In gastroparesis, the stomach empties its contents more slowly than normal. This can be caused by various underlying diseases, but there is no mechanical blockage. Why the right diet is important and whether life expectancy is affected.
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Quick overview: Frequently asked questions and answers
Is gastroparesis curable? No, gastric emptying disorders are generally not curable. The symptoms can be alleviated with prokinetic medication, diet and sometimes surgical interventions (gastric pacemaker).
How old can you get with gastroparesis? People with gastroparesis have a normal life expectancy if the disease is treated and symptoms are controlled.
How do you recognize gastroparesis? Typical symptoms include nausea, vomiting, feeling full after only small meals, flatulence and abdominal pain.
What to eat with gastroparesis? Experts recommend eating small meals more frequently and favoring foods low in fat and fiber to facilitate digestion.
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What is gastroparesis?
Gastroparesis (gastric paralysis, gastric atony) is a disorder of the motility of the stomach. This means that the stomach empties only slowly or not at all because the stomach muscles are not functioning properly. It is a functional delay in gastric emptying without there being a mechanical blockage.
Due to the gastric emptying disorder, even medications taken orally are transported only with a delay, which in turn can complicate the treatment of any underlying diseases that may exist.
Diabetic gastroparesis
Diabetic gastroparesis can occur as a result of long-term diabetes mellitus with chronic hyperglycemia (high blood sugar). The gastric paralysis occurs due to damage to the nerves that supply the stomach (autonomic neuropathy).
It occurs more frequently in patients with type 1 diabetes mellitus, but can also occur in type 2.
Does gastroparesis affect life expectancy?
The prognosis of gastroparesis depends mainly on the underlying cause. If it is diagnosed in time and the underlying disease is treated adequately, life expectancy is not significantly reduced in most cases. Serious complications can severely impair the quality of life of patients, but are usually not life-threatening.
Gastroparesis: These symptoms can occur
Due to the slowed emptying of the stomach, the food is transported more slowly into the small intestine. This can result in physical discomfort. The severity of the symptoms can vary greatly and range from mild discomfort to severe cases with severe impairment of food intake.
Typical complaints are:
- Feeling of fullness after eating (postprandial)
- early feeling of satiety
- Nausea and vomiting
- Reflux (stomach fluid flows back into the esophagus)
- Pain or cramps in the upper abdomen
- in severe cases weight loss
Possible complications include severe hypoglycemia (low blood sugar) in people with diabetes mellitus due to delayed food intake. Reflux esophagitis and Barrett’s esophagus can also occur, which are considered precancerous conditions.
Possible causes of gastroparesis
The most common cause is diabetic gastroparesis. High blood sugar levels over a long period of time damage the nerves that supply the stomach and control its emptying. In many cases, however, no trigger for the gastric paralysis can be identified.
Other causes are:
- neurological diseases such as Parkinson’s or multiple sclerosis
- muscular causes
- Surgical treatment of a stomach ulcer (vagotomy)
- Drugs such as GLP-1 agonists, opioids or antidepressants
- Infection with cytomegalovirus or norovirus
Treatment of gastric paralysis
The treatment of impaired gastric emptying usually consists of various components. Early nutritional advice is recommended to prevent consequences and complications such as malnutrition.
In addition to a change in diet, drug therapy plays an important role in alleviating symptoms. While prokinetics such as metoclopramide, domperidone or erythromycin accelerate the emptying of the stomach, antiemetics are used to control nausea and vomiting. Proton pump inhibitors (PPIs) can also be prescribed for reflux symptoms.
Severe cases may require invasive measures. These include
The last option is bypass surgery (bypassing the stomach) or partial removal of the stomach (partial gastrectomy).
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What should people with gastroparesis eat?
There are special nutritional recommendations and diet plans for people with gastroparesis that aim to improve tolerance and nutrient supply. The dietary change should be carried out together with a nutritionist to ensure a balanced supply.
Recommendations and tips:
4 to 6 small meals spread throughout the day (instead of three main meals)
prefer liquid and pureed foods
Choose easily digestible, low-fat food
Consume energy and nutrient-rich shakes as a supplement
Enrich food with proteins, vitamins and minerals if necessary
Avoid alcohol and spicy and acidic foods
Sit upright and eat slowly
The following foods should be avoided:
Fats delay gastric emptying, so fatty foods such as fried foods, mayonnaise or cream sauces should be avoided
Indigestible fiber from whole grain products, legumes and some fruits/vegetables can increase the feeling of fullness
Foods that lead to increased gas formation such as cabbage, legumes or carbonated drinks should be reduced
Hot spices and acidic foods such as citrus fruits or tomatoes can cause stomach problems
Alcohol and caffeine can slow down gastric emptying and thereby increase reflux
Diagnosis if gastroparesis is suspected
To diagnose gastroparesis, various methods are used to evaluate gastric emptying and gastric function.
First, the doctor will conduct a detailed conversation to determine the symptoms present, how they began and progressed, and possible triggers. A physical examination can provide clues to other illnesses.
Further investigations:
Gastric emptying scintigraphy: The gold standard for diagnosing gastroparesis. A small amount of radioactive substance is ingested with a meal. A special camera then tracks its movement through the stomach over several hours to determine the emptying rate.
C13 Octanoic Acid Breath Test: The breath test is a less invasive method in which a test meal containing a non-radioactive substance is administered. The amount of exhaled C13 in the breath provides information about gastric emptying.
Gastroscopy: A gastroscopy provides insights into the stomach lining, and at the same time the doctor can take tissue samples (biopsy).
Ultrasonic: An ultrasound-based method specifically developed to study gastric emptying can also be used. It is non-invasive and provides real-time images of the stomach.
Wireless Motility Capsule: This procedure uses a small capsule that is swallowed and records data on pressure, pH and temperature in the gastrointestinal tract.
Blood tests: Blood tests may be done to look for diabetes, thyroid problems, or other conditions that may cause or worsen gastroparesis.
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