Selected Podcast
What is Gastroparesis and How Can You Understand and Manage This Disease?
In this episode, Dr. Frey (Gastroenterologist) talks about what is Gastroparesis and how can you understand and manage this disease.
Featuring:
Eric Frey, MD
Dr. Eric Frey is currently a gastroenterologist at Southern Sierra Specialty Center, and has been a part of the medical staff at RRH since July 2015. He received a Bachelor of Science at the University of North Carolina at Chapel Hill, and after 2 years in the Peace Corps, attended Medical School at St. George’s University. He completed Internal Medicine residency at New York-Presbyterian Brooklyn Methodist Hospital. He was selected to serve as Chief Resident, overseeing the training and medical quality of Methodist’s 110 resident physicians. Following his Chief Resident tenure, he spent a year as a staff physician with the VA in San Diego, before completing his Gastroenterology Fellowship Training at Methodist in 2015. Transcription:
Prakash Chandran: Today, we're talking about gastroparesis. And joining us today is Dr. Eric Frey. He's a gastroenterologist at Southern Sierra Specialty Center. This is the Ridgecrest Regional Hospital Podcast. My name is Prakash Chandran. So Dr. Frey, thank you so much for being here today. We really appreciate your time. Let's start with the basics. What exactly is gastroparesis?
Dr Eric Frey: Okay. Well, first off, thank you for having me on this podcast. I think the question that you just asked, what is gastroparesis, that is actually a really good place to start since most people have never heard of this condition. Like a lot of medical terms, it has kind of a long name. And when I mention this term in the clinics, you know, I frequently watch people's eyes start to glaze over. When I drop terms like this in the clinic, they just tune out.
So, at the simplest level, gastroparesis, it's basically is a paralysis of the stomach. So in a more medical sense, it's really defined as delayed emptying of the stomach. So, you may or may not know this, but the stomach's main job is to receive food as in a meal, and to start mixing it up and then add a little bit of acid and some digestive enzymes. And then, really its main job is to mix these things up and slowly send it into the small intestine where digestion is finished. So in gastroparesis, the signals that the stomach gets, the nerve signals, the chemical signals that the stomach needs to sort of wake up and start doing its job, they don't get to the stomach and so the stomach just kind of stays asleep.
So normally, when you eat a meal, depending on what you eat, you know, it typically takes no longer than two hours or so to empty that food into the small intestine, sometimes more, sometimes less. In gastroparesis, the definition is that it takes more than four hours for a meal to leave the stomach. So, if you have ever had a large meal where you've overstuffed yourself, you know, think back to your last maybe Thanksgiving or Christmas dinner, and you ate a huge meal and you stuffed yourself, that feeling of like, "Oh my God, I am so full. That's what gastroparesis feels like all the time." Every meal you have, you're stuffed and it can be an awful experience and it will just sit there for hours and hours. Most people when they eat a meal like that, after an hour or two, they feel better. But in patients with gastroparesis, they almost never feel better. They just always feel like they're stuffed.
Prakash Chandran: That is a very good explanation of not only the digestive process, but what it feels like to have gastroparesis. Tell me, Dr. Frey, how many people are affected by this per year? And also, maybe tell us about the typical demographics of those people.
Dr Eric Frey: Oh, sure. Gastroparesis is a fairly rare condition. And, honestly, like many diseases, how many people actually have gastroparesis is not really clear. It doesn't garner much attention. It's not a deadly disease. It's not a contagious disease. It's not a dramatic disease where you're gonna have obvious things on your body. And there's no celebrities that really have this. So it goes under the radar. And in fact, even doctors overlook this as a possible explanation of patient's symptoms because it is an uncommon disease. And it's actually registered as a rare disease. And many other illnesses can mimic some of the same symptoms of gastroparesis. And so, we feel like it's underdiagnosed for many reasons. But when we do look at the data of how many people we think have it, estimates range anywhere from 15 to 300 per 100,000 people, right? So in a town the size of ours, which is Ridgecrest, where we have roughly about 30,000 people, we should expect in a town of our size to have anywhere between five and 90 people or so should have this disease. And so every year or so, we expect one or two people in our town to be diagnosed with gastroparesis.
