Gastroparesis is a relatively common digestive disorder, affecting up to four percent of people in the United States.
Symptoms can range from mild to severe and be temporary or chronic.
Several treatments are available, although dietary changes are usually the first option recommended to those with gastroparesis.
Gastroparesis is a medical condition that causes a delay in the emptying of the stomach. It occurs because the normal movement of the stomach muscles, which serves to push food through the digestive tract, does not work correctly or slows down.
Symptoms of gastroparesis include:
- stomach pain
Gastroparesis can be mild and produce few symptoms, or it can be severe and cause disability and frequent hospitalizations. Complications of gastroparesis include malnutrition, dehydration, and irregular blood sugar levels.
The cause is not apparent in most instances of gastroparesis. However, some cases can be linked to other medical conditions, including diabetes or lupus, or certain medical procedures, such as bariatric surgery.
Women are more likely than men to have gastroparesis.
According to the International Foundation for Functional Gastrointestinal Disorders, treatment for gastroparesis is primarily based on dietary changes, with medication being an additional option.
Some changes which can help to ease symptoms include:
1. Eating smaller meals
Increasing the number of daily meals and decreasing the size of each one can help alleviate bloating. The stomach may also be able to empty more quickly.
Eating smaller amounts of food at each meal means the number of meals should be 4 to 6 per day to meet nutritional needs.
2. Chewing food properly
If food is not chewed enough in the mouth, it requires more effort to be broken down in the stomach. Food that is not properly broken down in the stomach will not empty easily into the small intestine.
If necessary, a person should address any dental problems they have that may be preventing the thorough chewing of their food.
3. Avoiding lying down during and after meals
Lying down while eating, or within 3 hours of a meal, can delay stomach emptying. This is because the helpful effects of gravity are reduced. Lying down, during or following meals, also contributes to acid reflux.
Going for a walk after eating, or engaging in another gentle physical activity, may help to stimulate the stomach muscles.
4. Drinking liquids between meals
As fluids take up space in the stomach, it may be beneficial to drink liquids between meals, rather than during them.
5. Taking a daily supplement
Malnutrition is a possible complication of gastroparesis, so some people with the condition may wish to take daily multivitamin and multimineral supplements to avoid this.
6. Avoiding certain foods
Certain foods are more difficult to digest and can make the symptoms of gastroparesis worse. They include:
Fatty foods. Fats delay emptying of the stomach. However, some fats are still important for health. Liquids containing fats, such as smoothies and shakes, may be easier to digest than solids. Limiting high-fat meats and dairy products that can worsen symptoms is also helpful.
Fiber-filled foods. Fiber increases the time it takes for the stomach to empty and can contribute to blockages, also known as bezoars, in the stomach. High fiber foods to avoid include:
- fruits such as apples, berries, figs, and oranges
- vegetables such as broccoli, cauliflower, cabbage, and green beans
- whole grain cereals
- nuts and seeds
- beans and lentils
Foods that cannot be chewed easily. If foods are not easy to chew, they will not be sufficiently broken down by the time they reach the stomach. Examples include nuts, seeds, corn, and popcorn.
Junk foods. Because the stomach empties slowly in people with gastroparesis, it is important to consume mainly healthy and nutritious foods. These types of foods help to reduce the risk of becoming full on foods such as pizzas, chips, fries, sodas, and sweets, which do not provide adequate nutrition.
Alcohol. The rate of gastric emptying is delayed following alcohol consumption.
7. Foods to eat
It may be helpful for a person to work with a dietitian to discover what foods are easiest to digest and to ensure nutritional needs are met. However, in general, the following foods are encouraged for those with gastroparesis:
Fruits and vegetables
- blended fruits and vegetables, such as purees or smoothies
- canned peaches and pears
- well-cooked fruits and vegetables rather than raw ones
- soups and broths
Carbohydrates and starches
- corn tortillas
- English muffins
- puffed wheat and rice cereals
- potatoes and sweet potatoes, without skin
- white or refined breads, crackers, bagels, pasta, and rice
Meats, eggs, and dairy
- reduced-fat cottage cheese
- ground or pureed meats
- low-fat milk and milkshakes
- plain yogurt and frozen yogurt
- poultry without the skin and not fried
- tuna in water
8. Trying a 3-phase approach
The Gastroparesis Patient Association for Cures and Treatments recommend a 3-phase plan in their dietary guidelines that may be helpful for some people:
Phase 1: Consists of liquids such as broths and vegetable juices.
Phase 2: Includes more substantial soups containing noodles and rice, along with peanut butter, cheese, and crackers.
Phase 3: Adds in soft starches, as well as baked chicken and fish.
A person should consult a doctor before starting this diet.
While dietary interventions are considered the first-line treatment for gastroparesis, they do not work for everyone.
Some people may need to consider medication and other lifestyle changes in addition to altering their diet.
Furthermore, people with any underlying conditions contributing to gastroparesis will likely need to address those first to experience symptom relief.
Treating the underlying condition
If an underlying condition is leading to symptoms of gastroparesis, it is important that it is properly managed to reduce the symptoms and to limit the risk of any other complications.
Smoking should also be avoided, as it is known to affect gastric emptying.
Drug treatments for gastroparesis include:
Medications to enhance stomach emptying. These include metoclopramide, erythromycin, and domperidone. However, there is a risk of negative side effects with these medications, and erythromycin may also become less effective with time. A new drug, relamorelin, is currently being developed and may have fewer side effects than medications currently on the market.
Medications to reduce nausea and vomiting. These include prochlorperazine, diphenhydramine, and ondansetron.
Medications to avoid
Several medications are known to delay stomach emptying. People who are experiencing gastroparesis should tell their doctor about all the medications they are taking.
Medications that delay stomach emptying include:
- antacids, containing aluminum
- anticholinergic agents
In severe cases, people who are unable to take any food or liquids due to gastroparesis may require a feeding tube. Alternatively, a gastric venting tube may be used to relieve pressure in the stomach.
A procedure called gastric electrical stimulation (GES) has shown mixed results in the treatment of gastroparesis. People with diabetic gastroparesis, in particular, may experience benefits from it. GES involves surgically implanting a device to stimulate the stomach muscles.
The outlook for people with gastroparesis varies and depends on the cause and severity of the condition.
In any case, making dietary changes, gentle exercise after meals, and quitting smoking can significantly increase the chances of managing this gastrointestinal problem.
If these changes alone are not effective, medications, medical interventions, and alternative therapies may help relieve symptoms and avoid complications.