Gastroparesis 

National Digestive Diseases Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

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 

small intestine. Normally, the muscles of the 

stomach, which are controlled by the vagus 

nerve, contract to break up food and move it 

through the gastrointestinal (GI) tract. The 

GI tract is a series of hollow organs joined in 

a long, twisting tube from the mouth to the 

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 stomach to the small intestine or stops moving 

altogether. 

What causes gastroparesis? 

Most people diagnosed with gastroparesis 

have idiopathic gastroparesis, which means 

a health care provider cannot identify the 

cause, even with medical tests. Diabetes is 

the most common known cause of gastroparesis. People with diabetes have high levels 

of blood glucose, also called blood sugar. 

Over time, high blood glucose levels can 

damage the vagus nerve. Other identifiable 

causes of gastroparesis include intestinal 

surgery and nervous system diseases such as 

Parkinson’s disease or multiple sclerosis. For 

reasons that are still unclear, gastroparesis 

is more commonly found in women than in 

men. 

Small 

intestine 

Stomach 

Jejunum 

Gastroparesis slows or stops the movement of food 

from the stomach to the small intestine. 
 

What are the symptoms of 

gastroparesis? 

The most common symptoms of gastroparesis are nausea, a feeling of fullness after 

eating only a small amount of food, and 

vomiting undigested food—sometimes several hours after a meal. Other symptoms of 

gastroparesis include 

• gastroesophageal reflux (GER), also 

called acid reflux or acid regurgitation— 

a condition in which stomach contents 

flow back up into the esophagus, the 

organ that connects the mouth to the 

stomach 

• pain in the stomach area 

• abdominal bloating 

• lack of appetite 

Symptoms may be aggravated by eating 

greasy or rich foods, large quantities of 

foods with fiber—such as raw fruits and 

vegetables—or drinking beverages high in 

fat or carbonation. Symptoms may be mild 

or severe, and they can occur frequently in 

some people and less often in others. The 

symptoms of gastroparesis may also vary in 

intensity over time in the same individual. 

Sometimes gastroparesis is difficult to diagnose because people experience a range of 

symptoms similar to those of other diseases. 

How is gastroparesis 

diagnosed? 

Gastroparesis is diagnosed through a physical exam, medical history, blood tests, tests 

to rule out blockage or structural problems 

in the GI tract, and gastric emptying tests. 

Tests may also identify a nutritional disorder 

or underlying disease. To rule out any blockage or other structural problems, the health 

care provider may perform one or more of 

the following tests: 

• Upper gastrointestinal (GI) endoscopy. This procedure involves using 

an endoscope—a small, flexible tube 

with a light—to see the upper GI tract, 

which includes the esophagus, stomach, 

and duodenum—the first part of the 

small intestine. The test is performed 

at a hospital or outpatient center by 

a gastroenterologist—a doctor who 

specializes in digestive diseases. The 

endoscope is carefully fed down the 

esophagus and into the stomach and 

duodenum. A small camera mounted 

on the endoscope transmits a video 

image to a monitor, allowing close 

examination of the intestinal lining. A 

person may receive a liquid anesthetic 

that is gargled or sprayed on the back of 

the throat. An intravenous (IV) needle 

is placed in a vein in the arm if general 

anesthesia is given. The test may show 

blockage or large bezoars—solid collections of food, mucus, vegetable fiber, 

hair, or other material that cannot be 

digested in the stomach—that are sometimes softened, dissolved, or broken up 

during an upper GI endoscopy. 

2 Gastroparesis 
 

• Upper GI series. An upper GI series 

may be done to look at the small intestine. The test is performed at a hospital 

or outpatient center by an x-ray technician, and the images are interpreted 

by a radiologist—a doctor who specializes in medical imaging. Anesthesia 

is not needed. No eating or drinking 

is allowed for 8 hours before the procedure, if possible. If the person has 

diabetes, a health care provider may 

give different instructions about fasting 

before the test. During the procedure, 

the person will stand or sit in front of 

an x-ray machine and drink barium, a 

chalky liquid. Barium coats the small 

intestine, making signs of gastroparesis 

show up more clearly on x rays. Gastroparesis is likely if the x ray shows food 

in the stomach after fasting. A person 

may experience bloating and nausea for 

a short time after the test. For several 

days afterward, barium liquid in the 

GI tract causes stools to be white or 

light colored. A health care provider 

will give the person specific instructions 

about eating and drinking after the test. 

