Gastroparesis

National Digestive Diseases Information Clearinghouse

What is gastroparesis?
Gastroparesis, also called delayed gastric
emptying, is a disorder that slows or stops the
movement of food from the stomach to the
U.S. Department
of Health and small intestine. Normally, the muscles of the
Human Services stomach, which are controlled by the vagus
nerve, contract to break up food and move it
NATIONAL through the gastrointestinal (GI) tract. The
INSTITUTES
OF HEALTH GI tract is a series of hollow organs joined in
a long, twisting tube from the mouth to the Stomach
anus. The movement of muscles in the GI
tract, along with the release of hormones and
enzymes, allows for the digestion of food.
Gastroparesis can occur when the vagus
nerve is damaged by illness or injury and
the stomach muscles stop working normally.
Food then moves slowly from the stom-
ach to the small intestine or stops moving
Small Jejunum
altogether. intestine

What causes gastroparesis? Gastroparesis slows or stops the movement of food

Most people diagnosed with gastroparesis from the stomach to the small intestine.
have idiopathic gastroparesis, which means
a health care provider cannot identify the
cause, even with medical tests. Diabetes is causes of gastroparesis include intestinal
the most common known cause of gastropa- surgery and nervous system diseases such as
resis. People with diabetes have high levels Parkinson’s disease or multiple sclerosis. For
of blood glucose, also called blood sugar. reasons that are still unclear, gastroparesis
Over time, high blood glucose levels can is more commonly found in women than in
damage the vagus nerve. Other identifiable men.
What are the symptoms of How is gastroparesis
gastroparesis? diagnosed?
The most common symptoms of gastropa- Gastroparesis is diagnosed through a physi-
resis are nausea, a feeling of fullness after cal exam, medical history, blood tests, tests
eating only a small amount of food, and to rule out blockage or structural problems
vomiting undigested food—sometimes sev- in the GI tract, and gastric emptying tests.
eral hours after a meal. Other symptoms of Tests may also identify a nutritional disorder
gastroparesis include or underlying disease. To rule out any block-
age or other structural problems, the health
• gastroesophageal reflux (GER), also
care provider may perform one or more of
called acid reflux or acid regurgitation—
the following tests:
a condition in which stomach contents
flow back up into the esophagus, the • Upper gastrointestinal (GI) endos-
organ that connects the mouth to the copy. This procedure involves using
stomach an endoscope—a small, flexible tube
with a light—to see the upper GI tract,
• pain in the stomach area
which includes the esophagus, stomach,
• abdominal bloating and duodenum—the first part of the
• lack of appetite small intestine. The test is performed
at a hospital or outpatient center by
Symptoms may be aggravated by eating a gastroenterologist—a doctor who
greasy or rich foods, large quantities of specializes in digestive diseases. The
foods with fiber—such as raw fruits and endoscope is carefully fed down the
vegetables—or drinking beverages high in esophagus and into the stomach and
fat or carbonation. Symptoms may be mild duodenum. A small camera mounted
or severe, and they can occur frequently in on the endoscope transmits a video
some people and less often in others. The image to a monitor, allowing close
symptoms of gastroparesis may also vary in examination of the intestinal lining. A
intensity over time in the same individual. person may receive a liquid anesthetic
Sometimes gastroparesis is difficult to diag- that is gargled or sprayed on the back of
nose because people experience a range of the throat. An intravenous (IV) needle
symptoms similar to those of other diseases. is placed in a vein in the arm if general
anesthesia is given. The test may show
blockage or large bezoars—solid col-
lections of food, mucus, vegetable fiber,
hair, or other material that cannot be
digested in the stomach—that are some-
times softened, dissolved, or broken up
during an upper GI endoscopy.

