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Gastroparesis

Clinical Subject Page

Gastroparesis

Gastroparesis is a disorder characterized by delayed gastric emptying in the absence of
mechanical obstruction

Also called

Delayed Gastric Emptying

ICD-10

K31.84

Specialty

Gastroenterology

Onset

Chronic

Reviewed

July 2026

On This Page

Overview

Gastroparesis results from impaired gastric motility, leading to delayed emptying of stomach
contents. Common causes include diabetes mellitus, postsurgical complications, and medication
side effects, although many cases are idiopathic. Diagnosis requires exclusion of mechanical
obstruction with upper endoscopy and confirmation of delayed gastric emptying with a 4-hour
gastric emptying study.

Etiology & Risk Factors

Common Causes

  • Idiopathic (most common)

  • Diabetes mellitus (most common identifiable cause)

  • Postsurgical vagal nerve injury

  • Medications (e.g., opioids, GLP-1 receptor agonists, anticholinergics)

  • Neurological disorders (e.g., Parkinson disease, multiple sclerosis)

  • Connective tissue diseases (e.g., systemic sclerosis)

  • Viral infection (post-viral gastroparesis)

  • Hypothyroidism (less common)

Risk Factors

  • Long-standing diabetes mellitus

  • Poor glycemic control

  • Female sex

  • Previous gastric or esophageal surgery

  • Chronic opioid use

  • GLP-1 receptor agonist therapy

  • Parkinson disease

  • Autoimmune disorders

  • Viral gastroenteritis

Pathophysiology

1. Impaired gastric motility delays gastric emptying.
2. Food remains in the stomach longer than normal.
3. Delayed emptying causes symptoms such as nausea, vomiting, bloating, and early satiety.
4. Chronic delayed emptying may lead to nutritional and metabolic complications.

Clinical Presentation

Common symptoms include:
• Nausea
• Vomiting
• Bloating
• Upper abdominal pain
• Early satiety

History Taking

  • Ask about:
    • Nausea
    • Vomiting
    • Early satiety
    • Bloating
    • Upper abdominal pain
    • Duration and severity of symptoms
    • History of diabetes mellitus
    • Previous gastric or upper abdominal surgery
    • Current medications that may delay gastric emptying

Physical Examination

Assess for:
• Nutritional status
• Signs of dehydration
• Abdominal examination
• Evidence of complications such as weight loss

Investigations

  • Initial Tests

    • Complete blood count (CBC)

    • Electrolytes

    • Renal function tests

    • Blood glucose and HbA1c

    • Thyroid function tests (when indicated)

    Diagnostic Investigations

    Gastric Emptying Scintigraphy – Gold Standard

    • Gold standard investigation

    • Measures the rate of gastric emptying over 4 hours

    • Confirms delayed gastric emptying

    Upper Gastrointestinal Endoscopy (EGD)

    • Excludes mechanical obstruction

    • May show retained food in the stomach

    Upper GI Contrast Study

    • Helps exclude gastric outlet obstruction

    • May demonstrate delayed gastric emptying

    Additional Investigations

    • Wireless motility capsule (selected patients)

    • Breath test using a labeled meal (where available)

    • CT abdomen if another intra-abdominal pathology is suspected

Diagnosis

Diagnosis is established by:
• Absence of mechanical obstruction on EGD
• Delayed gastric emptying demonstrated on a 4-hour gastric emptying study

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Management

  • 1. Lifestyle & Dietary Modifications

    • Eat small, frequent meals

    • Low-fat, low-fiber diet

    • Prefer soft or liquid meals

    • Maintain adequate hydration

    • Avoid alcohol and smoking

    • Optimize blood glucose control in diabetic patients

    2. Medical Therapy

    Prokinetic Agents (First-Line)

    • Metoclopramide (first-line)

    • Domperidone (where available)

    • Erythromycin (short-term use)

    Antiemetics

    • Ondansetron

    • Prochlorperazine

    • Promethazine

    3. Nutritional Support

    • Oral nutritional supplements

    • Enteral feeding via jejunal feeding tube if oral intake is inadequate

    • Parenteral nutrition only when enteral feeding is not possible

    4. Advanced Therapy

    For severe, refractory gastroparesis:

    • Gastric electrical stimulation (selected patients)

    • Endoscopic pyloromyotomy (G-POEM)

    • Surgical pyloroplasty (selected patients)

    5. Follow-Up

    • Monitor symptom control

    • Assess nutritional status and weight

    • Optimize management of underlying diseases (especially diabetes)

    • Review medications that delay gastric emptying

Complications

• Malnutrition
• Electrolyte imbalances
• Postprandial hypoglycemia in patients with diabetes mellitus

Prognosis

  • Prognosis depends on the underlying cause and response to treatment.
  • Many patients improve with dietary modification, treatment of reversible causes, and prokinetic therapy
  • while refractory cases
    may require procedural intervention or enteral nutritional support.

Key Points / Clinical Pearls

• Gastroparesis is delayed gastric emptying without mechanical obstruction.
• Common causes include diabetes, surgery, medications, and idiopathic disease.
• Typical symptoms are nausea, vomiting, bloating, upper abdominal pain, and early satiety.
• EGD is performed to exclude mechanical obstruction.
• A 4-hour gastric emptying study confirms the diagnosis.
• Initial management includes small, frequent, low-fat meals and treatment of underlying causes.
• Metoclopramide and erythromycin are commonly used prokinetics.
• Refractory cases may require G-POEM or jejunostomy feeding.
• Major complications include malnutrition, electrolyte disturbances, and postprandial hypoglycemia
in diabetic patients.