The role of diet in counteracting gastroparesis

Abstract

Gastroparesis is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction. The most common symptoms associated with gastroparesis are early satiety, postprandial fullness, nausea and vomiting, but also abdominal discomfort and bloating. The most frequent causes of gastroparesis include diabetes (29 %), post-surgical issues (13 %), and idiopathic-related factors (36 %). Gastroparesis has been associated with abnormalities of: impaired gastric accommodation, antral hypomotility, pylorospasm, duodenal dysmotily, autonomic dysfunction and visceral hypersensitivity. Ingestion of nutrients induces changes in motility, secretion, and release of hormones, that coordinate the digestive process and depend on the nature and composition of the ingested nutrients. The emptying speed of a meal is inversely correlated with its caloric content and also depends on the acidity, osmolarity, and viscosity of the meal. The presence of lipids induces sensations of satiety at low concentrations, and occurrence of nausea at higher concentrations; liquid form is better. The general principles for treating symptomatic gastroparesis are to: 1) reduce symptoms, 2) correct and prevent fluid, electrolyte and nutritional deficiencies; 3) identify and treat the concomitant comorbidities. The gastroparesis severity classification can facilitate the selection of patients that can be treated as outpatients. Mild gastroparesis is characterized by intermittent, is treated with dietary modification and avoidance of medications that slow emptying. Compensated gastroparesis is characterized by moderately severe symptoms with infrequent hospitalizations that are treated with combined prokinetic and antiemetic agents. Gastric failure gastroparesis patients are medication-unresponsive, cannot maintain nutrition or hydration, and require frequent emergency department or inpatient care. Reduction in meal size and volume are a relevant factor in the dietary management, by using the gravity effect, after the meal, sitting upright for 1 to 2 hours or by even going for a gentle walk could play a role in helping patients to reduce their symptoms; the next step is to introduce a more liquid-pureed-based meal or have alternate days with some solid food and then consume more liquid-type meals as the symptoms progress and the feeling of fullness increases. The administration of a low wine dose increase gastric emptying and intestinal motility; ethanol has also been seen to cause pyloric relaxation, which may facilitate gastric emptying. Foods responsible for symptoms worsening include orange juice, fried chicken, cabbage, oranges, sausage, pizza, peppers, onions, tomato juice, lettuce, coffee, salsa, broccoli, bacon, and roast beef. Foods able to elicit symptoms are generally fatty, acidic, spicy, and roughage-based. Foods not provoking symptoms are generally bland, sweet, salty, and starchy. A pilot study on soy germ pasta containing isoflavones provided evidence that nutraceutical could be a potential treatment for diabetic gastroparesis.