Gastroparesis, also known as delayed gastric emptying, is a condition that affects the way the stomach’s muscle function, resulting in slowed emptying of the contents of the stomach. This causes digestive symptoms such as nausea, vomiting, abdominal pain, loss of appetite, and bloating, which are typically prevalent after eating a meal. These symptoms lead to added difficulty in a patient’s ability to eat.
Among cancer patients, specifically those with upper GI tumors, gastroparesis is a frequently overlooked complication of cancer. Typically misdiagnosed as chemotherapy-induced nausea and vomiting or cachexia, the condition is associated with 60% of patients with advanced pancreatic cancer. It has also been found in patients with lung cancer, and less commonly in breast and ovarian cancer.
The standard test for diagnosis of gastroparesis is a gastric scintigraphy after a solid meal; it is unknown whether this “malignant gastroparesis” is caused by treatment complications or the cancer itself, but the condition can have serious side effects such as electrolyte disruptions and more frequent hospitalizations in cancer patients who may already struggle with their nutrition.
August is Gastroparesis Awareness Month. To bring more notice to this often-overlooked complication, here are some ways to help patients who may be experiencing gastroparesis.
Assess Potential Complications
It is important to check for nutritional or metabolic complications in patients, such as possible vitamin deficiencies, electrolyte disruptions, volume depletion and weight loss. A scoring system such as the Gastroparesis Cardinal Symptom Index (GCSI) can help guide treatment options by measuring the severity of the three main symptoms – early satiety, nausea and vomiting, and bloating.
Diet Modifications
Gastroparesis patients are advised to eat in small portions consisting of low-fat, low-residue meals. Foods that are high in fat, as well as fiber, can delay gastric emptying, so low-fiber diets are also suggested.
Patients should avoid foods that may be hard to chew, such as broccoli, corn, popcorn, nuts, and seeds.
Reducing meal size helps to reduce distention of the stomach after eating and helps to reduce feelings of fullness or bloat. Since meals are smaller, increasing the number to meals to 4 to 6 per day is recommended.
Foods that are recommended include:
- Vegetables – Cooked and blended/strained, if necessary
- Fruits – Cooked and blended/strained, if necessary
- Ground or pureed meats
- Breads, cereals, or crackers
- Juices, beverages, and milk products, if tolerated
Smoking and the consumption of alcohol should also be discontinued.
Recommended Medications
If patients can add other medications to their regimen, the standard medication used to treat gastroparesis is erythromycin. The drug has been effective in improving gastric emptying and improving symptom scores. A major issue of erythromycin is tachyphylaxis, in which successive doses result in diminished response to the medication.
Rotating treatment cycles is suggested, where the medication will be administered for several consecutive weeks followed by a one-week “rest” period of stopping the medication. If patients do not respond to erythromycin, domperidone or metoclopramide may also be recommended, however these drugs may cause side effects such as QT prolongation.
To learn more about gastroparesis symptoms and treatments, visit AboutGastroparesis.org.
References
Pancreatic carcinoma is associated with delayed gastric emptying