In the sort of classic picture, we expect to see this condition in middle-aged women, but it can really affect anybody, young to old, male or female. And thankfully, in a way, there's no good data on race or ethnicity in terms of gastroparesis. And I should mention as a side note, that's probably a good thing because we should not be relying probably on race and ethnicity and even sex to think in the back of our minds what could be going on with a patient. So, we should really be ruling out diseases regardless of race or their ethnic backgrounds. And so, this is more of a general medical sort of opinion, I guess, but think it's better not to do that. But generally speaking, gastroparesis is much more common in women. Again, that doesn't mean it can't affect men. So about five times more common in women than men. So, of the people that have gastroparesis, about 80% of them are women.
Prakash Chandran: Got it. Interesting. And you're saying middle-aged women. So based on the data, what you're seeing, this is typically diagnosed in women. And I want to maybe talk a little bit about how it actually gets diagnosed. Do people come in and say like, "You know what? I just feel full for a really long time after I eat"? Are those the typical symptoms that people have that cause them to think, "Hmm, maybe I should see a specialist about this"?
Dr Eric Frey: Absolutely. The problem with gastroparesis is exactly that, a lot of conditions can lead to people feeling like, "Oh, I'm really full. I feel like I'm going to throw up. I feel bloated. Food doesn't feel like is leaving my stomach," I mean, that can be seen in many other conditions such as peptic ulcer disease or gastritis or even having an infection with a virus can lead to those symptoms. But I think the hallmark of gastroparesis is that these are symptoms that have lasted for months or years, and they've been causing problems with every meal. And so that's not typical of most other underlying diseases that can mimic the same symptoms. But oftentimes, we're able to be clued in that this may be gastroparesis based on underlying medical conditions such as diabetes, which is a very common cause of gastroparesis, probably because of the way the sugar will affect the nerves that feed the stomach.
And so other people that can be predisposed to gastroparesis are folks that have had surgery on their stomach where maybe the nerves have been cut or damaged or people that are on certain medications that can also cause a delay in the stomach emptying, especially narcotic pain medications like Norco, Percocet, these kinds of medications.
Prakash Chandran: So is gastroparesis something that gradually comes about or is it something that you aren't feeling it and then you are feeling it? You mentioned like surgery on the stomach, diabetes. Talk to us a little bit about the onset of gastroparesis and how it represents.
Dr Eric Frey: So in some cases, it can be a sudden onset such as surgery. Obviously, if you've had say a gastric bypass surgery or you've had some kind of surgery done in your stomach, where they've had to or accidentally even maybe cut one of the nerves that's feeding the stomach with its signals, then your symptoms may come on right away actually after the surgery. But you may misinterpret that as like, "Oh, I just had surgery. I don't feel good. It's because of my surgery." But after a few months of that, I think people started to clue in that, "Okay, this is not just from the surgery itself, it's actually from something deeper than that."
In other settings, and I should point out here actually that most patients with gastroparesis, we don't know the underlying cause. They're not a diabetic patient. They're not on medications that can cause slowing of gastric emptying. They haven't had surgery. So in these patients, it's a more insidious onset where they may feel full with one meal and like, "Okay, well ,maybe I just overate." And then, maybe a few meals later, again, the same feeling comes on. And then, gradually, it's more and more meals where they feel like, "Wow, I just stuffed myself and it will gradually come on where at some point it's every single meal is causing those symptoms to happen."
Prakash Chandran: You talked about the food getting mixed and sent to the small intestine, and you're saying that it can take more than four hours for a gastroparesis patient. Does that time just keep extending over time if not treated?
Dr Eric Frey: We don't really know the answer to that actually, because the way that we actually test for gastroparesis is there's cumbersome study that's called a gastric emptying study where patients will actually eat a radioactive egg. And we literally just watch this egg under a scanner and with a stopwatch. We time it to see how long it takes to leave. And so that kind of study is a little bit hard to do on the same patient over and over again to see, "Wait, is it getting longer and longer for that egg to leave the stomach?" It's expensive. It's time consuming. And we just don't have that sort of data. So we don't really know the answer actually to that question.
Prakash Chandran: But one thing that you mentioned is that it's not necessarily a life-threatening issue. It's not deadly. So is it fair to say that apart from the discomfort, and the discomfort is great that, outside of that, it's not like a critical condition that someone needs to worry about their life for?
