Gastroparesis Overview – Symptoms, Causes, Treatments

Gastroparesis is a condition where food passes through the stomach without being digested properly. This causes nausea, vomiting, bloating, abdominal pain, and other symptoms. If left untreated, gastroparesis can cause serious health problems.

Learn more about gastroparesis, its causes, symptoms, and treatments.  

What is Gastroparesis?

Gastroparesis is a digestive disorder in the stomach in which the wall muscles don’t function properly. That prevents the stomach contents from emptying properly or quickly.

Gastroparesis occurs when the vagus nerve, which normally controls the movement of food from the stomach into the intestines, becomes damaged. Because of this, the stomach muscles are not able to help push food along (peristaltic wave action), so they’re not able to perform their normal function. This causes food to be digested too slowly, and can prevent food from passing through the digestive tract.

This disruption of the normal digestive cycle interferes not only with proper digestion but also with blood sugar levels and nutritional absorption, leading to nausea and vomiting.

What Causes Gastroparesis?

Gastroparesis can occur due to direct damage to the stomach muscle, but vagus nerve damage itself causes delayed gastric emptying most often.

Here are factors that can damage nerves or stomach muscles:

  • Cancer treatments
  • Diabetes
  • Medical conditions such as anorexia and bulimia; smooth muscle disorders such as amyloidosis and scleroderma; nervous system disease such as Parkinson’s; metabolic disorders like hypothyroidism; and viral illnesses.
  • Medications such as narcotics, tricyclic antidepressants, antacids that contain aluminum hydroxide, anticholinergics (these calm intestinal muscle spasms), calcium channel blockers, some high blood pressure medications, and the psychiatric drug lithium.
  • Surgery involving the esophagus, stomach, or the upper part of the small intestine.

Signs and Symptoms of Gastroparesis

Gastroparesis can be difficult to diagnose because sufferers experience a variety of inconsistent symptoms. Some will have mild symptoms, while it’s severe for others. Symptoms can appear frequently in some people, but less so for others. 

Symptoms of gastroparesis include: 

  • Abdominal bloating
  • Changes in blood sugar levels
  • Early satiety (feeling full after eating just a few bites)
  • Heartburn or regurgitation
  • Lack of appetite
  • Nausea
  • Pain or cramps in the upper abdomen
  • Vomiting of undigested food, sometimes several hours after a meal
  • Weight loss and malnutrition

Fatty foods, carbonated beverages, and high fiber foods can exacerbate these symptoms. Examples include fried foods, soft drinks, vegetables and fruits.

Gastroparesis Complications

Bacterial Overgrowth and Bezoars

Foods that stay in the stomach for too long can cause bacterial overgrowth and disrupt gut flora balance, which may lead to digestive issues. Issues like small intestinal bacterial overgrowth (SIBO), also known as small bowel bacterial overgrowth, will appear. 

If conditions in the small intestine prevent muscular activity, bacteria can grow and multiply there. The lack of physical activity may also allow bacteria from the colon to move backward into the small intestine.

SIBO is a condition in which there are abnormally large numbers of small intestinal bacteria. The types of bacteria found in the small intestine are different from those in the colon. With SIBO, there is an abnormal number of bacteria similar to those found in the colon.

Undigested foods that remain in the stomach can also form into a bezoar. A bezoar is similar to a hairball in that both consist of unprocessed food that has hardened into a solid mass. That may lead to nausea, vomiting, and even intestinal blockages.

Diabetes and Blood Sugar Fluctuations

Delayed gastric emptying doesn’t directly cause diabetes, but it can make diabetes worse by causing blood sugar levels to be harder to control.

Changes in blood glucose levels caused by inconsistent food absorption and unpredictable stomach emptying can worsen both diabetes and gastroparesis.

Malnutrition and Weight Loss

A delayed stomach emptying can affect your body’s ability to digest and absorb nutrition, which leads to malabsorption and undesired weight loss.

Learn more about Malabsorption Symptoms.

Screening and Diagnosis of Gastroparesis

Health care providers normally begin with a full medical history, physical exam, blood count, and chemical and electrolyte level tests (like blood sugar level and thyroid function).