2 Gastroparesis
 • Upper GI series. An upper GI series • Gastric emptying scintigraphy. The test
may be done to look at the small intes- involves eating a bland meal—such as
tine. The test is performed at a hospital eggs or an egg substitute—that contains
or outpatient center by an x-ray techni- a small amount of radioactive material.
cian, and the images are interpreted The test is performed in a radiology
by a radiologist—a doctor who special- center or hospital by a specially trained
izes in medical imaging. Anesthesia technician and interpreted by a radi-
is not needed. No eating or drinking ologist; anesthesia is not needed. An
is allowed for 8 hours before the pro- external camera scans the abdomen to
cedure, if possible. If the person has show where the radioactive material is
diabetes, a health care provider may located. The radiologist is then able to
give different instructions about fasting measure the rate of gastric emptying at
before the test. During the procedure, 1, 2, 3, and 4 hours after the meal. If
the person will stand or sit in front of more than 10 percent of the meal is still
an x-ray machine and drink barium, a in the stomach at 4 hours, the diagnosis
chalky liquid. Barium coats the small of gastroparesis is confirmed.
intestine, making signs of gastroparesis
• SmartPill. The SmartPill is a small
show up more clearly on x rays. Gastro-
electronic device in capsule form. The
paresis is likely if the x ray shows food
SmartPill test is available at specialized
in the stomach after fasting. A person
outpatient centers. The images are
may experience bloating and nausea for
interpreted by a radiologist. The device
a short time after the test. For several
is swallowed and moves through the
days afterward, barium liquid in the
entire digestive tract, sending infor-
GI tract causes stools to be white or
mation to a cell-phone-sized receiver
light colored. A health care provider
worn around the person’s waist or neck.
will give the person specific instructions
The recorded information provides a
about eating and drinking after the test.
detailed record of how quickly food
• Ultrasound. Ultrasound uses a device, travels through each part of the diges-
called a transducer, that bounces safe, tive tract.
painless sound waves off organs to cre-
• Breath test. With this test, the person
ate an image of their structure. The
eats a meal containing a small amount
procedure is performed in a health care
of radioactive material; then breath
provider’s office, outpatient center, or
samples are taken over a period of
hospital by a specially trained techni-
several hours to measure the amount
cian, and the images are interpreted by
of radioactive material in the exhaled
a radiologist; anesthesia is not needed.
breath. The results allow the health
The images can show whether gallblad-
care provider to calculate how fast the
der disease and pancreatitis could be
stomach is emptying.
the cause of a person’s digestive symp-
toms, rather than gastroparesis.

3 Gastroparesis
How is gastroparesis helps improve symptoms. Puréed fresh or
cooked fruits and vegetables can be incorpo-
treated? rated into shakes and soups. A health care
Treatment of gastroparesis depends on the provider may recommend a dietitian to help
severity of the person’s symptoms. In most a person plan meals that minimize symptoms
cases, treatment does not cure gastroparesis, and ensure all nutritional needs are met.
which is usually a chronic, or long-lasting,
condition. Gastroparesis is also a relapsing When the most extreme cases of gastropa-
condition—the symptoms can come and go resis lead to severe nausea, vomiting, and
for periods of time. Treatment helps people dehydration, urgent care may be required
manage the condition so they can be as com- at a medical facility where IV fluids can be
fortable and active as possible. given.

Eating, Diet, and Nutrition Medications

Changing eating habits can sometimes help Several prescription medications are avail-
control the severity of gastroparesis symp- able to treat gastroparesis. A combination
toms. A health care provider may suggest of medications may be used to find the most
eating six small meals a day instead of three effective treatment.
large ones. If less food enters the stomach Metoclopramide (Reglan). This medication
each time a person eats, the stomach may not stimulates stomach muscle contractions to
become overly full, allowing it to empty more help with gastric emptying. Metoclopramide
easily. Chewing food well, drinking non- also helps reduce nausea and vomiting. The
carbonated liquids with a meal, and walking medication is taken 20 to 30 minutes before
or sitting for 2 hours after a meal—instead meals and at bedtime. Possible side effects
of lying down—may assist with gastric of metoclopramide include fatigue, sleepi-
emptying. ness, and depression. Currently, this is the
A health care provider may also recom- only medication approved by the FDA for
mend avoiding high-fat and fibrous foods. treatment of gastroparesis. However, the
Fat naturally slows digestion and some raw FDA has placed a black box warning on
vegetables and fruits are more difficult to this medication because of rare reports of it
digest than other foods. Some foods, such as causing an irreversible neurologic side effect
oranges and broccoli, contain fibrous parts called tardive dyskinesia—a disorder that
that do not digest well. People with gastro- affects movement.
paresis should minimize their intake of large Erythromycin. This antibiotic, prescribed
portions of these foods because the undi- at low doses, may improve gastric emptying.
gested parts may remain in the stomach too Like metaclopramide, erythromycin works by
long. Sometimes, the undigested parts form increasing the contractions that move food
bezoars. through the stomach. Possible side effects of
When a person has severe symptoms, a erythromycin include nausea, vomiting, and
liquid or puréed diet may be prescribed. As abdominal cramps.
liquids tend to empty more quickly from the
stomach, some people may find a puréed diet