Dr Eric Frey: So, the main concern of gastroparesis is actually just what you mentioned. It's a quality of life issue. You can imagine if every single meal is causing you to feel full and like you want to throw up and people actually do throw up a lot. So it's mainly a problem of quality of life and due the chronic symptoms. But there are a certain subset of people that have gastroparesis where it can become a life-threatening condition if they cannot eat enough where they start losing weight to the point where they're malnourished. They can become deficient in vitamins and minerals and things that they need to eat. So these kinds of patients, it can become more than just a quality of life issue, but more of like, yes, it can affect their health in ways that are beyond just the discomfort.
Prakash Chandran: So if someone has gastroparesis and they want to get help, what does that help look like? And how can they do that?
Dr Eric Frey: So really, as I mentioned earlier, I think the main thing is to make sure that you have gastroparesis and not some other underlying condition that may lead to the same symptoms. So this is a condition where if you think you have it, you should not be looking at this on your own and thinking, "I have this, let me just do the things that I should do for gastroparesis." You really need to see a doctor and we really need to confirm the diagnosis with something like a gastric emptying study, which is that radioactive egg test that I just mentioned earlier. But you really need to make sure that you're not dealing with something else, and so that's where the doctors get involved. And it's really important for you to rule out other things like peptic ulcer disease or gastritis or some other problem that might be more easily treated and can also be life-threatening if untreated. So it's important for patients to seek medical attention if they think they have gastroparesis.
Prakash Chandran: And in terms of getting that correct diagnosis afterwards, if you do determine that you have gastroparesis, can gastroparesis be healed? And if so, what are the steps or medication to take in order to do that?
Dr Eric Frey: So it will depend on the underlying cause of the gastroparesis as to whether or not it can be cured. Obviously, if you've undergone surgery where nerves to the stomach have been damaged or cut, then obviously there's no cure for that. If you have an underlying cause that is something like a medication that you're taking or you have diabetes or some treatable medical condition, you can possibly reverse the course of gastroparesis by, if you're taking medications that are causing it, well, then you stop them if that's possible. If you are a diabetic, then possibly getting your blood sugars under very good control can sometimes make the gastroparesis symptoms better. They may not cure you of gastroparesis, but at least your symptoms may improve. But really the mainstay of therapy for gastroparesis, if you were in fact diagnosed with it, is to modify your diet. That's the main thing. So we usually recommend patients to eat a low fiber diet, which is sort of the opposite of what doctors usually recommend for patients. You know, we're usually telling patients, "Eat lots of fiber. It's good for you." But in this condition, it's one of the only conditions where a low fiber diet is actually the preferred thing here. So low fiber diet, low fat, small frequent meals. Instead of sit down, breakfast, lunch, dinner, we usually recommend patients kind of graze all day long on food. Just have like a buffet table set up and they just keep picking at food all day long so that their stomach is not overly full at any moment.
Prakash Chandran: Yeah. So it's like continuous digestion. It's like you're trickling food into the system rather than a massive meal that is going to make you feel really full and uncomfortable, right?
Dr Eric Frey: That's exactly right. You've hit the nail right on the head. That's exactly what we recommend, that you just keep the stomach moving and working, but don't overload it with massive meals that will just sit there. And if you can do anything to help the food go through, like if you can blenderize your food or if you can drink lots of fluids; instead of having thick meals, maybe have a smoothie instead, then gravity can push fluid out better than it can push solid food out, so yeah.
Prakash Chandran: Well, this has been fascinating, Dr. Frey. Thank you so much for your time. Is there anything you'd like to share with our audience before we close?
Dr Eric Frey: Well, I want to thank you for having me. I think the most important thing I tell patients in general or anyone who's listening to this is I think it's always important to pay attention to your body. Don't ignore any symptoms whatsoever, no matter how unimportant they may seem at any moment. Don't be afraid to see your doctor about anything.
I see this a lot in my own clinic where patients are sometimes fearful to bring up symptoms in front of their doctor because they're not comfortable or they don't want to discuss these things. And if that's the relationship you have with your doctor, then I recommend that you see somebody else who will make you feel comfortable enough that you explain your symptoms to whoever you're seeing and have them listen to you and run the appropriate tests.
