Gastroparesis: Symptoms, Diagnosis, Causes & Treatment

Dr. Debora Poli
Clinical review: Dr. Debora Poli Gastroenterology CRM-SP 114099
Created by: Daisy Oliveira Registered Nurse

Gastroparesis is paralysis or reduced movement of the stomach. It is usually related to damage to the vagus nerve or stomach muscles.

This condition can cause symptoms such as nausea, vomiting, a constant feeling of fullness, gas buildup, and abdominal discomfort. The exact cause is unknown, but gastroparesis is more common in people with type 1 or type 2 diabetes, which is known as diabetic gastroparesis.

Some medications, including certain antidepressants and blood pressure medications such as calcium channel blockers, can also cause gastroparesis. Treatment for gastroparesis, also called delayed gastric emptying syndrome, is guided by a gastroenterologist and may involve medication and dietary changes to help prevent complications that can affect quality of life.

Imagem ilustrativa número 1

Symptoms of gastroparesis

The main symptoms of gastroparesis are:

  • Nausea;

  • Vomiting, which may contain food eaten several hours earlier;

  • Abdominal pain or bloating;

  • Feeling full even after eating a small meal;

  • A heavy feeling in the stomach, even if the last meal was many hours earlier;

  • Excessive gas.

Gastroparesis symptoms occur when the stomach is unable to move properly to digest food and send it to the intestines.

In more severe cases, symptoms may also include weight loss or loss of appetite, as well as signs of dehydration, such as weakness, dizziness, and dry mouth.

It is important to see a gastroenterologist whenever symptoms of gastroparesis occur, so that the condition can be diagnosed and the most appropriate treatment can be started.

Confirming a diagnosis

Gastroparesis is diagnosed by a gastroenterologist through an evaluation of symptoms and health history. The doctor will consider factors such as the person’s age, whether they have diabetes mellitus, medication use, and any previous abdominal surgeries.

Tests may also be ordered to check blood sugar and hormone levels, such as thyroxine and triiodothyronine, for example.

Other tests the doctor may order include gastric emptying measurement, scintigraphy, endoscopy, ultrasound, or X-ray with contrast. These tests can help evaluate the appearance of the stomach, check whether there is undigested food in the stomach after fasting for several hours, and determine how long food takes to pass into the intestines.

These exams allow the doctor to rule out other conditions, such as a gastric ulcer, mechanical obstruction, irritable bowel syndrome, indigestion, or gastroesophageal reflux, for example.

Possible causes

Most cases of gastroparesis have an unknown cause. This is known as idiopathic gastroparesis.

However, gastroparesis may be associated with health conditions such as:

  • Diabetes mellitus, causing diabetic gastroparesis;

  • Previous gastric surgery, which can damage the vagus nerve;

  • Neurological conditions, such as multiple sclerosis, Parkinson’s disease, brainstem tumors, or stroke;

  • Rheumatologic diseases, such as scleroderma or amyloidosis;

  • Viral infections, such as rotavirus or Norwalk virus;

  • Use of some medications, such as tricyclic antidepressants, opioids, or calcium channel blockers.

In addition, other medications that can cause gastroparesis include GLP-1 agonists, which are indicated for the treatment of type 2 diabetes or weight loss, such as liraglutide or semaglutide, for example.

Gastroparesis can also be caused by autoimmune conditions, such as autoimmune gastrointestinal dysmotility, which leads to delayed stomach emptying.

Treatment options

Treatment for gastroparesis should be guided by a gastroenterologist and may involve dietary changes, medication, gastric stimulation, or surgery.

The main treatments for gastroparesis are:

1. Diet changes

The doctor may recommend dietary changes, such as reducing portion sizes and following a light diet that is low in fat, rich in soluble fiber, and mostly liquid. This can help ensure adequate nutrient intake, maintain hydration, and make gastric emptying easier.

It is also important to control blood sugar levels, especially in people with diabetes.

2. Medication use

Medication such as metoclopramide may be prescribed by the doctor to help increase gastrointestinal movement.

In addition, antiemetic medication, such as metoclopramide, may be recommended to help control nausea and vomiting.

3. Botulinum toxin

A botulinum toxin injection may be performed by the doctor in the pylorus, which is a sphincter at the end of the stomach. The goal is to paralyze the pylorus and keep it open for longer, which may help relieve gastroparesis symptoms.

4. Gastric electrical stimulation

Gastric electrical stimulation may be recommended by the doctor to help relieve gastroparesis symptoms, especially frequent vomiting.

This type of treatment is done through surgery by laparotomy. During the procedure, the doctor places a battery-powered device near the pylorus, which sends electrical signals to the stomach and helps control vomiting.

5. Parenteral nutrition

In more severe cases of gastroparesis, when a person is unable to eat by mouth, parenteral nutrition may be necessary. This helps provide all the nutrients the person needs and prevents complications such as dehydration or malnutrition.

Parenteral nutrition is done by administering liquid, sterile nutrition into a vein.

6. Jejunostomy

Jejunostomy is a treatment in which the doctor places a tube through a surgical opening in the skin and connects it to the jejunum, which is the part of the intestine between the duodenum and the ileum.

This allows the person to receive enteral nutrition through the tube. This treatment is used in cases of severe malnutrition caused by gastroparesis.

7. Surgery

The doctor may also recommend surgery to help make gastric emptying easier. This may be indicated in cases where there is no improvement with other treatment options.

Possible complications

Complications of gastroparesis include severe malnutrition, dehydration due to constant vomiting, Mallory-Weiss syndrome, or difficulty controlling blood sugar levels in people with diabetes.

In addition, gastroparesis can cause undigested or partially digested food to build up in the stomach, forming masses that may become trapped in the stomach. This condition is known as bezoars.

Gastroparesis can also cause poor medication absorption, complications related to surgical procedures, the need for frequent hospitalization, and reduced quality of life.

Update History
We regularly update our content with the latest scientific information to maintain an exceptional level of quality.

References
  • Gastroparesis. Reddivari, A. K. R.; Mehta, P. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2022. Accessed 11 Oct 2023 https://www.ncbi.nlm.nih.gov/books/NBK551528/
  • CAMILLERI, Michael; et al. Clinical Guideline: Management of Gastroparesis. The American Journal of Gastroenterology. 2013;108(1):18-37.
  • MASAOKA, Tatsuhiro; TACK, Jan. Gastroparesis: Current Concepts and Management. Gut and Liver. Vol.III. III.ed; 166-173, 2009. Gastroparesis: Current Concepts and Management. Gut and Liver. 2009;3(3):166-173.
  • CESARINI, P.R.; FERREIRA, S. R. G. Gastroparesia diabética. Rev Ass Med Brasil. 1997;43(2):163-168.
  • TRONCON, L. E. de A. Gastroparesias: revisão de aspectos relacionados ao conceito, à etiopatogenia e ao manejo clínico. Revista da Associação Medica Brasileira. 1997;43(3):228-236.
  • PARKMAN, Henry; HASLER, William; FISHER, Robert. Revisión técnica sobre el diagnóstico y tratamiento de la gastroparesia. Asociación Americana de Gastroenterología. 2005;LXX(III):325-360.
  • Bosca, Marta; Marti, Lidia; Mínguez, Miguel. Aproximación diagnóstica y terapéutica al paciente con gastroparesia. Vol.XXX. VI.ed; ed. : Elsevier; 2007.