• Ultrasound. Ultrasound uses a device, 

called a transducer, that bounces safe, 

painless sound waves off organs to create an image of their structure. The 

procedure is performed in a health care 

provider’s office, outpatient center, or 

hospital by a specially trained technician, and the images are interpreted by 

a radiologist; anesthesia is not needed. 

The images can show whether gallbladder disease and pancreatitis could be 

the cause of a person’s digestive symptoms, rather than gastroparesis. 

• Gastric emptying scintigraphy. The test 

involves eating a bland meal—such as 

eggs or an egg substitute—that contains 

a small amount of radioactive material. 

The test is performed in a radiology 

center or hospital by a specially trained 

technician and interpreted by a radiologist; anesthesia is not needed. An 

external camera scans the abdomen to 

show where the radioactive material is 

located. The radiologist is then able to 

measure the rate of gastric emptying at 

1, 2, 3, and 4 hours after the meal. If 

more than 10 percent of the meal is still 

in the stomach at 4 hours, the diagnosis 

of gastroparesis is confirmed. 

• SmartPill. The SmartPill is a small 

electronic device in capsule form. The 

SmartPill test is available at specialized 

outpatient centers. The images are 

interpreted by a radiologist. The device 

is swallowed and moves through the 

entire digestive tract, sending information to a cell-phone-sized receiver 

worn around the person’s waist or neck. 

The recorded information provides a 

detailed record of how quickly food 

travels through each part of the digestive tract. 

• Breath test. With this test, the person 

eats a meal containing a small amount 

of radioactive material; then breath 

samples are taken over a period of 

several hours to measure the amount 

of radioactive material in the exhaled 

breath. The results allow the health 

care provider to calculate how fast the 

stomach is emptying. 

3 Gastroparesis 
 

How is gastroparesis 

treated? 

Treatment of gastroparesis depends on the 

severity of the person’s symptoms. In most 

cases, treatment does not cure gastroparesis, 

which is usually a chronic, or long-lasting, 

condition. Gastroparesis is also a relapsing 

condition—the symptoms can come and go 

for periods of time. Treatment helps people 

manage the condition so they can be as comfortable and active as possible. 

Eating, Diet, and Nutrition 

Changing eating habits can sometimes help 

control the severity of gastroparesis symptoms. A health care provider may suggest 

eating six small meals a day instead of three 

large ones. If less food enters the stomach 

each time a person eats, the stomach may not 

become overly full, allowing it to empty more 

easily. Chewing food well, drinking noncarbonated liquids with a meal, and walking 

or sitting for 2 hours after a meal—instead 

of lying down—may assist with gastric 

emptying. 

A health care provider may also recommend avoiding high-fat and fibrous foods. 

Fat naturally slows digestion and some raw 

vegetables and fruits are more difficult to 

digest than other foods. Some foods, such as 

oranges and broccoli, contain fibrous parts 

that do not digest well. People with gastroparesis should minimize their intake of large 

portions of these foods because the undigested parts may remain in the stomach too 

long. Sometimes, the undigested parts form 

bezoars. 

When a person has severe symptoms, a 

liquid or puréed diet may be prescribed. As 

liquids tend to empty more quickly from the 

stomach, some people may find a puréed diet 

helps improve symptoms. Puréed fresh or 

cooked fruits and vegetables can be incorporated into shakes and soups. A health care 

provider may recommend a dietitian to help 

a person plan meals that minimize symptoms 

and ensure all nutritional needs are met. 

When the most extreme cases of gastroparesis lead to severe nausea, vomiting, and 

dehydration, urgent care may be required 

at a medical facility where IV fluids can be 

given. 

Medications 

Several prescription medications are available to treat gastroparesis. A combination 

of medications may be used to find the most 

effective treatment. 

Metoclopramide (Reglan). This medication 

stimulates stomach muscle contractions to 

help with gastric emptying. Metoclopramide 

also helps reduce nausea and vomiting. The 

medication is taken 20 to 30 minutes before 

meals and at bedtime. Possible side effects 

of metoclopramide include fatigue, sleepiness, and depression. Currently, this is the 

only medication approved by the FDA for 

treatment of gastroparesis. However, the 

FDA has placed a black box warning on 

this medication because of rare reports of it 

causing an irreversible neurologic side effect 

called tardive dyskinesia—a disorder that 

affects movement. 