4 Gastroparesis
Other medications. Other medications may close-up view of the tissues. Once implanted,
be used to treat symptoms and problems the settings on the battery-operated device
related to gastroparesis. For example, medi- can be adjusted to determine the settings
cations known as antiemetics are used to that best control symptoms.
help control nausea and vomiting.
Jejunostomy
Botulinum Toxin If medications and dietary changes don’t
Botulinum toxin is a nerve blocking agent work, and the person is losing weight or
also known as Botox. After passing an requires frequent hospitalization for dehy-
endoscope into the stomach, a health care dration, a health care provider may rec-
provider injects the Botox into the pylo- ommend surgically placing a feeding tube
rus, the opening from the stomach into the through the abdominal wall directly into a
duodenum. Botox is supposed to help keep part of the small intestine called the jeju-
the pylorus open for longer periods of time num. The surgical procedure is known as a
and improve symptoms of gastroparesis. jejunostomy. The procedure is performed by
Although some initial research trials showed a surgeon at a hospital or outpatient center.
modest improvement in gastroparesis symp- Anesthesia is needed. The feeding tube
toms and the rate of gastric emptying follow- bypasses the stomach and delivers a special
ing the injections, other studies have failed to liquid food with nutrients directly into the
show the same degree of effectiveness of the jejunum. The jejunostomy is used only when
Botox injections.1 gastroparesis is extremely severe.

Gastric Electrical Stimulation Parenteral Nutrition

This treatment alternative may be effective When gastroparesis is so severe that dietary
for some people whose nausea and vomit- measures and other treatments are not help-
ing do not improve with dietary changes ing, a health care provider may recommend
or medications. A gastric neurostimulator parenteral nutrition—an IV liquid food
is a surgically implanted battery-operated mixture supplied through a special tube in
device that sends mild electrical pulses to the the chest. The procedure is performed by a
stomach muscles to help control nausea and surgeon at a hospital or outpatient center;
vomiting. The procedure may be performed anesthesia is needed. The surgeon inserts
at a hospital or outpatient center by a gas- a thin, flexible tube called a catheter into a
troenterologist. General anesthesia may be chest vein, with the catheter opening outside
required. The gastroenterologist makes sev- the skin. A bag containing liquid nutrients
eral tiny incisions in the abdomen and inserts is attached to the catheter, and the nutrients
a laparoscope—a thin tube with a tiny video are transported through the catheter into the
camera attached. The camera sends a mag- chest vein and into the bloodstream. This
nified image from inside the stomach to a approach is a less preferable alternative to
video monitor, giving the gastroenterologist a a jejunostomy and is usually a temporary
treatment to get through a difficult period of
gastroparesis.

1Bai Y, Xu MJ, Yang X, et al. A systematic review on

intrapyloric botulinum toxin injection for gastroparesis.

Digestion. 2010;81(1):27–34.

5 Gastroparesis
How is gastroparesis treated What are the problems of
if a person has diabetes? gastroparesis?
An elevated blood glucose level directly The problems of gastroparesis can include
interferes with normal stomach emptying, so
• severe dehydration due to persistent
good blood glucose control in people with
vomiting
diabetes is important. However, gastropare-
sis can make blood glucose control difficult. • gastroesophageal reflux disease
When food that has been delayed in the (GERD), which is GER that occurs
stomach finally enters the small intestine and more than twice a week for a few weeks;
is absorbed, blood glucose levels rise. Gas- GERD can lead to esophagitis—
tric emptying is unpredictable with gastropa- irritation of the esophagus
resis, causing a person’s blood glucose levels
• bezoars, which can cause nausea,
to be erratic and difficult to control.
vomiting, obstruction, or interfere with
The primary treatment goals for gastropare- absorption of some medications in pill
sis related to diabetes are to improve gastric form
emptying and regain control of blood glucose • difficulty managing blood glucose levels
levels. In addition to the dietary changes and in people with diabetes
treatments already described, a health care
provider will likely adjust the person’s insulin • malnutrition due to poor absorption of
regimen. nutrients or a low calorie intake

