What Is Gastroparesis?

• Idiopathic: Unknown cause (about 50 percent of cases)
• Diabetes-related: Caused by diabetes mellitus
• Post-surgical: A side effect of surgery
• Infection-related: Caused by an infection
• Autoimmune: Caused by an autoimmune disease
• Rheumatological: Caused by a rheumatic condition
• Neurological: Caused by a neurological condition
• Medication-related: A side effect of certain medications

• Bloating
• Quickly feeling full as you eat
• Feeling full long after you finish eating
• Nausea and vomiting
• Regurgitating or spitting up undigested food
• Poor appetite

• Diabetes mellitus: Gastroparesis can happen in people with type 1 or type 2 diabetes.
• Post-surgical injury: A surgical procedure that damages the stomach nerves or changes stomach anatomy can result in gastroparesis.
• Viral infection: When it comes to infectious causes, gastroparesis is most commonly seen with Norwalk virus (norovirus), rotavirus, and Epstein-Barr virus.
• Rheumatological diseases: Examples include amyloid neuropathy and systemic sclerosis (scleroderma).
• Autoimmune disease: This occurs when the body mistakenly attacks its own organs and tissues.
• Neurological conditions: These include Parkinson’s disease and multiple sclerosis.
• Medications: These can include opioids, nicotine, marijuana, antipsychotics, glucagon-like peptide-1 (GLP-1) agonists, and medicines for allergies and high blood pressure.

• Female sex: People assigned female at birth are more prone to developing gastroparesis than people assigned male at birth.
• Hypothyroidism: Insufficient thyroid hormone production can lead to gastroparesis.

Providers diagnose gastroparesis through a physical exam, medical history, and diagnostic tests. To start, your healthcare provider will ask about your symptoms and examine your abdomen.

Testing for Gastroparesis

If your provider suspects gastroparesis, they may order the following tests to confirm a diagnosis.

• Gastric Emptying Scintigraphy This is the most common test and the current gold standard used to diagnose gastroparesis. During this 4-hour procedure, you’ll eat a light meal including a small, safe amount of radioactive material. While you eat, a scanner tracks that material’s movement through your GI system and measures how quickly food leaves your stomach.

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• Upper GI Endoscopy While you’re sedated, a provider inserts a tiny camera on the end of a long flexible tube into your throat. They will pass it through your esophagus, stomach, and into the small intestine to check for conditions that cause similar symptoms to gastroparesis, like peptic ulcers or pyloric stenosis.

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Other less commonly performed tests that may be ordered include:

• Upper Gastrointestinal Barium Contrast Radiography For this X-ray study, you’ll swallow a solution called barium, which will coat your esophagus, stomach, and GI tract. Then, your provider will take an X-ray of your abdomen to see the emptying of the stomach and movement of the contrast through the small bowel.

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• Gastric Motility Breath Test (GEBT) For this test, you’ll consume a meal containing a substance (carbon-13) that your body will absorb. As your stomach digests this meal, the substance can be identified in your breath. Your provider then tests samples of your breath to measure how fast your stomach empties.

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• Antroduodenal Manometry In this specialized procedure, your provider will insert a thin catheter through your mouth and esophagus and into your stomach. Over six hours, they’ll measure electric and muscle activity in your stomach and first part of the small bowel (the duodenum) before, during, and after a meal. You’ll fast for the first few hours, and then later you’ll eat a solid meal. Your provider will record measurements during both periods.

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• Ultrasound Using high-frequency sound waves, this test shows images of organs and tissues within your abdomen. An ultrasound can help your provider rule out other potential causes of your symptoms.

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Medication Options

• Metoclopramide (Reglan) The only FDA-approved medication for gastroparesis
• Motilin Agonists These include erythromycin and azithromycin
• Serotonin Agonists These include prucalopride

• Diphenhydramine (Benadryl) This drug can help ease nausea and vomiting.
• Ondansetron This drug can help ease nausea and vomiting
• Prochlorperazine (Compazine) This can be prescribed if other medications for nausea and vomiting aren’t effective.

Surgery

If other treatments don’t work for you, additional procedures can be an option. The types of surgery used for gastroparesis include:

• Feeding Tube Placement For severe gastroparesis that makes you unable to eat or drink, your provider may offer to place a feeding tube in your small intestine. This tube allows you to feed nutritional formula straight into your small intestine.

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• Gastric Venting This tube placed into the stomach allows trapped gas and fluids to escape, easing discomfort from slow gastric motility.

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• Pyloroplasty This surgical procedure relaxes the pylorus muscle, a small muscle that sits between your stomach and small intestine. The pylorus typically helps your stomach hold food in, but a pyloroplasty allows food to move out of the stomach sooner. A newer version of this surgery, called G-POEM, can be done with endoscopy (a tube through your throat) so that no skin incisions are necessary.

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• Gastric Bypass This procedure, a type of bariatric surgery, removes part or all of your stomach and creates a new outlet from your stomach to your small intestine. Typically used as a weight loss solution, your provider may recommend this surgery for severe diabetes-related gastroparesis.

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Investigational Therapies

• Granisetron (Kytril)
• Aprepitant (Emend)
• Metoclopramide (Reglan) nasal spray
• Relamorelin

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• Prucalopride (Motegrity)

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• Velusetrag

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• Eat smaller, more frequent meals rather than three large meals.
• Chew your food thoroughly.
• Opt for cooked fruits and vegetables over raw ones.
• Follow a low-fat diet.
• Blend your food or ensure your food is in small pieces.
• Drink 1 to 1.5 liters of water daily.
• Do gentle exercise after eating, such as taking a walk.
• Avoid carbonated drinks and alcohol.
• Don’t smoke (or if you do, quit smoking).
• Sit upright for two hours after a meal.
• Take a daily multivitamin.
• Don’t eat and drink at the same time — try to space them out by an hour.

• Weight loss
• Malnutrition and dehydration
• Abdominal distention (stretching)
• Hypoglycemia or hyperglycemia (low or high blood sugar)
• Retention of food in stomach

• Functional Dyspepsia A condition causing chronic indigestion
• Gastric Outlet Obstruction A condition similar to gastroparesis, but symptoms are caused by a mechanical obstruction (physical blockage)
• Cyclical Vomiting Syndrome A chronic functional condition with vomiting episodes that last hours to days
• Rumination Syndrome A behavioral disorder with daily, effortless regurgitation of undigested food with no nausea or vomiting involved
• Cannabinoid Hyperemesis Syndrome A condition with episodes of vomiting coupled with a frequent desire for hot showers for symptom relief, often linked to high-dose or long-term cannabis use

Association of Gastrointestinal Motility Disorders

The Association of Gastrointestinal Motility Disorders (AGMD) offers support groups, which can help you connect with others who have the same diagnosis as you.

Northwestern University Gastroparesis Support Group

Northwestern University offers a gastroparesis support group, hosted by the Digestive Health Center’s Behavioral Medicine Program.

Inspire Community

Inspire, the world’s largest health community, offers an online, forum-style community for support and group discussion on issues related to gastrointestinal motility disorders like gastroparesis.

• Gastroparesis is a chronic disorder that impedes your stomach from moving food well, leading to symptoms like nausea, feeling full after a few bites, poor appetite, and potentially weight loss, among other symptoms.
• The cause of gastroparesis may not always be clear, but possible causes can include diabetes, surgery, or neurological disorders like Parkinson’s disease.
• Gastroparesis has no cure, but your provider may recommend treatment with medications, lifestyle changes, diet, and sometimes surgery.