15522 Gastroparesis

Overview

Gastroparesis (sometimes called delayed gastric emptying) is a condition where your stomach takes too long to empty its contents into your small intestine. The stomach muscles do not work as strongly as they should, so food may sit in your stomach for hours after you eat. It is not caused by a blockage. It just means your stomach's 'pumping action' is not working normally.

It is considered uncommon, but it may be underdiagnosed. Some studies suggest that around 1 to 2 in every 100 people may have it, but many live with mild symptoms without a formal diagnosis.

It can affect people of any age, including children and older adults. It is more commonly diagnosed in women than in men, and is especially linked to long-term diabetes. It can also happen after certain surgeries or with other medical conditions.

Symptoms

Common symptoms

• Feeling full after eating only a small amount
• Nausea or vomiting, sometimes with food that looks undigested
• Abdominal pain or bloating
• Poor appetite and unintentional weight loss
• Heartburn or acid reflux
• Changes in blood sugar levels (if you have diabetes)

Symptoms in children

• Poor weight gain or growth
• Feeling full quickly and eating very little
• Frequent nausea or vomiting
• Abdominal discomfort, bloating, or stomach pain
• Refusing to eat (in younger children)

Symptoms in older adults

• Loss of appetite and weight loss
• Nausea and vomiting, though sometimes less severe
• Bloating or abdominal discomfort
• Feeling full after small meals
• Withdrawal from meals or social eating due to symptoms

Causes

Main causes

• Diabetes – prolonged high blood sugar can damage the vagus nerve, which helps control stomach emptying
• In many cases, no clear cause is found (called idiopathic gastroparesis)
• Injury to the stomach or esophagus, such as after surgery
• Certain medications that can slow digestion (for example, some opioids or antidepressants)
• Other conditions like thyroid disease, Parkinson's disease, or a severe viral infection

Risk factors

• Diabetes, especially if it has been present for many years
• Being female
• Previous surgery on the stomach or intestines
• Use of certain medicines that slow stomach emptying
• Eating disorders or malnutrition
• Viral infections, such as norovirus or a stomach bug
• Neurological conditions like Parkinson's disease

When to see a doctor

See a doctor urgently if:

• Go to urgent care or your local emergency department if you have severe pain, cannot keep any food or fluids down, or have signs of dehydration.
• See a doctor within 24 hours if you have been vomiting repeatedly or are unable to swallow fluids.

Book a routine appointment if:

• Make an appointment with your usual doctor if you have had symptoms like feeling full quickly, nausea, or bloating for more than a few weeks.
• Also see your doctor if your symptoms are getting worse or affecting your daily life.
• People with diabetes who notice a change in their appetite or digestion should talk to their diabetes care team.

Diagnosis

There is no single test that can diagnose gastroparesis, so your doctor will start by asking about your symptoms, your medical history, and any medicines you take. They may also feel your stomach area and run blood tests to rule out other problems. If gastroparesis is still suspected, they may refer you to a stomach specialist for more specific tests.

Tests that may be done

• Gastric emptying study – you eat a small meal containing a tiny amount of a safe radioactive marker, and a scanner shows how fast the food leaves your stomach.
• Upper endoscopy – a thin, flexible tube with a camera is passed into your stomach to check for blockages or inflammation.
• Ultrasound – uses sound waves to look at your organs, such as the gallbladder or kidneys, and rule out other causes.
• Blood tests – can check for diabetes, thyroid problems, or nutrient deficiencies.

What to expect at your appointment

These tests are usually done in a hospital or clinic. A gastric emptying study takes a few hours, while other tests may be quicker. You will not feel pain during the scans, though you may be asked to eat and drink during the test. Your specialist will discuss the results with you and may recommend a treatment plan.

Treatment

The main goals are to relieve symptoms, help the stomach empty, and keep you nourished. Treatment is usually a combination of diet changes, medication, and, in some cases, procedures. Because gastroparesis affects each person differently, the plan will be based on your symptoms and any underlying causes.

