Gastroparesis (GP)

What Is Gastroparesis?

Gastroparesis, also called delayed gastric emptying, is a condition that slows or stops the movement of food from the stomach to the small intestine — without a physical blockage being present.

In gastroparesis, the stomach muscles and nerves do not work normally. Food, liquids and air remain in the stomach longer than they should. This disrupts the whole digestive process. It can lead to uncomfortable symptoms such as nausea, vomiting and bloating.

Gastroparesis is a chronic condition. While there is no cure, treatment can help manage symptoms and improve quality of life.

Causes of Gastroparesis

In many cases, the cause of gastroparesis is unknown (idiopathic gastroparesis). In other cases, common causes include:

• Diabetes (diabetic gastroparesis)
• Medications that slow stomach emptying
• Nerve injury after surgery
• Neurological disorders
• Viral infections

Conditions such as autoimmune disease, thyroid disorders and mitochondrial disease may also play a role.

Types of Gastroparesis

Idiopathic Gastroparesis

Idiopathic gastroparesis is the most common type of gastroparesis. "Idiopathic" means the cause is unknown. Some people develop symptoms after a viral illness, while others have no identifiable trigger. Researchers believe damage to the nerves or muscles that control stomach emptying may play a role.

Diabetic Gastroparesis

Diabetes is one of the leading known causes of gastroparesis. Over time, high blood sugar levels can damage the vagus nerve, which helps control stomach muscles and digestion. This damage can slow the movement of food through the stomach. Managing blood sugar levels is an important part of treating diabetic gastroparesis and may help improve symptoms.

Post-Surgical Gastroparesis

Gastroparesis can sometimes develop after surgery involving the stomach, esophagus or nearby organs. During these procedures, the vagus nerve or stomach muscles may be injured, affecting the stomach's ability to move food normally. Symptoms may improve over time in some people, while others require ongoing treatment.

Medication-Induced Gastroparesis

Certain medications can slow stomach emptying and cause symptoms similar to gastroparesis. Common examples include opioid pain medications and some medicines used to treat diabetes such as GLP-1 receptor agonists. Your doctor may recommend adjusting or changing your medication if it is contributing to your symptoms. Never stop taking a prescribed medication without first discussing it with your health care provider.

Risk Factors

Several factors can increase your risk of developing gastroparesis. Some medical conditions can damage the nerves or muscles that control stomach emptying, while certain medications or surgeries can interfere with normal stomach function. Although anyone can develop gastroparesis, it is more common in women and people with certain underlying health conditions. Risk factors include:

• Amyloidosis
• Cancers and cancer treatments in the chest or stomach
• Diabetes
• Hypothryroidism
• Medications like opioids, some antidepressants, hypertension and allergy drugs
• Multiple sclerosis
• Parkinson’s disease
• Scleroderma
• Vagus nerve damage
• Viral infection
• Women are more likely than men

Signs and Symptoms

Symptoms of gastroparesis can vary from mild to severe and may come and go. Symptoms often develop gradually and may range from mild and occasional to severe and persistent. They may also worsen after eating, particularly after large meals or foods that are high in fat or fiber. Common symptoms include:

• Abdominal pain
• Bloating
• Early fullness (feeling full quickly when eating)
• Nausea
• Reflux or heartburn
• Vomiting

Some people may also experience:

• Poor appetite
• Unintentional weight loss
• Difficulty maintaining nutrition

Complications

Gastroparesis can lead to complications, especially if symptoms are severe or untreated.

These may include:

• Blood sugar fluctuations (especially in diabetes)
• Bezoar (a hardened mass of undigested food in the stomach)
• Dehydration
• Malnutrition

Early treatment can help reduce the risk of these complications.

Diagnosis

Gastroparesis is diagnosed by combining symptoms with testing. Your doctor, a gastroenterologist, will consider several factors in diagnosing gastroparesis such as family history of diabetes, symptoms and risk factors. It is important to rule out a physical blockage in the intestines before confirming the diagnosis.

Imaging Tests

Endoscopy:

An upper endoscopy is a procedure that allows the doctor to look directly inside the esophagus, stomach and small intestine using a thin, flexible tube with a camera. It is used to check for blockages, inflammation, ulcers or other structural problems that could cause similar symptoms. While an endoscopy cannot diagnose gastroparesis, it is an important step to rule out other conditions before confirming delayed gastric emptying.

CT Scan or Abdominal Imaging: Computerized tomography (CT) scans or other abdominal imaging use detailed pictures to examine the stomach and surrounding organs. They help doctors look for structural problems such as blockages, inflammation or masses that could explain symptoms. While imaging does not diagnose gastroparesis, it is useful for ruling out other conditions before confirming delayed gastric emptying.

Diagnostic Procedures

Gastric Emptying Study (GES): A GES is the most common test used to diagnose gastroparesis. It measures exactly how long it takes for food or liquid to travel from your stomach to your small intestine (gastric emptying). During the test, you eat a small meal that contains a safe, trace amount of radioactive material. A scanner tracks how quickly the food leaves your stomach. Images are taken over several hours to measure the rate of gastric emptying. If food remains in the stomach longer than expected, it suggests delayed emptying and supports a diagnosis of gastroparesis.

