can be attributed to diseases, such as diabetes, or by surgery to the stomach or small intestine.

Who is at risk of gastroparesis?

• People with diabetes

• People who have had abdominal or esophageal surgery

• People who have suffered an infection, or a virus

• Certain medications can slow the rate of stomach emptying, such as narcotic pain medications

• People with scleroderma (a connective tissue disease)

• People with nervous system diseases, such as Parkinson's disease or multiple sclerosis

• People with hypothyroidism (low thyroid)

• Women are more likely to develop gastroparesis than men

Signs and Symptoms

It is important to understand that many people with gastroparesis don't show any observable signs or symptoms. However, if you are showing signs of the following symptoms, consult your physician:

  • Vomiting
  • Nausea
  • A feeling of fullness after eating just a few bites
  • Vomiting undigested food eaten a few hours earlier
  • Acid reflux
  • Abdominal bloating
  • Abdominal pain
  • Changes in blood sugar levels
  • Lack of appetite

Complications of gastroparesis

  • Severe dehydration: Frequent vomiting can contribute to dehydration
  • Malnutrition: Lack of appetite leads to low caloric intake, and results in an inability to absorb enough nutrients.
  • Undigested food that hardens and remains in your stomach: Foods that remain undigested in the stomach can solidify into a hardened mass called a bezoar. These solid masses cause nausea and vomiting and can be life threatening due to the prevention of digestion.
  • Unpredictable blood sugar changes: Gastroparesis does not directly cause diabetes, however it can lead to irregular changes in blood sugar levels. This can aggravate an existing case of diabetes and make it more difficult to manage.
  • Decreased quality of life: Gastroparesis flare ups can cause discomfort and affect an individual's ability to perform normal day to day activities.

Tests and Treatment

Physical exams will be performed by a doctor if gastroparesis is suspected. Inform your doctor about any medications you are taking. A test that measures how fast the stomach empties is done to confirm the diagnosis. The following tests are performed by doctors to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include:

Gastric emptying study:

This is a vital test in diagnosing gastroparesis. It involves eating a light meal that has a small amount of radioactive material. The radioactive material is monitored by a scanner that identifies its movement. This enables the doctor to monitor the rate/speed of gastric emptying.

You'll need to stop taking any medications that could slow gastric emptying. Ask your doctor if any of your medications might slow your digestion.

Upper gastrointestinal (GI) endoscopy:

This process is done to examine your upper digestive system — your esophagus, stomach and beginning of the small intestine (duodenum). A microscopic camera is placed on the tip of a long, malleable tube. This procedure can also diagnose other digestive conditions, such as peptic ulcer disease or pyloric stenosis, which all have similar symptoms to gastroparesis.

Ultrasound:

This procedure uses sound waves to develop images of masses within your body. Ultrasounds assist in diagnosing whether problems with your gallbladder or your kidneys could be the root of your symptoms.

Upper gastrointestinal series:

This is a series of X-rays in which you drink a white, chalky liquid (barium) that coats the digestive system to help abnormalities show up.

Treating gastroparesis

The first step in treating gastroparesis is treating the root cause or underlying condition. If it is diabetes your doctor will work with you to control it. A dietitian might suggest that you try to:

  • Eat smaller meals more frequently 
  • Chew food thoroughly 
  • Eat well-cooked fruits and vegetables rather than raw fruits and vegetables 
  • Avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars 
  • Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet 
  • Try soups and pureed foods if liquids are easier for you to swallow 
  • Drink about 1 to 1.5 liters of water a day 
  • Exercise gently after you eat, such as going for a walk 
  • Avoid carbonated drinks, alcohol and smoking 
  • Try to avoid lying down for 2 hours after a meal 
  • Take a multivitamin daily

Medications for gastroparesis:

Medications to treat gastroparesis may include: 

  • Medications to stimulate the stomach muscles 
  • Medications to control nausea and vomiting

Surgical treatment for gastroparesis:

Unfortunately, in severe cases, some patients may be unable to handle any food or liquids. In these instances doctors may recommend a feeding tube (jejunostomy tube) be inserted in the small intestine.

