Causes
- Diabetes: The most common known cause. Years of elevated blood sugar in diabetes can injure the vagus nerve, the same process that causes diabetic neuropathy in the feet and hands.
- Surgery: Operations on the stomach or esophagus can injure the vagus nerve.
- Medications: Opioid pain relievers, some antidepressants and anticholinergic drugs, and certain injectable diabetes and weight-loss medicines slow stomach emptying; sometimes stopping or adjusting a medication resolves the problem.
- Viral illness: Gastroparesis occasionally follows a viral infection and may slowly improve over months.
- Idiopathic: In a large share of cases, no cause is ever identified.
Symptoms
- Nausea and vomiting: Vomiting of undigested food eaten hours earlier is characteristic.
- Early fullness: Feeling full after only a few bites, with uncomfortable fullness lasting long after meals.
- Bloating and upper abdominal pain: Often daily and worse after eating.
- Heartburn and regurgitation: Food lingering in the stomach worsens reflux, overlapping with GERD.
- Erratic blood sugar: In people with diabetes, unpredictable stomach emptying makes glucose swing unpredictably — sometimes the first clue to the diagnosis.
- Weight loss and poor nutrition: In more severe cases.
Diagnosis
The first step is an upper endoscopy or imaging to make sure a physical blockage — such as an ulcer or narrowing — is not the real problem. The standard confirmatory test is a gastric emptying study: you eat a small meal tagged with a tiny amount of radioactive tracer, and a scanner measures how much remains in the stomach over four hours. Breath tests and a swallowed motility capsule are alternatives in some settings. Your doctor will also review your medication list carefully, since drug-induced slowing is common and reversible, and will avoid labeling the problem gastroparesis on symptoms alone, because several other conditions can mimic it.Treatment
- Dietary changes — the foundation: Smaller, more frequent meals; choosing lower-fat and lower-fiber foods, which leave the stomach faster; chewing thoroughly; walking after meals; and shifting toward soups, smoothies, and other liquids on difficult days, since liquids empty more easily than solids. A dietitian familiar with gastroparesis can be a valuable partner.
- Blood sugar control: In diabetic gastroparesis, steadier glucose improves stomach function over time, and the care team adjusts insulin timing around delayed meals.
- Prokinetic medication: Metoclopramide, which stimulates stomach contractions, is used at the lowest effective dose for limited periods because of potential neurologic side effects; erythromycin is sometimes used short-term.
- Anti-nausea medication: Ondansetron or promethazine can relieve nausea and make eating possible.
- Advanced options: For severe cases, specialists may consider gastric electrical stimulation, endoscopic procedures on the pyloric valve, or temporary feeding-tube support to maintain nutrition.