Gastric Emptying Breath Test (GEBT): Gastric emptying breath tests measure how quickly food moves through the stomach using a special meal that contains a harmless, labeled substance. After eating, breath samples are collected over several hours to track how the substance is absorbed and released in the breath. Slower-than-normal results suggest delayed gastric emptying, which may indicate gastroparesis. This test is a noninvasive alternative to a gastric emptying study and can help confirm the diagnosis.

Wireless Motility Capsule: A wireless motility capsule is a small, pill-sized device that you swallow to measure how food moves through your digestive tract. As it travels, it records data such as pH, temperature and pressure, which helps determine how quickly the stomach empties. The information is sent to a receiver worn on the body and later analyzed by your doctor. Delayed movement through the stomach can indicate gastroparesis and help guide treatment decisions.

Treatment

Gastroparesis treatment often involves a combination of dietary adjustments, medications and lifestyle changes to help food move through the stomach more effectively and reduce symptoms such as nausea, bloating, reflux and early fullness. Your treatment plan will depend on the cause of gastroparesis, the severity of your symptoms and how well you respond to different therapies.

Medications

Medications may be used to improve gastroparesis symptoms or support stomach function.

Common options include:

• Antiemetics: Reduce nausea and vomiting
• Medications: Manage pain or reflux
• Prokinetic medications: To help the stomach empty more effectively

Some medications are available only through specialized programs and require careful monitoring. Your doctor will determine which options are appropriate based on your symptoms and overall health.

Procedures

Procedures may be considered if symptoms are severe or do not improve with other treatments.

Botox Injections

Botulinum toxin, commonly known as Botox, may be injected into the pylorus, the muscular valve between the stomach and small intestine, during an upper endoscopy. The injection temporarily relaxes the pylorus and may help food leave the stomach more easily.

Gastric Electrical Stimulation: Gastric electrical stimulation involves surgically placing a small device (similar to a pacemaker) under the skin of the abdomen. The device sends mild electrical signals to the stomach muscles to help improve motility and reduce symptoms such as nausea and vomiting. It is most often used for people with severe gastroparesis who have not responded to medications. While it may not improve stomach emptying in all cases, many patients experience meaningful symptom relief.

Jejunostomy Feeding Tube: A jejunostomy (J-tube) is a feeding tube placed directly into the small intestine, bypassing the stomach. This allows nutrients, fluids and medications to be delivered without relying on stomach emptying. It is used when people cannot maintain adequate nutrition due to severe symptoms such as vomiting or early fullness. A J-tube can help prevent malnutrition and dehydration and may be used temporarily or long term, depending on the patient’s needs.

Pyloroplasty:

Pyloroplasty is a surgical procedure that widens the pylorus, the valve between the stomach and small intestine. In gastroparesis, this valve may not open properly, which slows the movement of food out of the stomach. By opening this passage, pyloroplasty can help food empty more easily and reduce symptoms such as nausea, vomiting and bloating. This procedure is typically considered when other treatments have not been effective.

Upper Endoscopy (EGD)

An upper endoscopy, also called an esophagogastroduodenoscopy (EGD), can sometimes be used to treat certain problems related to gastroparesis. During the procedure, your doctor passes a thin, flexible tube with a camera through your mouth to examine the esophagus, stomach and first part of the small intestine. In addition to looking for blockages or other conditions, an EGD can be used to remove hardened masses of undigested food (bezoars) that may develop when the stomach empties slowly. In some cases, your doctor may also perform additional endoscopic treatments during the procedure if they are appropriate.

Venting Gastrostomy Tube:

A venting gastrostomy (G-tube) is placed into the stomach through the abdominal wall to release trapped air and fluid. This can help relieve symptoms such as bloating, nausea and abdominal pressure. Unlike feeding tubes, a venting G-tube is used mainly for symptom control rather than nutrition. It may be used alone or in combination with other treatments, such as a J-tube for feeding.

Lifestyle Management

Lifestyle changes can help reduce symptoms and support better digestion in people with gastroparesis.

Helpful strategies include:

• Avoid alcohol and carbonated beverages which can trigger symptoms
• Avoid lying down after eating to help gravity move food through the stomach
• Chew food thoroughly to make it easier to digest
• Eat small, frequent meals instead of large meals
• Limit high-fat and high-fiber foods, which can slow stomach emptying
• Stay hydrated, especially if experiencing nausea or vomiting
• Take a short walk after meals to help stimulate digestion

When to See a Specialist

It’s important to be evaluated by a gastroenterologist if you or a loved one:

• Has symptoms of gastroparesis
• Would like strategies to help improve your current treatment of gastroparesis

At National Jewish Health in Denver, Colorado, we have one of most respected gastroenterology programs in the nation. Learn more about our program or use the button below to make an appointment.