To better control blood glucose, people with • decreased quality of life, including work
diabetes and gastroparesis may need to absences due to severe symptoms

• take insulin more often or change the Points to Remember

type of insulin they take
• Gastroparesis, also called delayed gas-
• take insulin after meals, instead of
tric emptying, is a disorder that slows or
before
stops the movement of food from the
• check blood glucose levels frequently stomach to the small intestine.
after eating and administer insulin when • Gastroparesis can occur when the vagus
necessary nerve is damaged by illness or injury
A health care provider will give specific and the stomach muscles stop working
instructions for taking insulin based on normally. Food then moves slowly from
the individual’s needs and the severity of the stomach to the small intestine or
gastroparesis. stops moving altogether.

In some cases, the dietitian may suggest eat- • Most people diagnosed with gastropare-
ing several liquid or puréed meals a day until sis have idiopathic gastroparesis, which
gastroparesis symptoms improve and blood means a health care provider cannot
glucose levels are more stable. identify the cause, even with medical
tests.

6 Gastroparesis
 • Diabetes is the most common known Researchers are studying whether new
cause of gastroparesis. People with dia- medications or surgery can improve gastric
betes have high levels of blood glucose, emptying and reduce gastroparesis symp-
also called blood sugar. Over time, high toms. Researchers are evaluating the safety
blood glucose levels can damage the and effectiveness of nortriptyline for treat-
vagus nerve. ment of gastroparesis. More information
about one such study, funded under the
• The most common symptoms of gastro-
National Institutes of Health clinical trial
paresis are nausea, a feeling of fullness
number NCT00765895, can be found at
after eating only a small amount of
www.ClinicalTrials.gov.
food, and vomiting undigested food—
sometimes several hours after a meal. Participants in clinical trials can play a more
Other common symptoms include gas- active role in their own health care, gain
troesophageal reflux (GER), pain in the access to new research treatments before
stomach area, abdominal bloating, and they are widely available, and help others
lack of appetite. by contributing to medical research. For
• Gastroparesis is diagnosed through a information about current studies, visit
physical exam, medical history, blood www.ClinicalTrials.gov.
tests, tests to rule out blockage or struc-
tural problems in the gastrointestinal For More Information
(GI) tract, and gastric emptying tests. American College of Gastroenterology
• Changing eating habits can sometimes 6400 Goldsboro Road, Suite 450
help control the severity of gastropare- Bethesda, MD 20817–5846
sis symptoms. A health care provider Phone: 301–263–9000
may suggest eating six small meals a day Email: [email protected]
instead of three large ones. When a Internet: www.acg.gi.org
person has severe symptoms, a liquid or
American Diabetes Association
puréed diet may be prescribed.
1701 North Beauregard Street
• Treatment of gastroparesis may include Alexandria, VA 22311
medications, botulinum toxin, gastric Phone: 1–800–DIABETES
electrical stimulation, jejunostomy, and (1–800–342–2383)
parenteral nutrition. Email: [email protected]
Internet: www.diabetes.org
• For people with gastroparesis and dia-
betes, a health care provider will likely International Foundation for Functional
adjust the person’s insulin regimen. Gastrointestinal Disorders
P.O. Box 170864
Hope through Research Milwaukee, WI 53217–8076
Phone: 1–888–964–2001 or 414–964–1799
The National Institute of Diabetes and
Fax: 414–964–7176
Digestive and Kidney Diseases’ (NIDDK’s)
Email: [email protected]
Division of Digestive Diseases and Nutrition
Internet: www.iffgd.org
supports basic and clinical research into GI
motility disorders, including gastroparesis.

7 Gastroparesis
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U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES
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NIH Publication No. 12–4348

June 2012

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