What Is Gastroparesis, and What Causes It?

When you eat, normally food passes from the stomach and into the intestines with no problem. But that is not the case with gastroparesis. Gastroparesis is a serious condition where the stomach does not work properly. It keeps food and liquid from leaving the stomach, even though there’s no blockage. When your stomach doesn’t empty well, it can cause pain, nausea, and vomiting. You can also have severe problems like ulcers or even pneumonia.

Fortunately, gastroparesis is not a common problem. Out of every 100,000 people in the U.S., about 50 will have gastroparesis in their lifetime.  

What causes gastroparesis?

Digestion is a complex process. The nerves and smooth muscle in the stomach and small intestine work together to move food along. Some things can affect how the nerves or muscles work. And this can slow how the stomach empties, which results in gastroparesis.

Some health conditions, medications, and surgeries can cause gastroparesis. Causes include:

• Diabetes

• Pain medications (opioids)

• Surgery on the stomach

• Infections 

• Autoimmune disorders

• Nerve injury

• Marijuana use

• Nervous system disorders (like Parkinson’s disease or multiple sclerosis)

• Unknown reasons (idiopathic)

Diabetes is the most common cause of gastroparesis. People with diabetes have higher blood sugar levels than normal. Diabetic neuropathy occurs when diabetes damages nerves. Over time, high blood sugar levels can damage the vagus nerve. This is the main nerve that controls the action of the stomach and small intestine. High blood sugar levels can also damage cells in the smooth muscle of the stomach. 

What are symptoms of gastroparesis?

When your stomach doesn’t empty as it should, it can be quite uncomfortable. Some common symptoms of gastroparesis are:

• Stomach pain

• Bloating

• Nausea and vomiting

• Feeling unusually full after eating very little

• Weight loss

These symptoms are a result of the stomach being too full and stretched. The food may even become packed into a hard ball. This can completely block the movement of food into the small intestine. 

How do you diagnose gastroparesis?

There are three common tests to diagnose gastroparesis:

1. Gastric emptying scintigraphy: For this test, you eat a meal treated with a safe radioactive substance that an X-ray can see. You’ll get X-rays as food and liquid pass through the stomach into the bowel. These images help to figure out how long it takes for your stomach to empty. You may have gastroparesis if it takes longer than expected or if your stomach doesn’t empty all the way.

2. Gastric emptying breath test: Your healthcare provider will ask you to eat a meal and then take breath samples every few minutes. As food moves through the esophagus and stomach it’s detected on the breath. Once it moves past the stomach and into the intestine, it’s no longer detected. If your breath samples show food for longer than expected, it may be due to gastroparesis.

3. Wireless motility capsule: In this test you swallow a small, electronic pill that gathers information. Over 5 days, the pill sends information about your stomach, including how long it takes food to move through it. Your healthcare provider collects the data with a receiver. If your stomach isn’t moving well, or if food takes too long to leave the stomach, you may have gastroparesis.

How do you treat gastroparesis?

While there’s no cure, there are things you can do to decrease your symptoms. Your provider may suggest one or more of the following treatments.

Changes in diet and lifestyle

Sometimes changes in diet and lifestyle can help to improve symptoms. These can include:

• Eating small and frequent meals that are low in fat, fiber, and spices

• Avoiding carbonated beverages that may bloat the stomach 

• Avoiding alcohol and smoking

Medications

Some medications that can treat gastroparesis are:

• Metoclopramide: speeds up the rate at which the stomach empties

• Proton pump inhibitors: lower stomach acid, reducing the symptoms of stomach pain and reflux

• Erythromycin: an antibiotic that increases the speed of digestion

• Domperidone: boosts emptying of the stomach, reducing nausea and vomiting

• Antiemetics: help treat nausea and vomiting

Surgery

For some people, surgery on the stomach can slow vomiting and improve quality of life. The type of surgery depends on how severe the gastroparesis is, but it may include:

• Gastrostomy: A provider places a tube from the stomach to the outside of the body. This allows gasses and extra fluids to escape.

• Gastrojejunostomy: A surgeon connects the stomach to the jejunum, a lower part of the bowel. The goal is to allow food to empty faster.

• Pyloroplasty: This surgery makes the opening from the stomach to the intestine wider so that food can empty more easily.

• Gastrectomy: A surgeon removes a portion of the stomach or all of the stomach.

• Feeding tube placement: A provider places a tube in the intestines to bypass the stomach and deliver food in liquid form. 

Other treatments

There are other treatments that may help to treat gastroparesis. This might include:

• Gastric electrical stimulation (an electronic device stimulates the stomach to contract) 

• Acupuncture

• Better blood sugar control in people with diabetes

• Medication changes (medications you take may cause gastroparesis)

How can you lower your risk of gastroparesis?

If you have diabetes, you can lower your risk of gastroparesis by keeping excellent control of your blood sugars. Avoiding medications that can cause gastroparesis is another way to lower the risk. But close to 40% of cases of gastroparesis have no identifiable cause.

What are complications of gastroparesis?

Gastroparesis can lead to a decreased quality of life if symptoms are severe. Some complications of the condition include:

• Small intestine bacterial overgrowth (too much bacteria grows in the small bowel)

• Malnutrition  

• Dehydration 

• Low potassium levels

• Hypoglycemia (low blood sugar)

• Bezoar (food that stays in the stomach can form a hard ball and need surgical removal)

• Aspiration (when food from the stomach comes up and enters the windpipe) 

Why trust our experts?

Written by:

Frank Schwalbe, MD

Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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