Nutritional Management of Gastroparesis in People With Diabetes

Abstract

Gastroparesis, or slow emptying of the stomach, is a debilitating disease process that affects an estimated 4% of the population.1 The most common etiologies preceding the development of gastroparesis symptoms are diabetes (50%), status post vagotomy or gastric resection, and a viral episode before symptom development. Before the diagnosis can be made, however, mechanical or structural disorders of the gastrointestinal tract must be ruled out. Clinically, patients with gastroparesis are at risk for fluid, electrolyte, and nutrient deficits and, in patients with diabetes, erratic glycemic control. Treatment is targeted at correcting fluid, electrolyte, and nutritional deficiencies, reducing symptoms, and correcting the precipitating cause of gastroparesis, if possible. Although the mainstay of treatment for gastroparesis is anti-emetic and prokinetic therapy,1 this article will focus on nutrition interventions. Stratifying the nutrition status of patients with gastroparesis into mild, moderate, or severe malnutrition is an important first step in the treatment of gastroparesis. This will help identify those who need aggressive nutritional support early on versus those who might benefit from some initial adjustments in oral food selections. Unintentional weight loss over time is one of the first and most important parameters to assess regardless of the patient's overall appearance. A 5–10% unintentional loss of weight over a 3- to 6-month period signifies severe malnutrition.2 Most guidelines identify patients at nutritional risk if they: 1. Are < 80% of ideal weight 2. Have a BMI < 20 kg/m2 3. Have lost 5 lb or 2.5% of baseline weight in 1 month 4. Have lost 10 lb or 10% of usual body weight in 6 months One often-overlooked population includes patients requiring hemodialysis. Given the percentage of hemodialysis patients who have a long-standing history of diabetes, gastroparesis can frequently be found if clinicians know what to look for.3,4Because of the …