What are the non-pharmacological (non-medication) management options for gastroparesis?

Non-Pharmacological Management of Gastroparesis

A low-fiber, low-fat diet with small, frequent meals (5-6 per day) and increased proportion of liquid calories is the cornerstone of non-pharmacological management for gastroparesis. 1, 2

Dietary Modifications

Dietary management is the primary non-pharmacological approach for gastroparesis:

• Meal structure modifications:

  • Small, frequent meals (5-6 per day) instead of 3 large meals 2
  • Increase proportion of liquid calories (easier to empty from stomach) 1, 2
  • Foods with small particle size to facilitate gastric emptying 1, 2

• Food composition adjustments:

  • Low-fiber diet (fiber delays gastric emptying) 1, 2
  • Low-fat diet (fat slows gastric emptying) 1, 2
  • Pureed or blended foods for easier digestion 2

• Stepwise nutritional approach for severe cases:

  1. Modified solid foods
  2. Blended/pureed foods
  3. Liquid diet with oral nutritional supplements
  4. Enteral nutrition via jejunostomy tube (for severe cases) 2

Medication Adjustments

• Withdraw medications that delay gastric emptying:

  • GLP-1 receptor agonists
  • Pramlintide
  • Opioids
  • Anticholinergics
  • Tricyclic antidepressants (when used at higher doses) 1, 2

• Consider diabetes medications with neutral effect on gastric emptying:

  • DPP-4 inhibitors
  • Sulfonylureas
  • Thiazolidinediones 2

Glycemic Control

• Achieve near-normal glycemic control to prevent progression of gastroparesis 2
• Adjust insulin timing and dosage to account for delayed gastric emptying 2

Surgical and Interventional Options for Refractory Cases

For patients with severe, refractory gastroparesis who have failed standard medical therapy:

• Gastric electrical stimulation (GES):

  • FDA-approved for treating refractory gastroparesis
  • Most effective for nausea and vomiting symptoms
  • Not effective for accelerating gastric emptying
  • Contraindicated in patients with predominant abdominal pain or current opioid use 2

• Gastric peroral endoscopic myotomy (G-POEM):

  • May be considered for patients with severe delay in gastric emptying
  • Evidence level is low 2

• Enteral nutrition via jejunostomy tube:

  • For patients with inadequate oral intake despite dietary modifications
  • Bypasses the dysfunctional stomach 2, 3

Practical Implementation Tips

• Start with the least restrictive dietary modifications and progress as needed
• Monitor nutritional status, electrolytes, and hydration regularly 2
• Maintain a food diary to identify specific food triggers
• Consume the majority of daily calories earlier in the day
• Remain upright for 1-2 hours after meals to aid gastric emptying
• Avoid carbonated beverages that can cause gastric distension

Common Pitfalls and Caveats

• Avoid overly restrictive diets that may lead to nutritional deficiencies
• Don't neglect glycemic control in diabetic gastroparesis, as hyperglycemia can worsen gastric emptying
• Consider psychological support as gastroparesis significantly impacts quality of life 4
• Regular reassessment is crucial as symptoms and severity may fluctuate over time
• Recognize when to escalate care - persistent vomiting, weight loss >10%, or inability to maintain hydration may require more aggressive interventions

The American Diabetes Association and American Gastroenterological Association emphasize that dietary management should be the first-line approach for most patients with gastroparesis, with more invasive interventions reserved for refractory cases 1, 2.