Gastroparesis awareness
August was Gastroparesis Awareness Month and in this article we take a closer look at the under-recognised medical condition.
What is Gastroparesis?
Gastroparesis, also referred to as “delayed gastric emptying”¹, is a long-term condition in which the stomach is unable to function, or empty the food it contains, in the usual way². Inefficient functioning of the nerves and muscles that control how the stomach empties, means that food stays in the stomach for longer than normal, causing a persistent array of symptoms¹.
Research into the condition is limited, with the vast majority of data originating from the USA³. However, a recent epidemiological study conducted in the UK, suggested that the prevalence of diagnosed gastroparesis is roughly 14 per 100,000 persons³. Gastroparesis is also more common in women than in men³,⁴.
Symptoms
Symptoms and their severity varies from person to person⁵, and although not always visible, the condition can have a considerable impact on their quality of life⁶,⁷.
Symptoms of gastroparesis can include¹,²:
Nausea
Feeling full very quickly
Vomiting
Loss of appetite
Bloating
Abdominal pain
Weight loss
Due to these symptoms, serious complications such as dehydration and malnutrition can arise¹,².
Causes
The known causes of gastroparesis include; diabetes (type 1 and 2) and complication of some types of abdominal surgery¹,².
Other cases of gastroparesis may be ‘idiopathic’, i.e. there is no known cause⁸. This accounts for around 39% of all cases in the UK³.
Possible risk factors include: Parkinson’s disease, use of opioid painkillers and scleroderma¹,². It may also be seen in patients with connective tissue disorders, such as Ehlers-Danlos Syndrome (hypermobility type)⁹,¹⁰, but more research is needed to understand the possible link.
Diagnosis
To diagnose gastroparesis, a doctor will ask about symptoms and medical history, and complete a physical examination, which may involve a variety of different tests in a hospital setting¹,¹¹.
It is also important to note that although gastroparesis can lead to weight loss, a patient with gastroparesis is not always underweight. In fact, it’s estimated that around 60% of UK patients with gastroparesis are overweight or obese³. Therefore, the presence of obesity should not mean that consideration of gastroparesis is disregarded³.
Treatment
Gastroparesis is a chronic condition that cannot usually be cured, but there are a variety of treatment options available, depending on symptom severity⁸.
Some treatment options for gastroparesis include²,¹⁰:
Dietary changes
Medications
Surgery
Feeding tubes
Q&A with Dietitian
To learn more about dietary changes for this condition we conducted a Q+A with Registered Dietitian, Isabelle Fry - an expert in this area.
As a dietitian, how do you manage a patient with gastroparesis?
After diagnosis, it is important that the patient is referred to a dietitian for dietary management. This is often the first method used to treat gastroparesis. The condition may affect people in different ways, and for those with milder gastroparesis, making dietary changes may help with symptom control. However, for those with more severe gastroparesis – medication, surgery, or artificial feeding may be required.
What role does diet have to play in the management of gastroparesis?
Diet has an essential role to play in the management of gastroparesis and is often the first method used to treat it. After diagnosis, it is important that the patient is referred to a dietitian. A dietitian can provide the patient with appropriate recommendations, ensuring that symptoms are more likely to be managed and their nutritional requirements are being met.
It is important the patient knows that finding a way of eating to help to manage symptoms is often a matter of trial and error and could take some time.
Which foods are best tolerated by those with gastroparesis?
Nutrient rich foods that are easy to digest should be the focus for those with gastroparesis. These may include:- Lower fibre carbohydrates (e.g. white bread, white rice, cornflakes)- Low fat dairy alternatives, as fat is more difficult to digest (e.g. low fat yoghurt, milk etc)- Lean cuts of meat, fish and poultry (making sure to avoid the skin)- Well cooked, soft vegetables (the cooking process means the fibre is broken down more and is therefore easier to digest)- Energy rich liquids (e.g. soups, smoothies, milkshakes and juices).
Any foods that should be avoided by those with gastroparesis?
Patients with gastroparesis may be recommended to avoid the following foods due to their fibre or fat content, or due to their effect on the gut:
- Raw vegetables
- Higher fibre vegetables (green leafy vegetables, potatoes with skin on, corn, peas)
- Whole nuts and seeds
- Legumes (lentils, chickpeas etc) and beans
- Fatty cuts of meat
- Higher fat foods (deep fried foods, full fat dairy etc)
- Alcohol
- Fizzy drinks
Any other dietary recommendations?
Making certain changes in lifestyle and tweaks at meal times could help someone with gastroparesis alleviate their symptoms further:
- Eating slowly and chewing food thoroughly
- Ensuring meals are eaten whilst sitting upright
- Keeping drinks separate from meals
- Moving around / walking after meals may help symptoms
- If the patient is overweight, losing weight may help
- Avoiding clothing that fits tightly around the abdomen
What is the most common misconception about gastroparesis?
There are a few misconceptions about gastroparesis and those who live with it, below are two of the main misconceptions that Isabelle has encountered:
· Myth 1: Sticking to a gastroparesis friendly diet will cure it.
Truth: It will merely help to alleviate the symptoms and improve uptake of nutrients. The stomach may begin to function more normally again over time, but this will not have been caused by diet.
· Myth 2: Gastroparesis is an eating disorder.
Truth: Gastroparesis can leave people with a feeling of fullness and prevent them from eating normally. It is therefore paramount for patients to be careful about what they eat since the condition can lead to weight loss and malnutrition.
Note: Isabelle Fry is on instagram as @positive.family.dietitian, her website is https://www.diet-matters.com/
Author: Georgina Hardy
Resources
UK Gastroparesis Charity:
https://www.giftuksupport.org/?fbclid=IwAR14o4pWBrsRmqEiG0gIGAJoFWofNTZ8DTeRKybpqlXm6a8F1e-BUAbwVk8
Video of a specialist gastroenterologist talking about gastroparesis: https://www.facebook.com/giftuk/videos/345054386258151
Gastroparesis support facebook support group: https://www.facebook.com/gastroparesissupport/
Support group for Gastroparesis linked with EDS:
https://www.facebook.com/Gastroparesis.EDS/