Subsequent lab and blood tests to diagnose gastroparesis may include the following procedures:

Barium X-ray coats the stomach with a thin layer of barium to make it visible in the X-ray. If food is still present in the stomach after 12 hours of fasting, gastroparesis is likely. It can also help to rule out anatomic abnormalities like narrowing or blockage in the intestine, which can cause similar symptoms.

A breath test involves eating a meal that contains a small amount of isotopes. The patient then exhales and the carbon dioxide form the breath is measured for the isotope. The test results show the rate at which the stomach is emptying.  This is often used more for a diagnosis of SIBO, but symptoms can overlap and the diagnoses can co-exist.

Gastric emptying scintigraphy involves eating a meal that contains a small amount of a radioisotope (a radioactive substance) that will show up on scans. Then the gastric emptying rate is measured at 1, 2, 3, and 4 hours. If more than 10% of the meal still shows up in scans, a gastroparesis diagnosis is confirmed. This is the standard diagnostic tool for evaluating gastroparesis.

Gastroduodenal manometry involves threading a pressure-sensitive plastic tube starting in the throat,to the stomach, and small intestine. Connected to a computer, the tube monitors the frequency, strength, and coordination of muscle contractions before and after eating. This is primarily used in a research setting.

The SmartPill is a small capsule-shaped device that is swalled. The pill travels through the digestive tract, collecting data along the way and sending it to a cell phone-sized receiver worn by the patient. Once the SmartPill passes through and exits the body in stool, a healthcare provider enters the collected information into a computer for analysis. The SmartPill analyzes motility through the GI tract and measures the time duration that is spent in the stomach.

Ultrasonography/ultrasound uses high-frequency sound waves that bounce off internal tissue. The sound wave echoes are then converted into images. This test helps to rule out gallbladder disease and pancreatitis, which can cause similar symptoms. Learn more about Pancreatitis Signs and Symptoms.

Upper gastrointestinal (GI) endoscopy is a procedure using a long, lighted, flexible tube to obtain diagnostic images of the upper digestive tract (esophagus, stomach and duodenum). Through the endoscope, the gastrointestinal tract and stomach lining is examined for abnormalities. That helps rule out any conditions that can cause gastroparesis, while also looking for the presence of retained food (despite fasting for 8 hours prior to the exam) or a bezoar.

Treatment for Gastroparesis

There is currently no cure for gastroparesis. The level of treatment for gastroparesis depends on how severe the symptoms are. 

Gastroparesis is common among people with diabetes, so controlling blood sugar levels is essential to prevent the onset of and reduce the severity of symptoms in those who already have it.

Other possible underlying conditions that can cause gastroparesis need to be explored. If a medication is suspected as being the culprit, it should be discontinued or changed to an alternate medication if possible. 

Dietary changes (low fat, low fiber diet) and smaller, more frequent meals can help to control gastroparesis symptoms. There are also a few medications which can help. However, medication is not always effective, and most drugs can have negative side effects.

Treatments can help people manage their condition, so they can function as normal as possible.

Dietary Changes for Gastroparesis Relief

Making adjustments to your diet can help treat gastroparesis symptoms. Here are the top food tips for gastroparesis relief: 

  • Eat smaller, more frequent meals (i.e. six small ones per day instead of three large ones).
  • Eat solid, nutrient-dense foods in the morning with lighter meals or liquids in the afternoon and evening. This helps reduce fullness and nocturnal regurgitation.
  • Avoid high-fat / high-fiber foods.
  • Eat more fiber from well-cooked fruits and vegetables, chicken, fish, yogurt, and refined breads and grains. These are more easily digestible.
  • Avoid apples, dried figs, berries, coconut, corn, Brussels sprouts, and potato and tomato peels. These can trigger bezoars.
  • After eating, lying on the right side can help gravity empty the stomach.
  • For severe cases, eating a liquid or pureed diet, including soups is often helpful. Cooked fruits and vegetables, cereals with milk or rice milk, poached or baked chicken in broth, as well as pasta dishes can all be puréed. Liquids empty faster than solid foods from the stomach.
  • Vitamin B12, iron, and calcium levels can be checked and supplemented if needed.
  • Drinking plenty of water is important to avoid dehydration. If you’re feeling nauseous, take small sips of water or suck on an ice chip.