Prakash Chandran: Well, Dr. Frey, I think that's great advice and a perfect place to end. Thanks so much for your time today.
Dr Eric Frey: All right. Thank you.
Prakash Chandran: That was Dr. Eric Frey, a gastroenterologist at Southern Sierra Specialty Center. Thanks for checking out this episode of the Ridgecrest Regional Hospital Podcast. To learn more, you can visit rrh.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. My name's Prakash. Thanks again for listening and we'll talk next time.
Prakash Chandran: Today, we're talking about gastroparesis. And joining us today is Dr. Eric Frey. He's a gastroenterologist at Southern Sierra Specialty Center. This is the Ridgecrest Regional Hospital Podcast. My name is Prakash Chandran. So Dr. Frey, thank you so much for being here today. We really appreciate your time. Let's start with the basics. What exactly is gastroparesis?
Dr Eric Frey: Okay. Well, first off, thank you for having me on this podcast. I think the question that you just asked, what is gastroparesis, that is actually a really good place to start since most people have never heard of this condition. Like a lot of medical terms, it has kind of a long name. And when I mention this term in the clinics, you know, I frequently watch people's eyes start to glaze over. When I drop terms like this in the clinic, they just tune out.
So, at the simplest level, gastroparesis, it's basically is a paralysis of the stomach. So in a more medical sense, it's really defined as delayed emptying of the stomach. So, you may or may not know this, but the stomach's main job is to receive food as in a meal, and to start mixing it up and then add a little bit of acid and some digestive enzymes. And then, really its main job is to mix these things up and slowly send it into the small intestine where digestion is finished. So in gastroparesis, the signals that the stomach gets, the nerve signals, the chemical signals that the stomach needs to sort of wake up and start doing its job, they don't get to the stomach and so the stomach just kind of stays asleep.
So normally, when you eat a meal, depending on what you eat, you know, it typically takes no longer than two hours or so to empty that food into the small intestine, sometimes more, sometimes less. In gastroparesis, the definition is that it takes more than four hours for a meal to leave the stomach. So, if you have ever had a large meal where you've overstuffed yourself, you know, think back to your last maybe Thanksgiving or Christmas dinner, and you ate a huge meal and you stuffed yourself, that feeling of like, "Oh my God, I am so full. That's what gastroparesis feels like all the time." Every meal you have, you're stuffed and it can be an awful experience and it will just sit there for hours and hours. Most people when they eat a meal like that, after an hour or two, they feel better. But in patients with gastroparesis, they almost never feel better. They just always feel like they're stuffed.
Prakash Chandran: That is a very good explanation of not only the digestive process, but what it feels like to have gastroparesis. Tell me, Dr. Frey, how many people are affected by this per year? And also, maybe tell us about the typical demographics of those people.
Dr Eric Frey: Oh, sure. Gastroparesis is a fairly rare condition. And, honestly, like many diseases, how many people actually have gastroparesis is not really clear. It doesn't garner much attention. It's not a deadly disease. It's not a contagious disease. It's not a dramatic disease where you're gonna have obvious things on your body. And there's no celebrities that really have this. So it goes under the radar. And in fact, even doctors overlook this as a possible explanation of patient's symptoms because it is an uncommon disease. And it's actually registered as a rare disease. And many other illnesses can mimic some of the same symptoms of gastroparesis. And so, we feel like it's underdiagnosed for many reasons. But when we do look at the data of how many people we think have it, estimates range anywhere from 15 to 300 per 100,000 people, right? So in a town the size of ours, which is Ridgecrest, where we have roughly about 30,000 people, we should expect in a town of our size to have anywhere between five and 90 people or so should have this disease. And so every year or so, we expect one or two people in our town to be diagnosed with gastroparesis.
In the sort of classic picture, we expect to see this condition in middle-aged women, but it can really affect anybody, young to old, male or female. And thankfully, in a way, there's no good data on race or ethnicity in terms of gastroparesis. And I should mention as a side note, that's probably a good thing because we should not be relying probably on race and ethnicity and even sex to think in the back of our minds what could be going on with a patient. So, we should really be ruling out diseases regardless of race or their ethnic backgrounds. And so, this is more of a general medical sort of opinion, I guess, but think it's better not to do that. But generally speaking, gastroparesis is much more common in women. Again, that doesn't mean it can't affect men. So about five times more common in women than men. So, of the people that have gastroparesis, about 80% of them are women.
