Gastroparesis

Delayed gastric emptying: etiology, diagnosis with 4-hour GES, dietary management, glycemic optimization, prokinetics (metoclopramide REMS), antiemetics, and interventional therapies including G-POEM — ACG 2022.

📖 4 Sections⏱ ~35 min✅ 4-question quiz

Overview & Diagnosis

Definition, etiology, symptoms, gastric emptying

Gastroparesis: Delayed Emptying Without Obstruction

Gastroparesis is a chronic symptomatic disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. It impairs quality of life significantly and represents a major management challenge in clinical gastroenterology.

Idiopathic

~36% of cases

Most common. Often follows viral illness (post-viral gastroparesis). Better long-term prognosis than diabetic.

Diabetic

~29% of cases

Type 1 > Type 2 diabetes. Chronic hyperglycemia damages interstitial cells of Cajal and enteric neurons. Glycemic control is key.

Post-surgical

~13% of cases

After fundoplication, bariatric surgery, esophagectomy, or vagotomy. Vagal nerve injury is central mechanism.

Other etiologies: connective tissue disorders (scleroderma, EDS), Parkinson's disease, hypothyroidism, medications (opioids, GLP-1 agonists, anticholinergics), post-COVID, paraneoplastic.

Cardinal Symptoms (Cardinal Symptom Index — GCSI)

Nausea / Vomiting

Most prominent. Nausea often exceeds vomiting. Vomiting of undigested food ≥1 hr after eating is classic.

Early Satiety

Inability to finish a normal-sized meal. Often the first symptom to emerge in diabetic gastroparesis.

Postprandial Fullness / Bloating

Abdominal discomfort and distension after meals; overlaps with functional dyspepsia.

Abdominal pain occurs in ~90% of patients but is not a primary diagnostic feature — distinguish from functional dyspepsia.

Gastroparesis vs. Functional Dyspepsia

Significant symptom overlap exists between gastroparesis and functional dyspepsia (FD). ACG 2022 emphasizes that delayed gastric emptying is NOT required for a diagnosis of functional dyspepsia, and ~30–40% of FD patients have delayed emptying. Management may be similar. Gastroparesis diagnosis requires objective documentation of delayed emptying on standardized testing.

Medication-Induced Gastroparesis — Screen First

Before extensive workup, review medications. Opioids, GLP-1 receptor agonists (semaglutide, liraglutide), anticholinergics, TCAs, and calcium channel blockers all delay gastric emptying. Discontinue offending agents and reassess before confirming a diagnosis.

Camilleri M et al. ACG Clinical Guideline: Gastroparesis. Am J Gastroenterol. 2022;117(8):1197–1220.