When gastroparesis is particularly severe, or when blood sugar levels cannot be controlled by any other means, a temporary feeding tube may be recommended by healthcare providers.

Another temporary feeding option for patients who have severe gastroparesis is parenteral nutrition. Parenteral nutrition delivers nutrients directly into the bloodstream and bypasses the digestive system altogether.

A catheter (thin tube) with an opening outside the skin is inserted into an arm or chest vein. A bag containing liquid nutrition is attached to the catheters, enabling nutrient-rich fluids to enter the bloodstream through the vein.

This is usually not recommended for long-term use and carries a high likelihood of complications like infection and blood clotting.

Medications for Gastroparesis

There are two common medications used to treat gastroparesis. They may be injected into the body or given as a liquid for maximum absorption.

  • Antiemetics – helps to control nausea and vomiting.
  • Prokinetics – stimulates stomach muscle contractions. 

Metoclopramine is a common prokinetik used to stimulate stomach muscle contractations to help emptying. It also reduces nausea and vomiting. Unfortunately, it has been shown to have some serious side effects, and isn’t ideal for long-term usage. There is a risk of tardive dyskinesia, a motor tic, which can be irreversible. 

In other countries, domperidone is used instead of metoclopramide because it has fewer side effects. Domperidone is currently restricted in the U.S., but it is under review with the Food and Drug Administration (FDA).  Patients in the United States are typically able to order this from Canada or Mexico if recommended by their doctor.

Erythromycin is an antibiotic, but one of its side effects is to stimulate bowel motility. It helps to increase contractions in the digestive tract to move food. Common side effects include abdominal cramps, nausea, vomiting, and diarrhea.

 The body gets used to erythromycin, so it can only be used on a short term basis and is often a rescue medication for patients that are hospitalized due to a flare of gastroparesis symptoms.

New Therapies for Gastroparesis

Botulinum toxin (Botox) relaxes the pyloric muscle in some patients. That helps the stomach release more food, which has shown improvements in gastroparesis symptoms. More research is needed, however, as current results are mixed on its efficacy.

Gastric electrical stimulation involves surgically implanting a battery-operated device (gastric neurostimulator or pacemaker) that releases mild electrical pulses to stimulate stomach contractions. That will improve stomach emptying, and also help control the nausea and vomiting from gastroparesis.

Surgery for Gastroparesis

If all the previous treatments do not help with emptying the stomach, there’s one last option: surgery.

The surgery route is a surgical procedure to staple or bypass the lower part of the stomach. This surgery can have serious complications though. It’s only recommended when all the other treatment options have not been able to offer gastroparesis relief. 

Gastroparesis Prevention, Health, and Overall Wellness

There are many treatments for gastroparesis, but success varies from person to person, and some come with undesirable side effects. One of the easiest ways to avoid the disease is to improve your overall health. 

If you already have gastroparesis, the best thing you can do is strengthen your body with nutrition. Gastroparesis causes the body’s ability to digest and absorb nutrition to be impaired, leading to malabsorptions problems and unwanted weight loss

Gastroparesis can cause bacterial overgrowth, which may lead to other health problems including SIBO. Probiotics (like lactobacillus acidophilus) help the body maintain and restore healthy levels of gut flora (otherwise known as healthy bacteria) for good health.

Dietary modification is the first step to controlling gastroparesis symptoms and improving your quality of life.  If this is failing to alleviate symptoms, your doctor may be able to help you return to normal life

Julie C. Guider MyGoodGut

Medically reviewed by Julie Guider, M.D.

Dr. Julie Guider earned her medical degree from Louisiana State University School of Medicine. She completed residency in internal medicine at the University of Virginia. She completed her general gastroenterology and advanced endoscopy fellowships at University of Texas-Houston. She is a member of several national GI societies including the AGA, ACG, and ASGE as well as state and local medical societies.