Self-care at home

• Eat six or more small meals a day instead of three large ones
• Chew your food very well and eat slowly
• Drink plenty of fluids, but try to have drinks between meals rather than with meals
• Choose foods that are soft or puréed, like soup, mashed potatoes, or smoothies
• Avoid fatty, greasy, raw, or high-fibre foods that are hard to digest
• Stay upright (sitting or standing) for at least two hours after eating
• Keep a food diary to identify which foods trigger your symptoms

Medical treatments

Your doctor may recommend medicines that help the stomach muscles to contract, or medicines that relieve nausea. These are usually taken before meals. There are also medicines that can be given as skin patches or liquids if swallowing is difficult. Your healthcare team will explain each option, including possible side effects, and help you choose what is best. Always talk to your doctor or pharmacist before starting or stopping any medicine.

When is surgery considered?

Surgery is rarely needed and is only considered for severe symptoms that do not improve with other treatments. Options include a gastric neurostimulator (a small device placed under the skin that sends gentle electrical pulses to the stomach muscles) or a feeding tube to help you get nutrition if you are losing weight rapidly. These are complex decisions, so your specialist will explain the benefits and risks.

Living with this condition

Living with gastroparesis often takes planning. You may worry about when symptoms will happen, what foods are safe, and how to stay hydrated. Try to keep a routine, prepare meals in advance, and communicate openly with your family, friends, and doctor. On good days, enjoy as much activity as you can, and on bad days, allow yourself to rest.

Lifestyle tips

• Keep a symptom diary to track what you eat and how you feel
• Plan your meals so you have a steady supply of safe, easy-to-digest foods
• Consider supplements, like a multivitamin or liquid nutrition, if you struggle to get enough vitamins and minerals
• Work with a registered dietitian/nutritionist (if available) to build a meal plan that suits you
• If you have diabetes, work with your doctor to keep your blood sugar stable and adjust any diabetes medicines under their guidance

Diet and exercise

Diet plays a central role in managing gastroparesis. In general, you should focus on smaller, more frequent meals that are low in fat and low in insoluble fibre (like seeds, skin, and raw vegetables). Cooked and puréed fruits and vegetables are often easier to digest. Gentle exercise such as walking or yoga can help digestion and reduce stress, but avoid vigorous exercise right after eating.

Mental health and emotional wellbeing

It is completely normal to feel frustrated, anxious, or sad when living with a long-term digestive condition. Nausea and eating difficulties can be isolating, especially if you miss meals or avoid social situations. Please remember that your feelings are valid. Talk to your doctor about support – they can refer you to a counsellor or psychologist. If you ever feel in crisis, call your local emergency number or a mental health helpline right away.

Prevention

You cannot always prevent gastroparesis, especially when the cause is unknown. However, if you have diabetes, keeping your blood sugar levels well controlled can reduce the risk of nerve damage that may contribute to it. It is also helpful to avoid overusing medicines that can slow digestion, such as certain strong pain medicines (like opioids). Always talk to a doctor before changing how you take your medicines.

Vaccines

There is no vaccine for gastroparesis.

Screening programmes

There is no routine screening test for gastroparesis in people without symptoms. Testing is based on your specific symptoms and medical history.

Complications

If left untreated

• Poor nutrition, weight loss, and muscle weakness
• Dehydration (from repeated vomiting or poor fluid intake)
• Bezoars – a hard, undigested food mass that can block the stomach
• Unpredictable blood sugar levels, which can be dangerous in diabetes
• Reduced quality of life because of ongoing discomfort and limitations

Long-term outlook

While gastroparesis is a chronic condition, most people do not experience constant severe symptoms. With the right treatment plan, many people feel a significant improvement in their nausea, pain, and ability to eat. The long-term outlook depends on the cause, your overall health, and how well you respond to treatment. Stay in close contact with your healthcare team, and do not be afraid to ask for adjustments to your plan.

Find support

International organisations

• International Foundation for Gastrointestinal Disorders (IFFGD) ↗
• Gastroparesis Patient Association for Cures and Treatments (G-PACT) ↗

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