Erythromycin. This antibiotic, prescribed 

at low doses, may improve gastric emptying. 

Like metaclopramide, erythromycin works by 

increasing the contractions that move food 

through the stomach. Possible side effects of 

erythromycin include nausea, vomiting, and 

abdominal cramps. 

4 Gastroparesis 
 

Other medications. Other medications may 

be used to treat symptoms and problems 

related to gastroparesis. For example, medications known as antiemetics are used to 

help control nausea and vomiting. 

Botulinum Toxin 

Botulinum toxin is a nerve blocking agent 

also known as Botox. After passing an 

endoscope into the stomach, a health care 

provider injects the Botox into the pylorus, the opening from the stomach into the 

duodenum. Botox is supposed to help keep 

the pylorus open for longer periods of time 

and improve symptoms of gastroparesis. 

Although some initial research trials showed 

modest improvement in gastroparesis symptoms and the rate of gastric emptying following the injections, other studies have failed to 

show the same degree of effectiveness of the 

Botox injections.1 

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

intrapyloric botulinum toxin injection for gastroparesis. 

Digestion. 2010;81(1):27–34. 

Gastric Electrical Stimulation 

This treatment alternative may be effective 

for some people whose nausea and vomiting do not improve with dietary changes 

or medications. A gastric neurostimulator 

is a surgically implanted battery-operated 

device that sends mild electrical pulses to the 

stomach muscles to help control nausea and 

vomiting. The procedure may be performed 

at a hospital or outpatient center by a gastroenterologist. General anesthesia may be 

required. The gastroenterologist makes several tiny incisions in the abdomen and inserts 

a laparoscope—a thin tube with a tiny video 

camera attached. The camera sends a magnified image from inside the stomach to a 

video monitor, giving the gastroenterologist a 

close-up view of the tissues. Once implanted, 

the settings on the battery-operated device 

can be adjusted to determine the settings 

that best control symptoms. 

Jejunostomy 

If medications and dietary changes don’t 

work, and the person is losing weight or 

requires frequent hospitalization for dehydration, a health care provider may recommend surgically placing a feeding tube 

through the abdominal wall directly into a 

part of the small intestine called the jejunum. The surgical procedure is known as a 

jejunostomy. The procedure is performed by 

a surgeon at a hospital or outpatient center. 

Anesthesia is needed. The feeding tube 

bypasses the stomach and delivers a special 

liquid food with nutrients directly into the 

jejunum. The jejunostomy is used only when 

gastroparesis is extremely severe. 

Parenteral Nutrition 

When gastroparesis is so severe that dietary 

measures and other treatments are not helping, a health care provider may recommend 

parenteral nutrition—an IV liquid food 

mixture supplied through a special tube in 

the chest. The procedure is performed by a 

surgeon at a hospital or outpatient center; 

anesthesia is needed. The surgeon inserts 

a thin, flexible tube called a catheter into a 

chest vein, with the catheter opening outside 

the skin. A bag containing liquid nutrients 

is attached to the catheter, and the nutrients 

are transported through the catheter into the 

chest vein and into the bloodstream. This 

approach is a less preferable alternative to 

a jejunostomy and is usually a temporary 

treatment to get through a difficult period of 

gastroparesis. 

5 Gastroparesis 
 

How is gastroparesis treated 

if a person has diabetes? 

An elevated blood glucose level directly 

interferes with normal stomach emptying, so 

good blood glucose control in people with 

diabetes is important. However, gastroparesis can make blood glucose control difficult. 

When food that has been delayed in the 

stomach finally enters the small intestine and 

is absorbed, blood glucose levels rise. Gastric emptying is unpredictable with gastroparesis, causing a person’s blood glucose levels 

to be erratic and difficult to control. 

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

emptying and regain control of blood glucose 

levels. In addition to the dietary changes and 

treatments already described, a health care 

provider will likely adjust the person’s insulin 

regimen. 

To better control blood glucose, people with 

diabetes and gastroparesis may need to 

• take insulin more often or change the 

type of insulin they take 

• take insulin after meals, instead of 

before

• check blood glucose levels frequently 

after eating and administer insulin when 

necessary 

A health care provider will give specific 

instructions for taking insulin based on 

the individual’s needs and the severity of 

gastroparesis. 

