Gastroparesis
 

National Digestive Diseases Information Clearinghouse 

National 

Institute of 

Diabetes and 

Digestive 

and Kidney 

Diseases 

NATIONAL 

INSTITUTES 

OF HEALTH 

U.S. Department 

of Health and 

Human Services

What is gastroparesis? 

Gastroparesis, also called delayed gastric 

emptying, is a disorder in which the stomach takes too long to empty its contents. 

Normally, the stomach contracts to move 

food down into the small intestine for 

digestion. The vagus nerve controls the 

movement of food from the stomach 

through the digestive tract. Gastroparesis 

occurs when the vagus nerve is damaged 

and the muscles of the stomach and intestines do not work normally. Food then 

moves slowly or stops moving through the 

digestive tract. 

What causes gastroparesis? 

The most common cause of gastroparesis is 

diabetes. People with diabetes have high 

blood glucose, also called blood sugar, 

which in turn causes chemical changes in 

nerves and damages the blood vessels that 

carry oxygen and nutrients to the nerves. 

Over time, high blood glucose can damage 

the vagus nerve. 

Some other causes of gastroparesis are 

•	 surgery on the stomach or vagus nerve 

•	 viral infections 

•	 anorexia nervosa or bulimia 

•	 medications—anticholinergics and 

narcotics—that slow contractions in 

the intestine 

•	 gastroesophageal reflux disease 

Esophagus 

Stomach 

Small 

intestine 

The digestive system. 

•	 smooth muscle disorders, such as amyloidosis and scleroderma 

•	 nervous system diseases, including 

abdominal migraine and Parkinson’s 

disease 

•	 metabolic disorders, including
 

hypothyroidism
 

Many people have what is called idiopathic 

gastroparesis, meaning the cause is 

unknown and cannot be found even after 

medical tests. 
What are the symptoms of 

gastroparesis? 

Signs and symptoms of gastroparesis are 

•	 heartburn 

•	 pain in the upper abdomen 

•	 nausea 

•	 vomiting of undigested food—sometimes several hours after a meal 

•	 early feeling of fullness after only a
 

few bites of food
 

•	 weight loss due to poor absorption of 

nutrients or low calorie intake 

•	 abdominal bloating 

•	 high and low blood glucose levels 

•	 lack of appetite 

•	 gastroesophageal reflux 

•	 spasms in the stomach area 

Eating solid foods, high-fiber foods such as 

raw fruits and vegetables, fatty foods, or 

drinks high in fat or carbonation may contribute to these symptoms. 

The symptoms of gastroparesis may be mild 

or severe, depending on the person. Symptoms can happen frequently in some people 

and less often in others. Many people with 

gastroparesis experience a wide range of 

symptoms, and sometimes the disorder is 

difficult for the physician to diagnose. 

What are the complications 

of gastroparesis? 

If food lingers too long in the stomach, it 

can cause bacterial overgrowth from the 

fermentation of food. Also, the food can 

harden into solid masses called bezoars that 

may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food 

into the small intestine. 

Gastroparesis can make diabetes worse by 

making blood glucose control more difficult. When food that has been delayed in 

the stomach finally enters the small intestine and is absorbed, blood glucose levels 

rise. Since gastroparesis makes stomach 

emptying unpredictable, a person’s blood 

glucose levels can be erratic and difficult 

to control. 

How is gastroparesis 

diagnosed? 

After performing a full physical exam and 

taking your medical history, your doctor 

may order several blood tests to check 

blood counts and chemical and electrolyte 

levels. To rule out an obstruction or other 

conditions, the doctor may perform the 

following tests: 

•	 Upper endoscopy. After giving you a 

sedative to help you become drowsy, 

the doctor passes a long, thin tube 

called an endoscope through your 

mouth and gently guides it down 

the throat, also called the esophagus, 

into the stomach. Through the endoscope, the doctor can look at the 

lining of the stomach to check for 

any abnormalities. 

•	 Ultrasound. To rule out gallbladder 

disease and pancreatitis as sources of 

the problem, you may have an ultrasound test, which uses harmless sound 

waves to outline and define the shape 

of the gallbladder and pancreas. 

•	 Barium x ray. After fasting for 

12 hours, you will drink a thick liquid 

called barium, which coats the stomach, making it show up on the x ray. 

If you have diabetes, your doctor may 

have special instructions about fasting. 

Normally, the stomach will be empty 

of all food after 12 hours of fasting. 

2	 Gastroparesis 
Gastroparesis is likely if the x ray 

shows food in the stomach. Because a 

person with gastroparesis can sometimes have normal emptying, the doctor may repeat the test another day if 

gastroparesis is suspected. 

