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Diabetes is the most common known cause. Damage to the nerves involved in digestive motility can disrupt stomach emptying.
What is gastroparesis?
After a meal, the stomach grinds food and moves it on to the small intestine. In gastroparesis, this process is slowed or disrupted, with no mechanical blockage.
The condition can cause very rapid satiety, fullness that lasts long after a meal, nausea, vomiting, pain or bloating. Its impact varies greatly from person to person.
What can go wrong after a meal
For a meal to gradually leave the stomach, several functions must work together. In gastroparesis, one or more of these steps may be disrupted, differently from one person to another.
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Receiving the meal
The upper part of the stomach relaxes to receive food without an excessive rise in pressure.
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Grinding
Stomach contractions break food down into small particles and mix them with digestive juices.
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Emptying
The contents gradually pass through the pylorus into the small intestine.
Typical emptying
With gastroparesis
Symptoms
Symptoms and their intensity differ from one person to another.
Early satiety
Feeling full very quickly, sometimes after only a few mouthfuls.
Fullness after meals
The feeling that the meal stays in the stomach for a long time, with lasting heaviness or discomfort.
Nausea and vomiting
They can be occasional or frequent. Some people have gastroparesis without vomiting.
Pain and bloating
Upper abdominal pain, distension or bloating can come with the other symptoms.
Good to know: symptoms alone are not enough to confirm gastroparesis. Other conditions can look similar.
The cause cannot always be identified
Gastroparesis can have several causes. In many cases, no specific cause is found: this is called idiopathic gastroparesis.
After certain surgeries
Surgery on the oesophagus, stomach or nearby area can sometimes damage the nerves involved in how the stomach works.
Neurological or systemic diseases
Some diseases, such as scleroderma or neurological diseases, can be associated with gastroparesis.
Certain medicines
Opioids, some antidepressants and GLP-1 treatments (such as Ozempic or Wegovy) slow down stomach emptying and can cause or worsen symptoms.
After an infection
Gastroparesis can appear after a viral infection, such as gastroenteritis. It sometimes improves over time.
Idiopathic
For many people, tests do not find the cause of the gastric emptying disorder.
EDS and digestive problems
In people with Ehlers-Danlos syndrome, especially the hypermobile type, digestive problems are common: reflux, nausea, bloating, a feeling of slow digestion or bowel problems.
Some people also have slowed gastric emptying. Several explanations have been suggested, such as connective tissue fragility or a disorder of the autonomic nervous system (dysautonomia), but the mechanisms are still being studied.
Talk to a gastroenterologist about it, if possible one who knows about your EDS.
Actually measuring gastric emptying
Diagnosis is based on symptoms, medical history, ruling out a mechanical obstruction and a test that measures how fast the stomach empties.
Gastric emptying scintigraphy with a solid meal is the reference test. The American College of Gastroenterology guidelines favour a study of at least 3 hours, ideally 4 hours.
Depending on the context, other tests may be used, in particular a gastric emptying breath test. An endoscopy or imaging may also be carried out to look for another cause of the symptoms, especially an obstruction.
Adapting your diet without forgetting nutritional needs
Dietary changes must take into account symptoms, individual tolerance and the risk of malnutrition or dehydration.
Small portions
Several small meals may be better tolerated than a few very large ones.
Adapted texture
Soft, well-cooked, blended or liquid foods can sometimes go down better, depending on each person’s tolerance.
Nutritional follow-up
When intake becomes insufficient, medical and dietary follow-up is important to prevent or treat malnutrition and dehydration.
Important: there is no single diet that suits everyone with gastroparesis. Advice must be tailored to each person, especially in case of weight loss, malnutrition, diabetes or tube feeding.
Several approaches can be combined
Treatment depends on the cause, symptoms, severity, nutritional status and response to the different options.
Dietary and nutritional measures
The aim is to make eating easier while maintaining enough calories, nutrients and fluids.
Medication
Treatments may be offered to help stomach motility or reduce nausea and vomiting. The choice depends on the medical context and the risks specific to each medicine.
In France, some of them, such as metoclopramide or domperidone, are subject to dose and duration limits because of neurological or heart risks. Your doctor takes this into account: never change a treatment without their advice.
Nutritional support
If intake remains insufficient despite adjustments, enteral nutrition may be needed. Parenteral nutrition is reserved for certain specific situations.
Understanding artificial nutritionSpecialist options
For some patients whose symptoms remain severe despite treatment, specialised techniques may be discussed in expert centres, including G-POEM (an endoscopic procedure that relaxes the pylorus, the stomach outlet) or gastric electrical stimulation.
Consequences beyond digestive symptoms
When eating and drinking become difficult, gastroparesis can lead to weight loss, undernutrition or dehydration. In people with diabetes, the unpredictable slowing of digestion can also make blood sugar harder to control. Talk to your diabetes specialist: your treatment may need adjusting.
Your relationship with food can also change: when eating hurts or makes you ill, a fear of meals can set in and reduce intake even further. This is neither a whim nor a lack of willpower. Talk to your care team; if an eating disorder is suspected, the French federation for anorexia and bulimia ↗ offers a helpline and a directory of specialist services.
Sources and resources
This page is based on recognised medical resources and guidelines on gastroparesis.
See also the resources offered by the association to support those affected and their loved ones.
FMC-HGE (French gastroenterologists)
Gastroparesis: when to suspect it, how to treat it (article for healthcare professionals, PDF in French)
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NIDDK / National Institutes of Health
Definition, symptoms, diagnosis, nutrition and treatments
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American College of Gastroenterology
Patient information and guidelines on gastroparesis
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NHS
Overview, symptoms and care
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Medical information
The content of this page is provided for information only. It does not replace a consultation, a diagnosis or personalised advice from a healthcare professional.
Are you affected by gastroparesis?
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