6/3/2020 7:57:00 AM Gastroparesis treated
primarily with diet
Dear Doctor: My husband started having a lot of stomach pain and was also feeling queasy. Needless to say, I feared the worst -- cancer -- but, instead, his doctor says it's gastroparesis. Is it dangerous? What's the best treatment?
Dear Reader: Gastroparesis is the name of a condition in which the stomach is slow to empty its contents into the small intestine. This isn't due to any type of blockage. Instead, as the name of the condition suggests ("gastro" refers to the stomach, and "paresis" indicates nerve-related muscle weakness), the cause is a malfunction in the nerves that serve the region. This includes the vagus nerve, which animates the stomach muscles and helps send food to the small intestine. Symptoms include the pain and nausea your husband experienced, as well as poor appetite, feeling full after only small amounts of food or drink, heartburn and unintended weight loss.
When functioning properly, the stomach takes about four hours to saturate its contents with gastric juices, break everything up into smaller particles and pass the majority of it along to the small intestine. For people living with gastroparesis, the process takes significantly longer.
The result is delayed digestion, which can lead to a range of problems. Food that remains in the stomach for too long is susceptible to fermentation, which can encourage the growth of bacteria. The condition can interfere with appetite and sometimes leads to malnutrition. When the contents of the stomach are stalled, they can coagulate into a mass known as a bezoar, which can cause a blockage. And for people living with diabetes, the delayed movement of food from the stomach to the small intestine can interfere with glucose control.
Gastroparesis is often seen in people living with diabetes, which can cause nerve damage. It may also arise as the result of viral stomach infections, hypothyroidism, certain autoimmune or neurological disorders, or surgical injury. It's a known (albeit rare) side effect of medications such as opioids, antihistamines, tricyclic antidepressants and calcium-channel blockers, which can impede digestion.
Diet is important in the management of gastroparesis, with an emphasis on nutrient density and ease of digestion. Patients are asked to eat small meals of soft, well-cooked food, and to avoid high-fat foods, which delay the emptying of the stomach. Foods high in fiber are difficult to digest and are also limited, or in some cases eliminated. Fruits and vegetables, which contain nondigestible fiber, should be served cooked, and in some cases pureed. For instance, instead of an apple, a patient will have a small serving of applesauce. They are also encouraged drink liquids that contain glucose and electrolytes, including clear soups, low-fat broths, low-fiber fruit and vegetable juices, or sports drinks. Since glucose control and malnutrition are both a challenge, many people with gastroparesis work with a registered dietitian.
When the condition can't be managed with diet, medications that cause the stomach to contract and emerging therapies such as electrical gastric stimulation may be an option. In severe cases, surgery may be necessary. We recommend that your husband seek out a gastroenterologist to fully assess his case and plan his treatment.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to email@example.com, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.