Once other causes have been ruled out, the 

doctor will perform one of the following 

gastric emptying tests to confirm a diagnosis of gastroparesis. 

•	 Gastric emptying scintigraphy. This 

test involves eating a bland meal, such 

as eggs or egg substitute, that contains 

a small amount of a radioactive substance, called radioisotope, that shows 

up on scans. The dose of radiation 

from the radioisotope is not dangerous. The scan measures the rate of 

gastric emptying at 1, 2, 3, and 4 hours. 

When more than 10 percent of the 

meal is still in the stomach at 4 hours, 

the diagnosis of gastroparesis is 

confirmed. 

•	 Breath test. After ingestion of a meal 

containing a small amount of isotope, 

breath samples are taken to measure 

the presence of the isotope in carbon 

dioxide, which is expelled when a person exhales. The results reveal how 

fast the stomach is emptying. 

•	 SmartPill. Approved by the U.S. 

Food and Drug Administration (FDA) 

in 2006, the SmartPill is a small device 

in capsule form that can be swallowed. 

The device then moves through the 

digestive tract and collects information 

about its progress that is sent to a cell 

phone-sized receiver worn around 

your waist or neck. When the capsule 

is passed from the body with the stool 

in a couple of days, you take the 

receiver back to the doctor, who 

enters the information into a 

computer. 

How is gastroparesis 

treated? 

Treatment of gastroparesis depends on the 

severity of the symptoms. In most cases, 

treatment does not cure gastroparesis—it 

is usually a chronic condition. Treatment 

helps you manage the condition so you can 

be as healthy and comfortable as possible. 

Medication 

Several medications are used to treat gastroparesis. Your doctor may try different 

medications or combinations to find the 

most effective treatment. Discussing the 

risk of side effects of any medication with 

your doctor is important. 

•	 Metoclopramide (Reglan). This drug 

stimulates stomach muscle contractions to help emptying. Metoclopramide also helps reduce nausea and 

vomiting. Metoclopramide is taken 

20 to 30 minutes before meals and at 

bedtime. Side effects of this drug 

include fatigue, sleepiness, depression, 

anxiety, and problems with physical 

movement. 

•	 Erythromycin. This antibiotic also 

improves stomach emptying. It works 

by increasing the contractions that 

move food through the stomach. Side 

effects include nausea, vomiting, and 

abdominal cramps. 

•	 Domperidone. This drug works like 

metoclopramide to improve stomach 

emptying and decrease nausea and 

vomiting. The FDA is reviewing 

domperidone, which has been used 

elsewhere in the world to treat gastroparesis. Use of the drug is restricted 

in the United States. 

3	 Gastroparesis 
•	 Other medications. Other medications may be used to treat symptoms 

and problems related to gastroparesis. 

For example, an antiemetic can help 

with nausea and vomiting. Antibiotics 

will clear up a bacterial infection. If 

you have a bezoar in the stomach, the 

doctor may use an endoscope to inject 

medication into it to dissolve it. 

Dietary Changes 

Changing your eating habits can help control gastroparesis. Your doctor or dietitian 

may prescribe six small meals a day instead 

of three large ones. If less food enters the 

stomach each time you eat, it may not 

become overly full. In more severe cases, 

a liquid or pureed diet may be prescribed. 

The doctor may recommend that you avoid 

high-fat and high-fiber foods. Fat naturally 

slows digestion—a problem you do not 

need if you have gastroparesis—and fiber is 

difficult to digest. Some high-fiber foods 

like oranges and broccoli contain material 

that cannot be digested. Avoid these foods 

because the indigestible part will remain in 

the stomach too long and possibly form 

bezoars. 

Feeding Tube 

If a liquid or pureed diet does not work, 

you may need surgery to insert a feeding 

tube. The tube, called a jejunostomy, is 

inserted through the skin on your abdomen 

into the small intestine. The feeding tube 

bypasses the stomach and places nutrients 

and medication directly into the small 

intestine. These products are then digested 

and delivered to your bloodstream quickly. 

You will receive special liquid food to use 

with the tube. The jejunostomy is used only 

when gastroparesis is severe or the tube is 

necessary to stabilize blood glucose levels 

in people with diabetes. 

Parenteral Nutrition 

Parenteral nutrition refers to delivering 

nutrients directly into the bloodstream, 

bypassing the digestive system. The doctor 

places a thin tube called a catheter in a 

chest vein, leaving an opening to it outside 

the skin. For feeding, you attach a bag 

containing liquid nutrients or medication to 

the catheter. The fluid enters your bloodstream through the vein. Your doctor will 

tell you what type of liquid nutrition to use. 

