Overview

Gastroparesis is a condition in which the stomach muscles fail to contract properly, leading to delayed emptying of food into the small intestine. This disorder can cause a variety of gastrointestinal symptoms and significantly disrupt daily life. While the exact causes are not always clear, researchers have identified several contributing factors. Gastroparesis is estimated to affect up to 2% of people in the U.S., with a higher prevalence among women. Understanding this condition is critical to managing its symptoms and improving quality of life.

Common Symptoms

Gastroparesis presents differently in each person, but some symptoms are more common:

  • Nausea and vomiting, especially after eating

  • Early satiety (feeling full after a few bites)

  • Bloating and abdominal discomfort

  • Loss of appetite

  • Weight loss or malnutrition

  • Belching or excessive gas

In mild cases, symptoms may be intermittent and manageable. However, in moderate to severe gastroparesis, symptoms can be persistent and significantly impact nutrition and hydration.

Causes

Gastroparesis can result from various underlying conditions. The most common cause is diabetes, particularly type 1 diabetes. In this case, nerve damage from prolonged high blood sugar affects the vagus nerve, which controls stomach muscle contractions.

Other causes include:

  • Neurological disorders like Parkinson’s or multiple sclerosis

  • Viral infections (e.g., Epstein-Barr virus)

  • Autoimmune diseases such as lupus

  • Muscular disorders like muscular dystrophy

  • Hypothyroidism

  • Post-surgical complications

  • Eating disorders such as anorexia or bulimia

  • Certain medications, including opioids, antidepressants, and anticholinergics

In many cases, the cause remains unknown (idiopathic gastroparesis).

Risk Factors

Some factors can increase your likelihood of developing gastroparesis:

  • Poorly controlled diabetes

  • Smoking and alcohol use

  • History of abdominal surgery

  • Use of medications that affect stomach motility

  • Genetic predisposition (e.g., mutations in CFTR, SPINK1, PRSS1)

How It Is Diagnosed

Diagnosis begins with a review of symptoms, medical history, and a physical examination. Because symptoms overlap with many gastrointestinal disorders, additional testing is essential:

  • Blood tests: Check for glucose, electrolytes, thyroid function, and infection markers

  • Gastric emptying scan (scintigraphy): Assesses how quickly food exits the stomach

  • Breath test: Non-invasive and used to estimate gastric emptying rate

  • Upper endoscopy (EGD): Rules out physical obstructions like tumors or ulcers

  • Wireless motility capsule: Measures pressure, pH, and temperature through the GI tract

Treatment Options

There is currently no cure for gastroparesis, but treatments aim to relieve symptoms and improve stomach emptying. A multidisciplinary approach is often necessary.

Dietary Changes:

  • Eat small, frequent meals (5-6 per day)

  • Choose soft, easy-to-digest foods (e.g., pureed or mashed)

  • Avoid high-fat and high-fiber foods

  • Consider nutritional shakes or soups for easier digestion

Medications:

  • Prokinetics: Help stimulate stomach contractions (e.g., metoclopramide, domperidone)

  • Antiemetics: Control nausea and vomiting (e.g., ondansetron, promethazine)

  • Tricyclic antidepressants: Used in low doses to manage pain (e.g., nortriptyline)

Procedures and Surgery:

  • Botulinum toxin injection: Temporarily relaxes pyloric sphincter

  • Gastric electrical stimulation: Implanted device to promote motility

  • Pyloroplasty or pyloromyotomy: Surgical widening or cutting of the pylorus to improve gastric emptying

Managing Diabetes and Gastroparesis

For people with diabetes, strict blood sugar control is vital to managing gastroparesis. Elevated blood glucose worsens nerve damage and delays stomach emptying.

  • Monitor glucose frequently

  • Adjust insulin timing and dosage with meals

  • Work with an endocrinologist to tailor diabetes care

Preventive Strategies

Because the causes are not always preventable, general wellness habits are key:

  • Maintain stable blood sugar levels if diabetic

  • Avoid excessive alcohol and recreational drug use

  • Refrain from smoking

  • Follow a healthy, balanced diet

  • Stay physically active to enhance GI motility

Associated Conditions

Gastroparesis is often linked with other medical problems:

  • Anxiety and depression (due to chronic discomfort and diet restrictions)

  • Chronic pancreatitis

  • Renal (kidney) disease

  • Hypothyroidism

  • Systemic lupus erythematosus

These conditions may worsen gastroparesis or complicate its management.

Living With Gastroparesis

Living with gastroparesis involves ongoing symptom management, dietary vigilance, and emotional support. Consider these strategies:

  • Keep a food diary to identify triggers

  • Join a gastroparesis support group

  • Consult with a registered dietitian

  • Seek mental health support for anxiety or depression

  • Have regular follow-ups with a gastroenterologist

Despite the challenges, many people with gastroparesis can lead fulfilling lives with proper management.