Gastroparesis

Overview

Gastroparesis is a condition where your stomach takes too long to empty its contents into your small intestine. This happens because the muscles in the stomach work poorly or the nerves that control them are damaged. It is not a blockage; it is a problem with how the stomach moves food along.

No, gastroparesis is not common. It affects a small percentage of the population, though it is more frequent in people with long-standing diabetes.

It can affect anyone, but it is more common in women and in people with type 1 or type 2 diabetes, especially if their blood sugar control has been poor for many years.

Symptoms

Common symptoms

• Nausea and vomiting (sometimes of undigested food eaten hours earlier)
• Feeling full after only a few bites of food
• Bloating in the upper belly
• Pain or discomfort in the upper abdomen
• Poor appetite and unintentional weight loss
• Acid reflux or heartburn

Symptoms in children

• The same general symptoms as adults, but children may also have poor weight gain or growth, picky eating, and stomach pain that comes and goes.

Symptoms in older adults

• Older adults may experience more severe dehydration and malnutrition because symptoms are often more subtle or mistaken for other age-related issues.

Causes

Main causes

• Damage to the vagus nerve, which helps control stomach muscles – most often caused by long-term diabetes (diabetic gastroparesis)
• Idiopathic (no clear cause found – the most common type)
• After surgery on the stomach or esophagus
• Certain medications (such as strong painkillers or some antidepressants)
• Radiation therapy on the chest or abdomen
• Neurologic conditions like Parkinson’s disease or multiple sclerosis

Risk factors

• Long-standing diabetes (especially with poor blood sugar control)
• Being female
• Previous stomach surgery
• Eating disorders (such as anorexia or bulimia)
• Viral infections (rarely, a virus may trigger gastroparesis)

When to see a doctor

See a doctor urgently if:

• If you have severe nausea and vomiting that prevents you from keeping down fluids for more than a day
• If you have severe belly pain or a swollen stomach that feels hard
• If you faint or feel extremely dizzy upon standing
• If you have diabetes and your blood sugar levels become dangerously high or low without a clear reason

Book a routine appointment if:

• If you often feel sick, vomit after meals, or stay full long after eating
• If you are losing weight without trying
• If your appetite has dropped and you feel full after only a small amount of food

Diagnosis

Your doctor will listen to your symptoms, examine your belly, and order tests to see how fast your stomach empties. They will also check for other conditions that can cause similar symptoms, like a stomach ulcer or blockage.

Tests that may be done

• Gastric emptying test: You eat a light meal (usually egg or toast) that has a small amount of a safe radioactive tracer. A special camera then takes pictures over several hours to see how fast the food leaves your stomach.
• Upper endoscopy: A thin, flexible tube with a camera is passed through your mouth into your stomach to check for blockages or other problems.
• Antroduodenal manometry: A thin tube is placed through your nose into your stomach and small intestine to measure muscle contractions.
• Breath test: You drink a meal with a special substance, and later breath samples are tested to see how quickly it leaves the stomach.

What to expect at your appointment

Most tests are done in a hospital or clinic and are not painful. The gastric emptying test takes about four hours. Your doctor will explain each step and how to prepare (for example, fasting the night before). Results usually come back in a few days to a week.

Treatment

Treatment aims to relieve symptoms, ensure you get enough nutrition, and address any underlying cause (like diabetes). There is no one-size-fits-all plan, so your doctor will work with you to find what helps most.

Self-care at home

• Eat small, frequent meals – six or more tiny meals a day instead of three large ones.
• Choose foods that are easier to digest: low in fat and low in fiber (such as white rice, baked chicken, well-cooked vegetables).
• Chew your food very well and eat slowly.
• Avoid foods that delay stomach emptying, like high-fat items, red meat, raw vegetables, and high-fiber cereals.
• Stay hydrated by sipping fluids between meals rather than with meals.
• Try liquid meal replacements (like smoothies or broths) if solid food is hard to tolerate.

Medical treatments

Your doctor may prescribe medicines that help the stomach muscles contract more effectively (these are called prokinetics) or medicines that reduce nausea and vomiting. In some cases, a portable device that sends mild electrical pulses to the stomach (gastric electrical stimulation) may be used when symptoms are severe and other treatments have not worked.

When is surgery considered?

Surgery is rarely needed. It may be considered for severe, persistent symptoms that do not respond to other treatments. Options include placing a feeding tube directly into the small intestine (jejunostomy) or, in very rare cases, partial removal of the stomach.

Living with this condition

Living with gastroparesis often means planning your meals carefully and listening to your body. You may need to eat at certain times, avoid some foods, and keep a diary of your symptoms to share with your doctor. It can be unpredictable, but with time you can learn what triggers your symptoms.

Lifestyle tips

• Eat small portions throughout the day rather than three large meals.
• Avoid lying down for two hours after eating to help digestion.
• Stay active with gentle exercise like walking, which can aid digestion.
• Find ways to manage stress, as stress can worsen symptoms.

Diet and exercise

A diet low in fat and fiber is usually recommended. Cooked fruits and vegetables, lean proteins, and soft grains like oatmeal are often better tolerated. Drinking plenty of water between meals helps. Gentle exercise like walking after meals can sometimes help move food along, but avoid intense exercise right after eating.

Mental health and emotional wellbeing

Gastroparesis can be frustrating and isolating because it affects eating, which is a social and essential part of life. It is common to feel anxious or depressed about managing symptoms. Talking to a counselor or joining a support group can help you cope.

Prevention

In many cases, gastroparesis cannot be prevented because the causes are not fully understood. However, if you have diabetes, keeping your blood sugar levels well-controlled may reduce the risk of damage to the stomach nerves. Avoiding unnecessary stomach surgeries may also lower the risk.

Vaccines

String — not relevant

Screening programmes

String — There is no routine screening test for gastroparesis. If you have diabetes and develop digestive symptoms, your doctor may test you earlier.

Complications

If left untreated

• Malnutrition and weight loss from not absorbing enough nutrients
• Dehydration from vomiting or not drinking enough
• Formation of bezoars – solid masses of undigested food that can block the stomach
• Poor blood sugar control in people with diabetes (making it hard to manage diabetes)
• Reduced quality of life due to constant nausea and discomfort

Long-term outlook

With proper management, many people with gastroparesis can improve their symptoms and maintain a normal level of activity. While it is a chronic condition that may ebb and flow, most people find a plan that works for them. Research continues, and new treatments are being developed. You can live well with gastroparesis with the help of your healthcare team.

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