This approach is an alternative to the 

jejunostomy tube and is usually a temporary method to get you through a difficult 

period with gastroparesis. Parenteral 

nutrition is used only when gastroparesis is 

severe and is not helped by other methods. 

Gastric Electrical Stimulation 

A gastric neurostimulator is a surgically 

implanted battery-operated device that 

releases mild electrical pulses to help control nausea and vomiting associated with 

gastroparesis. This option is available to 

people whose nausea and vomiting do not 

improve with medications. Further studies 

will help determine who will benefit most 

from this procedure, which is available in a 

few centers across the United States. 

Botulinum Toxin 

The use of botulinum toxin has been associated with improvement in symptoms of gastroparesis in some patients; however, 

further research on this form of therapy is 

needed. 

4	 Gastroparesis 
What if I have diabetes and 

gastroparesis? 

The primary treatment goals for gastroparesis related to diabetes are to improve 

stomach emptying and regain control of 

blood glucose levels. Treatment includes 

dietary changes, insulin, oral medications, 

and, in severe cases, a feeding tube and 

parenteral nutrition. 

Dietary Changes 

The doctor will suggest dietary changes 

such as six smaller meals to help restore 

your blood glucose to more normal levels 

before testing you for gastroparesis. In 

some cases, the doctor or dietitian may 

suggest you try eating several liquid or 

pureed meals a day until your blood glucose levels are stable and the symptoms 

improve. Liquid meals provide all the 

nutrients found in solid foods, but can 

pass through the stomach more easily 

and quickly. 

Insulin for Blood Glucose 

Control 

If you have gastroparesis, food is being 

absorbed more slowly and at unpredictable 

times. To control blood glucose, you may 

need to 

•	 take insulin more often or change the 

type of insulin you take 

•	 take your insulin after you eat instead 

of before 

•	 check your blood glucose levels frequently after you eat and administer 

insulin whenever necessary 

Your doctor will give you specific instructions for taking insulin based on your 

particular needs. 

Hope Through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases’ Division of 

Digestive Diseases and Nutrition supports 

basic and clinical research into gastrointestinal motility disorders, including gastroparesis. Among other areas, researchers 

are studying whether experimental medications can relieve or reduce symptoms of 

gastroparesis, such as bloating, abdominal 

pain, nausea, and vomiting, or shorten the 

time the stomach needs to empty its contents following a meal. 

Points to Remember 

•	 Gastroparesis is the result of damage 

to the vagus nerve, which controls 

the movement of food through the 

digestive system. Instead of moving 

through the digestive tract normally, 

the food is retained in the stomach. 

•	 Gastroparesis may occur in people 

with type 1 diabetes or type 2 diabetes. 

The vagus nerve becomes damaged 

after years of high blood glucose, 

resulting in gastroparesis. In turn, 

gastroparesis contributes to poor 

blood glucose control. 

•	 Symptoms of gastroparesis include 

early fullness, abdominal pain, stomach spasms, heartburn, nausea, vomiting, bloating, gastroesophageal reflux, 

lack of appetite, and weight loss. 

•	 Gastroparesis is diagnosed with tests 

such as x rays, manometry, and gastric 

emptying scans. 

•	 Treatment includes dietary changes, 

oral medications, adjustments in 

insulin injections for people with diabetes, a jejunostomy tube, parenteral 

nutrition, gastric neurostimulators, or 

botulinum toxin. 

5	 Gastroparesis 
For More Information

American College of Gastroenterology

P.O. Box 342260

Bethesda, MD 20827–2260

Phone: 301–263–9000

Internet: www.acg.gi.org

American Diabetes Association

1701 North Beauregard Street

Alexandria, VA 22311

Phone: 1–800–342–2383

Email: AskADA@diabetes.org

Internet: www.diabetes.org

International Foundation for Functional

Gastrointestinal Disorders

P.O. Box 170864

Milwaukee, WI 53217

Phone: 1–888–964–2001 or 414–964–1799

Fax: 414–964–7176

Email: iffgd@iffgd.org

Internet: www.iffgd.org

You may also find additional information about this

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about 

medications. When prepared, this publication

included the most current information available. 

For updates or for questions about any medications,

contact the U.S. Food and Drug Administration 

toll-free at 1–888–INFO–FDA (1–888–463–6332) 

or visit www.fda.gov. Consult your doctor for more

information.

The U.S. Government does not endorse or favor any

specific commercial product or company. Trade,

proprietary, or company names appearing in this

document are used only because they are considered

necessary in the context of the information provided.

If a product is not mentioned, the omission does not

mean or imply that the product is unsatisfactory.

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No. 07–4348

July 2007

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