Management of gastroparesis-associated malnutrition.
Gastroparesis (GP) is a chronic debilitating dysmotility characterized by unrelenting nausea, vomiting, bloating, early satiety, postprandial fullness and abdominal pain. Patients with GP experience other associated conditions, including gastroesophageal reflux disease, gastric bezoars and small bowel bacterial overgrowth. Furthermore, GP is associated with poor quality of life, increased emergency room visits, hospitalizations and subsequent increased healthcare costs. Currently, the managements of GP consist of glycemic control, antiemetics, prokinetics and the use of gastric electrical stimulation. However, most GP patients are at risk for significant nutritional abnormalities. As such, it is essential to screen and diagnose malnutrition in these patients. Poor oral intake in such patients could be supplemented by enteral tube feeding. Parenteral nutrition, although a last resort, is associated with a number of complications and should be used only for the short term. In summary, a systematic approach including initial nutritional screening, diet recommendations, medical therapy, nutritional re-evaluation and enteral and parental nutrition should be considered in complex GP patients.
Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA.
Shishira
S
Bharadwaj
Department of Gastroenterology/Hepatology, Michigan State University, East Lansing, MI, USA.
Krishna
K
Meka
Department of Gastroenterology/Hepatology, Michigan State University, East Lansing, MI, USA.
Parul
P
Tandon
Department of Gastroenterology/Hepatology, Michigan State University, East Lansing, MI, USA.
Abdullah
A
Rathur
Department of Gastroenterology/Hepatology, Cleveland Clinic, West Palm Beach, Florida, USA.
John M
JM
Rivas
Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA.
Hiren
H
Vallabh
Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA.
Andrea
A
Jevenn
Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA.
John
J
Guirguis
University of Mississippi Medical Center, Jackson, Mississippi, USA.
Imran
I
Sunesara
Department of Gastroenterology/Hepatology, Center for Human Nutrition, Cleveland Clinic Foundation, College of Osteopathic Medicine Cleveland, Ohio, USA.
Amy
A
Nischnick
Department of Gastroenterology/Hepatology, Cleveland Clinic, West Palm Beach, Florida, USA.
Andrew
A
Ukleja
D019468:Disease Management; D005746:Gastric Emptying; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D018589:Gastroparesis / Q000150:complications / Q000628:therapy*; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D015596:Nutrition Assessment; D018529:Nutritional Support / Q000379:methods*; D011788:Quality of Life
D005765:Gastrointestinal Agents
enteral nutrition; gastroparesis; malnutrition; parenteral nutrition