Doctors may also recommend a gastric venting tube to help alleviate pressure from gastric build-up. Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. This procedure is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can't be managed any other way. Some individuals may require an IV (parenteral) feeding tube that goes directly into a vein in the chest.

Lifestyle and home remedies for gastroparesis:

If you're a smoker, stop. Your gastroparesis symptoms are less likely to improve over time if you keep smoking. People with gastroparesis who are overweight are also less likely to get better over time.

Diet Plan

Managing Gastroparesis

According to Minnesota Gastroenterology Clinic, the diet plan below consists of three phases and is designed for people with gastroparesis to help improve the way food passes through the stomach. Talk to your healthcare provider before making any dietary changes.

Phase 1 – Phase 1 is a strict liquid only diet. It consists of nutrient rich fluids that assist in providing caloric intake while putting very little strain on the digestive system.

Phase 2 – Phase 2 builds on Phase 1 by allowing the patient a small amount of fat and fibe. Foods high in fat prevent the stomach from emptying, so fat intake should be limited to 40 grams per day.

Phase 3 – Phase 3 is meant to be a long-term diet for gastroparesis. This phase includes all the foods allowed in Phase 2 and incorporates additional fat and fibrous foods into the diet. Fibrous foods should be cooked well so they are tender and easy to digest and fat intake should be limited to 50 grams per day.

Duration: Each patient is different, and the phasing of the diet should be prescribed and monitored by your physician. Due to the low nutrition content of Phase 1, if a patient needs to remain on this phase for more that 3 days, they may need to also be put on an IV. If your symptoms are still active, check in with your healthcare provider for direction. Phases 2 & 3 can be prescribed for 4-6 weeks at a time as long as the patient is checking in with a Dietitian or healthcare provider every 2-4 weeks.

Below is a list of recommended foods and foods to avoid, developed by the Minnesota Gastroenterology Clinic for people with gastroparesis. Always consult your health care professional before making any changes to your diet if you have gastroparesis.

Phase 1 - Diet plan for people with gastroparesis

Food GroupRecommendedAvoid
Milk & Dairy
products
• Skim milk
• Fat-free non-dairy milk substitutes
• Fat-free yogurt without fruit/seeds (plain, lemon,
vanilla, etc.)
• All others
Vegetables• Vegetable juice: V-8, tomato• All raw and cooked vegetables
Breads,
Cereals &
Grains
• Cooked, refined cereals: Cream of rice, cream of
  wheat, grits, farina
• Plain saltine, oyster, graham and animal crackers
• All others
Meat & Meat
Substitutes
• None• All
Fats & Oils• None• All
Sweets &
Desserts
• Gelatin (Jell-O)
• Popsicles, fruit ice
• Sugar, honey, sugar substitutes
• Fat-free custard and pudding
• Milkshakes made with skim milk or fat-free nondairy substitutes
• Fat free ice cream and sherbet
• All others
Fruits & Juices• Juices without pulp: apple, cranberry,
grape
• Citrus juices, juice with pulp, prune
  juice
• All fresh, frozen, canned and dried
  fruits

© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145

Phase 1 - Sample menu for people with gastroparesis

BreakfastLunchDinner
4 oz juice
1 cup cooked cereal
4 oz skim milk
8 oz coffee or tea
4 oz juice
1 cup fat-free broth 4
plain saltine crackers
½ fat-free pudding
4 oz juice
1 cup strained cream soup made with skim
milk 4 plain saltine crackers
½ cup gelatin
Morning SnackAfternoon SnackEvening Snack
6 oz fat-free yogurt8 oz nutritional supplement such as
Boost or Ensure
½ cup fruit ice

© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145

Phase 2 - Diet plan for people with gastroparesis

Food GroupRecommendedAvoid
Milk & Dairy
products
• Skim and 1% milk
• Fat-free and low-fat non-dairy milk substitutes
• Fat-free and low-fat yogurt without fruit/seeds
• Low-fat cheeses & cottage cheese
• Whole and 2% milk and milk products
• Full fat non-dairy substitutes
Vegetables• Vegetable juice: V-8, tomato
• Well-cooked vegetables without
  skins/seeds/hulls (potatoes without skin, carrots,
  beets, green beans, squash, asparagus, etc.)
• Raw vegetables
• Cooked vegetables with
  skins/seeds/hulls (corn, peas, broccoli,
  cauliflower, etc.)
Fruits & Juices• Juices without pulp: apple, cranberry, grape
• Canned fruits without skin
• Fresh ripe banana and seedless melon
• Juice with pulp and prune juice
• Canned fruits with skins
• All other fresh and dried fruits
Breads,
Cereals &
Grains
• White bread, English muffins, bagels, biscuits,
  and other refined bread products
• Pancakes, waffles, refined dry cereals (Rice
  Krispies, Corn Flakes, Special K, etc.)
• Cooked, refined cereals: Cream of rice, cream of
  wheat, grits, farina
• White rice, white pasta & egg noodles
• Saltine, oyster, graham and animal crackers
• Pretzels
• Whole grain breads and bread
  products made with bran, rye with
  seeds, or whole wheat
• Oatmeal, bran cereals, granola,
  shredded wheat
• Brown rice, wild rice, oats, barley, and
  quinoa, whole wheat pasta
• Popcorn
• Breads or rolls with nuts, seeds, or
  fruit
Meat & Meat
Substitutes
• Eggs
• Creamy peanut butter - limit to 2 tbsp/day
• Tofu
• Beef, poultry, pork, lamb, fish
• Dried beans, peas & lentils
• Nuts, seeds & crunchy peanut butter
Fats & Oils• Any tolerated - limit to 2 tbsp/day• None
Sweets &
Desserts
• Gelatin (Jell-O), Popsicles, fruit ice
• Sugar, honey, sugar substitutes, jelly and
  seedless jams, hard candy
• Fat-free and low-fat custard, pudding, ice cream,
  sherbet, and frozen yogurt
• Milkshakes made with skim milk or low-fat milk
  products/non-dairy substitutes
• Full-fat desserts (cakes, cookies, pies,
  ice cream)
• Desserts, jams and candies
  containing nuts, seeds, coconut, dried
  fruits, or fruits with skins
Beverages• All• None
Soups• Fat-free or low-fat broth & bouillon
• Broth soups with rice/noodles and allowed
  vegetables
• Cream soups made with skim or 1% milk
• Broths containing fat
• Soups made with cream, whole or 2%
  milk

© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145

Phase 2 - Sample menu for people with gastroparesis

BreakfastLunchDinner
1 cup dry cereal
4 oz skim milk
1 small ripe banana 8 oz
coffee or tea
1 cup tomato soup made with skim
milk 4 plain saltine crackers
½ cup gelatin
4 oz juice
1 cup Campbell’s chicken noodle soup
4 plain saltine crackers
½ cup canned fruit (in juice)
4 oz skim milk
Morning SnackAfternoon SnackEvening Snack
1 slice white toast
2 tbsp smooth peanut butter
1 string cheese
1 oz pretzels
½ cup fat-free sherbet

© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145

Phase 3 - Diet plan for people with gastroparesis

The following foods may be added to the foods allowed in Phase 2:

Food GroupRecommendedAvoid
Vegetables• Raw vegetables without skins/seeds/hulls• Raw and cooked vegetables with
  skins/seeds/hulls
Fruits & Juices• Juices
• Fresh and canned fruits without skins
• Fresh fruit with skins
• Dried fruit
Meat & Meat
Substitutes
• Lean, tender cuts of beef, pork, poultry, and
  lamb
• Fish, canned tuna
• Fatty cuts of beef, poultry, pork, lamb
Fats & Oils• Any tolerated – limit to 2 tbsp/day• None
Soups• Fat-free or low-fat broth & bouillon
• Soups with allowed foods
• Broths containing fat
• Soups made with cream or whole milk

© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145

Phase 3 - Sample menu for people with gastroparesis

BreakfastLunchDinner
1 slice white toast with 1 tbsp seedless
jelly 2 eggs scrambled
4 oz juice
6 oz fat-free Greek yogurt
8 oz coffee or tea
3 oz canned tuna (packed in
water) 2 tbsp light mayonnaise
2 slices white bread
½ cup canned fruit (in juice)
4 oz skim milk
3 oz baked chicken breast
1 medium skinless baked potato
1 tbsp fat-free sour cream
½ cup cooked carrots
1 white dinner roll with1 tbsp
margarine 4 oz juice
Morning SnackAfternoon SnackEvening Snack
2 large graham cracker
squares 4 oz skim milk
1 string cheese
1 small ripe banana
½ cup low-fat vanilla frozen yogurt

© 4/2014 Minnesota Gastroenterology, PA (612) 871-1145

Preparing for an Appointment

You're likely to first see your primary care doctor if you have signs and symptoms of gastroparesis. If your doctor agree that your symptoms point to gastroparesis, you may be referred to a gastroenterologist ( a specialist in digestive diseases.) You may also be referred to a dietitian who can help you manage your diet plan.

What you can do:

Because appointments can be quick, it's important to be well-prepared. To get ready, try to:

  • Be aware of any pre-appointment protocols. When you make your appointment, be sure to inquire if there's anything you need to do in advance, such as restrict your diet. The doctor's office might request that you stop using certain medications, prior to coming for an appointment. • Record any symptoms you've experienced, including any that may not seem related.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Consider taking a family member or a friend with you. It can often be tough to recall all the information provided during an appointment. A friend of family member may be able to help you remember something you forgot down the road.

Questions to ask your doctor if you think you have gastropresis:

Prepare a list of questions ahead of time to ensure that you optimize your time with your doctor or specialist. Take this list of questions to ask your doctor if you're worried you have gastroparesis with you to your next appointment:

  • What's the most likely cause of my symptoms?
  • Could any of my medications be causing my signs and symptoms
  • What kinds of tests do I need?
  • Is this condition temporary or long lasting?
  • Do I need treatment for my gastroparesis?
  • Should I see a dietitian?
  • What are my treatment options, and what are the potential side effects?
  • I have diabetes, how will gastroparesis affect my diabetes management?

Statistics

  • Gastroparesis is characterized by delayed gastric emptying in the absence of a mechanical obstruction.
  • Most cases of gastroparesis (more than one-third) are idiopathic, i.e. have an unknown cause. Other common causes are diabetes and postgastric surgery. (Parkman 2015)
  • Patients with idiopathic gastroparesis are typically young or middle-aged women. (Parkman 2015)
  • Although the true prevalence of gastroparesis is unknown, US data suggest that it may affect 2% of the general population. (Parkman 2015)
  • Gastroparesis is associated with psychological distress and poor quality of life.
  • 24% of patients have combined anxiety and depression. (Woodhouse et al. 2017)
  • Two-thirds of people affected by gastroparesis report having a poor or fair quality of life. (Yu et al. 2017)
  • Nearly one-third (30%) report they are not working because of the condition. (Yu et al. 2017).
  • The economic burden of gastroparesis in Canada is unknown.
  • In the US, mean hospital charges increased significantly by 159% from US$13,350 in 1997 to US$34,585 per patient in 2013, after adjustment for inflation. At the national level, the costs of hospital visits also increased substantially, by 1026%, from $50,456,642 to $568,417,666. (Wadhwa et al. 2017)

Citations:

Parkman HP. Idiopathic gastroparesis. Gastroenterol Clin North Am. 2015 Mar;44(1):59-68.

Wadhwa V et al. Healthcare utilization and costs associated with gastroparesis. World J Gastroenterol. 2017 Jun 28;23(24):4428-36.

Woodhouse S et al. Psychological controversies in gastroparesis: A systematic review. World J Gastroenterol. 2017 Feb 21;23(7):1298-309.

Yu D et al. The burdens, concerns, and quality of life of patients with gastroparesis. Dig Dis Sci. 2017 Apr;62(4):879-93.

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