In some cases, the dietitian may suggest eating several liquid or puréed meals a day until 

gastroparesis symptoms improve and blood 

glucose levels are more stable. 

What are the problems of 

gastroparesis? 

The problems of gastroparesis can include 

• severe dehydration due to persistent 

vomiting 

• gastroesophageal reflux disease 

(GERD), which is GER that occurs 

more than twice a week for a few weeks; 

GERD can lead to esophagitis— 

irritation of the esophagus 

• bezoars, which can cause nausea, 

vomiting, obstruction, or interfere with 

absorption of some medications in pill 

form 

• difficulty managing blood glucose levels 

in people with diabetes 

• malnutrition due to poor absorption of 

nutrients or a low calorie intake 

• decreased quality of life, including work 

absences due to severe symptoms 

Points to Remember 

• Gastroparesis, also called delayed gastric emptying, is a disorder that slows or 

stops the movement of food from the 

stomach to the small intestine. 

• 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 stomach to the small intestine or 

stops moving altogether. 

• Most people diagnosed with gastroparesis have idiopathic gastroparesis, which 

means a health care provider cannot 

identify the cause, even with medical 

tests. 

6 Gastroparesis 
 

• Diabetes is the most common known 

cause of gastroparesis. People with diabetes have high levels of blood glucose, 

also called blood sugar. Over time, high 

blood glucose levels can damage the 

vagus nerve. 

• The most common symptoms of gastroparesis are nausea, a feeling of fullness 

after eating only a small amount of 

food, and vomiting undigested food— 

sometimes several hours after a meal. 

Other common symptoms include gastroesophageal reflux (GER), pain in the 

stomach area, abdominal bloating, and 

lack of appetite. 

• Gastroparesis is diagnosed through a 

physical exam, medical history, blood 

tests, tests to rule out blockage or structural problems in the gastrointestinal 

(GI) tract, and gastric emptying tests. 

• Changing eating habits can sometimes 

help control the severity of gastroparesis symptoms. A health care provider 

may suggest eating six small meals a day 

instead of three large ones. When a 

person has severe symptoms, a liquid or 

puréed diet may be prescribed. 

• Treatment of gastroparesis may include 

medications, botulinum toxin, gastric 

electrical stimulation, jejunostomy, and 

parenteral nutrition. 

• For people with gastroparesis and diabetes, a health care provider will likely 

adjust the person’s insulin regimen. 

Hope through Research 

The National Institute of Diabetes and 

Digestive and Kidney Diseases’ (NIDDK’s) 

Division of Digestive Diseases and Nutrition 

supports basic and clinical research into GI 

motility disorders, including gastroparesis. 

Researchers are studying whether new 

medications or surgery can improve gastric 

emptying and reduce gastroparesis symptoms. Researchers are evaluating the safety 

and effectiveness of nortriptyline for treatment of gastroparesis. More information 

about one such study, funded under the 

National Institutes of Health clinical trial 

number NCT00765895, can be found at 

www.ClinicalTrials.gov. 

Participants in clinical trials can play a more 

active role in their own health care, gain 

access to new research treatments before 

they are widely available, and help others 

by contributing to medical research. For 

information about current studies, visit 

www.ClinicalTrials.gov. 

For More Information 

American College of Gastroenterology 

6400 Goldsboro Road, Suite 450 

Bethesda, MD 20817–5846 

Phone: 301–263–9000 

Email: info@acg.gi.org 

Internet: www.acg.gi.org 

American Diabetes Association 

1701 North Beauregard Street 

Alexandria, VA 22311 

Phone: 1–800–DIABETES 

(1–800–342–2383) 

Email: AskADA@diabetes.org 

Internet: www.diabetes.org 

International Foundation for Functional 

Gastrointestinal Disorders 

P.O. Box 170864 

Milwaukee, WI 53217–8076 

Phone: 1–888–964–2001 or 414–964–1799 

Fax: 414–964–7176 

Email: iffgd@iffgd.org 

Internet: www.iffgd.org 

7 Gastroparesis 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acknowledgments 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK scientists and outside experts. This publication 

was reviewed by Linda A. Lee, M.D., Johns 

Hopkins University School of Medicine. 

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov. 

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medications. When prepared, this publication 

included the most current information available. 

For updates or for questions about any medications, 

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U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 12–4348 

June 2012 

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