Prakash Chandran: Got it. Interesting. And you're saying middle-aged women. So based on the data, what you're seeing, this is typically diagnosed in women. And I want to maybe talk a little bit about how it actually gets diagnosed. Do people come in and say like, "You know what? I just feel full for a really long time after I eat"? Are those the typical symptoms that people have that cause them to think, "Hmm, maybe I should see a specialist about this"?
Dr Eric Frey: Absolutely. The problem with gastroparesis is exactly that, a lot of conditions can lead to people feeling like, "Oh, I'm really full. I feel like I'm going to throw up. I feel bloated. Food doesn't feel like is leaving my stomach," I mean, that can be seen in many other conditions such as peptic ulcer disease or gastritis or even having an infection with a virus can lead to those symptoms. But I think the hallmark of gastroparesis is that these are symptoms that have lasted for months or years, and they've been causing problems with every meal. And so that's not typical of most other underlying diseases that can mimic the same symptoms. But oftentimes, we're able to be clued in that this may be gastroparesis based on underlying medical conditions such as diabetes, which is a very common cause of gastroparesis, probably because of the way the sugar will affect the nerves that feed the stomach.
And so other people that can be predisposed to gastroparesis are folks that have had surgery on their stomach where maybe the nerves have been cut or damaged or people that are on certain medications that can also cause a delay in the stomach emptying, especially narcotic pain medications like Norco, Percocet, these kinds of medications.
Prakash Chandran: So is gastroparesis something that gradually comes about or is it something that you aren't feeling it and then you are feeling it? You mentioned like surgery on the stomach, diabetes. Talk to us a little bit about the onset of gastroparesis and how it represents.
Dr Eric Frey: So in some cases, it can be a sudden onset such as surgery. Obviously, if you've had say a gastric bypass surgery or you've had some kind of surgery done in your stomach, where they've had to or accidentally even maybe cut one of the nerves that's feeding the stomach with its signals, then your symptoms may come on right away actually after the surgery. But you may misinterpret that as like, "Oh, I just had surgery. I don't feel good. It's because of my surgery." But after a few months of that, I think people started to clue in that, "Okay, this is not just from the surgery itself, it's actually from something deeper than that."
In other settings, and I should point out here actually that most patients with gastroparesis, we don't know the underlying cause. They're not a diabetic patient. They're not on medications that can cause slowing of gastric emptying. They haven't had surgery. So in these patients, it's a more insidious onset where they may feel full with one meal and like, "Okay, well ,maybe I just overate." And then, maybe a few meals later, again, the same feeling comes on. And then, gradually, it's more and more meals where they feel like, "Wow, I just stuffed myself and it will gradually come on where at some point it's every single meal is causing those symptoms to happen."
Prakash Chandran: You talked about the food getting mixed and sent to the small intestine, and you're saying that it can take more than four hours for a gastroparesis patient. Does that time just keep extending over time if not treated?
Dr Eric Frey: We don't really know the answer to that actually, because the way that we actually test for gastroparesis is there's cumbersome study that's called a gastric emptying study where patients will actually eat a radioactive egg. And we literally just watch this egg under a scanner and with a stopwatch. We time it to see how long it takes to leave. And so that kind of study is a little bit hard to do on the same patient over and over again to see, "Wait, is it getting longer and longer for that egg to leave the stomach?" It's expensive. It's time consuming. And we just don't have that sort of data. So we don't really know the answer actually to that question.
Prakash Chandran: But one thing that you mentioned is that it's not necessarily a life-threatening issue. It's not deadly. So is it fair to say that apart from the discomfort, and the discomfort is great that, outside of that, it's not like a critical condition that someone needs to worry about their life for?
Dr Eric Frey: So, the main concern of gastroparesis is actually just what you mentioned. It's a quality of life issue. You can imagine if every single meal is causing you to feel full and like you want to throw up and people actually do throw up a lot. So it's mainly a problem of quality of life and due the chronic symptoms. But there are a certain subset of people that have gastroparesis where it can become a life-threatening condition if they cannot eat enough where they start losing weight to the point where they're malnourished. They can become deficient in vitamins and minerals and things that they need to eat. So these kinds of patients, it can become more than just a quality of life issue, but more of like, yes, it can affect their health in ways that are beyond just the discomfort.
