We recently profiled Lisa G.
, a spirited woman who has an active family and travel schedule despite relying on a feeding tube to get the nutritional therapy she needs. Lisa uses a feeding tube and Peptamen®
specialized nutritional therapy formula from Nestlé Health Science because she has gastroparesis—a condition that causes a delayed emptying of the stomach. Here, we catch up with Cindy Lowen, RD, LD, and Nestlé Health Science Medical Scientific Liaison to learn more about what causes gastroparesis.
So, what is gastroparesis?
Gastroparesis1 is a partial stomach paralysis which causes delayed emptying of stomach contents. Delayed gastric emptying is associated with nausea, vomiting, abdominal distention and pain. To people who suffer from gastroparesis, it may feel much like a stomach virus that doesn’t go away.
Do we know what causes gastroparesis?
What causes gastroparesis is often unclear, but, in about a third of the cases, it is related to diabetes and nerve damage from high levels of glucose (sugar) in the body. In rare cases, it can also be a medical side effect or tied to another condition such as Parkinson’s disease or Scleroderma. But for approximately a third of the time, including Lisa’s case, it's idiopathic which means we don't know what causes gastroparesis.
How does gastroparesis get diagnosed?
Gastroparesis is usually diagnosed using a Gastric Emptying Scan. The patient eats food that contains a small amount of radiolabeled material (radioisotopes) which allows the process of digestion to be filmed for four hours. After four hours, if ten percent or more radioisotopes are still in the stomach, the person is diagnosed as having gastroparesis.
Is gastroparesis a common disease?
Fortunately, gastroparesis is relatively rare with only 24.2 people diagnosed for every 100,000.2 However, some researchers estimate that as many as 1.8% of the population may have the condition since so few people get the proper diagnostic tests.1 In fact, it took over a year before Lisa was officially diagnosed.
What is done to treat gastroparesis?
The first line of defense is to prescribe the appropriate diet, sometimes in combination with a medication to try and get the food to move out of the stomach. If that doesn’t work, injections or surgery can be used to relax the valve between the stomach and small bowel.
What about nutritional therapy?
Nutritional therapy is a very important component of managing gastroparesis. The first thing that happens is a special diet is prescribed by the health care practitioner. The medical team may suggest a low fat diet, consisting of small meals that are emptied more readily from the stomach, leading to fewer symptoms.
If that doesn't work, liquid oral supplements are given. And if that doesn't work, there's a trial period where nutrition is administered either through the vein, which is called parenteral nutrition (PN), or through a feeding tube, which is called enteral nutrition. If the gastroparesis doesn’t go away, then a more permanent catheter is placed either enterally for tube feeding or parenterally for PN or sometimes, as with Lisa, access for both are created.
The goal of nutritional therapy is to restore optimal nutritional status, providing adequate nutrients to support health and well-being. Nutritional therapy is also important in getting people back to their optimal body weight. For example, at one point, Lisa only weighed 87 pounds, which was 67% of her ideal body weight. A major goal of Lisa’s treatment was for her to gain weight. And while Lisa still has gastroparesis, I am happy to report that she is now 140 pounds, 100% of her usual body weight.
Lisa mentioned she uses nutritionally-complete Peptamen® formula for nutritional support. Could you tell us more about it?
Sure, Peptamen® formula contains 100% whey protein that has been carefully broken down or pre-digested into smaller protein fragments known as peptides. It also contains a special kind of fat called medium chain triglycerides (MCT).
Want to learn more about enteral nutrition and tube feeding?
Get information and resources on tube feeding for adults or tube feeding for children.
- Rey E et al, Prevalence of Hidden Gastroparesis in the Community: The Gastroparesis "Iceberg" J Neurogastroenterol Motil 2012; 18(1): 34-42 https://doi.org/10.5056/jnm.2012.18.1.34