Prakash Chandran: So if someone has gastroparesis and they want to get help, what does that help look like? And how can they do that?
Dr Eric Frey: So really, as I mentioned earlier, I think the main thing is to make sure that you have gastroparesis and not some other underlying condition that may lead to the same symptoms. So this is a condition where if you think you have it, you should not be looking at this on your own and thinking, "I have this, let me just do the things that I should do for gastroparesis." You really need to see a doctor and we really need to confirm the diagnosis with something like a gastric emptying study, which is that radioactive egg test that I just mentioned earlier. But you really need to make sure that you're not dealing with something else, and so that's where the doctors get involved. And it's really important for you to rule out other things like peptic ulcer disease or gastritis or some other problem that might be more easily treated and can also be life-threatening if untreated. So it's important for patients to seek medical attention if they think they have gastroparesis.
Prakash Chandran: And in terms of getting that correct diagnosis afterwards, if you do determine that you have gastroparesis, can gastroparesis be healed? And if so, what are the steps or medication to take in order to do that?
Dr Eric Frey: So it will depend on the underlying cause of the gastroparesis as to whether or not it can be cured. Obviously, if you've undergone surgery where nerves to the stomach have been damaged or cut, then obviously there's no cure for that. If you have an underlying cause that is something like a medication that you're taking or you have diabetes or some treatable medical condition, you can possibly reverse the course of gastroparesis by, if you're taking medications that are causing it, well, then you stop them if that's possible. If you are a diabetic, then possibly getting your blood sugars under very good control can sometimes make the gastroparesis symptoms better. They may not cure you of gastroparesis, but at least your symptoms may improve. But really the mainstay of therapy for gastroparesis, if you were in fact diagnosed with it, is to modify your diet. That's the main thing. So we usually recommend patients to eat a low fiber diet, which is sort of the opposite of what doctors usually recommend for patients. You know, we're usually telling patients, "Eat lots of fiber. It's good for you." But in this condition, it's one of the only conditions where a low fiber diet is actually the preferred thing here. So low fiber diet, low fat, small frequent meals. Instead of sit down, breakfast, lunch, dinner, we usually recommend patients kind of graze all day long on food. Just have like a buffet table set up and they just keep picking at food all day long so that their stomach is not overly full at any moment.
Prakash Chandran: Yeah. So it's like continuous digestion. It's like you're trickling food into the system rather than a massive meal that is going to make you feel really full and uncomfortable, right?
Dr Eric Frey: That's exactly right. You've hit the nail right on the head. That's exactly what we recommend, that you just keep the stomach moving and working, but don't overload it with massive meals that will just sit there. And if you can do anything to help the food go through, like if you can blenderize your food or if you can drink lots of fluids; instead of having thick meals, maybe have a smoothie instead, then gravity can push fluid out better than it can push solid food out, so yeah.
Prakash Chandran: Well, this has been fascinating, Dr. Frey. Thank you so much for your time. Is there anything you'd like to share with our audience before we close?
Dr Eric Frey: Well, I want to thank you for having me. I think the most important thing I tell patients in general or anyone who's listening to this is I think it's always important to pay attention to your body. Don't ignore any symptoms whatsoever, no matter how unimportant they may seem at any moment. Don't be afraid to see your doctor about anything.
I see this a lot in my own clinic where patients are sometimes fearful to bring up symptoms in front of their doctor because they're not comfortable or they don't want to discuss these things. And if that's the relationship you have with your doctor, then I recommend that you see somebody else who will make you feel comfortable enough that you explain your symptoms to whoever you're seeing and have them listen to you and run the appropriate tests.
Prakash Chandran: Well, Dr. Frey, I think that's great advice and a perfect place to end. Thanks so much for your time today.
Dr Eric Frey: All right. Thank you.
Prakash Chandran: That was Dr. Eric Frey, a gastroenterologist at Southern Sierra Specialty Center. Thanks for checking out this episode of the Ridgecrest Regional Hospital Podcast. To learn more, you can visit rrh.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. My name's Prakash. Thanks again for listening and we'll talk next time.