Impaired Gastric Emptying

gastroparesis, delayed gastric emptying, stomach paralysis

• Stomach
• Small intestine
• Esophagus
• Pyloric valve

Impaired gastric emptying, also known as gastroparesis, is a condition where the stomach takes much longer than normal to move food into the small intestine, even though there is no physical blockage preventing this movement.

Table of contents

• What Is Impaired Gastric Emptying?
• What Causes This Condition?
• Signs and Symptoms
• How Is It Diagnosed?
• Treatment Options
• Possible Complications
• Living With Impaired Gastric Emptying

What Is Impaired Gastric Emptying?

Impaired gastric emptying, commonly called gastroparesis, is a condition affecting the nerves and muscles in your stomach. The name literally means stomach (gastro) paralysis (paresis). It’s a long-term disorder where the stomach doesn’t move food through to the small intestine as it should for proper digestion.^[1]

When you eat, food enters your stomach where enzymes and acid begin breaking it down. Normally, strong muscle contractions called peristaltic waves push the food toward the pyloric valve, which leads to the upper part of the small intestine. After a meal, it usually takes around four hours for 90 percent of the food to move out of your stomach and into your small intestine.^[6]

With impaired gastric emptying, the stomach’s movement, called motility, slows down or doesn’t work at all. This happens because the muscles contract more weakly and slowly than they need to, or because the nerves that control these muscles aren’t working correctly. As a result, food sits in your stomach for much longer than normal.^[1][2]

The condition can affect people of any age, but it is more common in females than in males. It’s also more common among people with type 1 and type 2 diabetes. The number of people diagnosed is about 14 per 100,000 people in the United Kingdom, which makes it a rare condition.^[10][12]

What Causes This Condition?

The most common single cause of impaired gastric emptying is diabetes. Around one-third of cases are related to diabetes, particularly when blood sugar levels are difficult to manage over time. High blood sugar can damage the nerves in the stomach, including the vagus nerve, which controls stomach muscle activity.^[2][10]

However, the most frequent category overall is idiopathic gastroparesis, which means that doctors cannot identify a specific cause. Between a quarter and half of all cases fall into this category.^[2][3]

Other known causes of impaired gastric emptying include:^[3][10][12]

• Surgery on the stomach, esophagus, pancreas, or lungs that may damage the vagus nerve
• Viral infections, including norovirus and rotavirus
• Certain medications, such as opioid pain relievers, some antidepressants, and medicines for high blood pressure, weight loss, and allergies
• Neurological disorders like Parkinson’s disease and multiple sclerosis
• Autoimmune conditions, such as autoimmune gastrointestinal dysmotility (AGID), where the immune system damages the nerves that control stomach muscles
• Other conditions including amyloidosis and scleroderma

In children, idiopathic gastroparesis is the most common cause, affecting 7 out of 10 children with the condition. Medication is the second most common cause in children, affecting about 9 out of every 50 children with gastroparesis.^[12]

Signs and Symptoms

People with impaired gastric emptying experience a range of uncomfortable symptoms related to digestion. The most common symptoms include:^[1][2][10]

• Nausea and vomiting, which may include vomiting undigested food
• Feeling full very quickly after eating just a few bites
• Feeling full for a long time after finishing a meal
• Belly bloating
• Upper abdominal pain
• Belching
• Heartburn and acid reflux
• Loss of appetite
• Unexplained weight loss

When stomach muscles aren’t working right, food sits in your stomach for a long time after you eat. You may feel full almost immediately and for hours after eating. Your stomach may feel bloated or stretched. Because the stomach doesn’t empty properly, stomach acid can backwash into your esophagus (the tube connecting your throat to your stomach), causing heartburn.^[2]

Impaired gastric emptying also slows down your whole digestive process, which can delay bowel movements and sometimes cause constipation. The condition can also deliver large, undigested pieces of food to your intestines, which are more difficult to pass through.^[2]

How much pain people feel doesn’t always match how severe their impaired gastric emptying is, or how slowly their stomach empties. Some people may feel more pain because their nerves are more sensitive, which may be related to the cause of their condition.^[2]

How Is It Diagnosed?

To diagnose impaired gastric emptying, your doctor will review your medical history, perform a physical exam, and order diagnostic tests. During the physical exam, your doctor will closely examine your abdomen and look for signs of malnutrition (not getting enough nutrients from food) and dehydration (not having enough fluid in your body).^[10]

Several tests help diagnose impaired gastric emptying and rule out other conditions. The main tests include:^[6][7]

Gastric emptying study (also called gastric emptying scan or scintigraphy): This is the gold standard test for diagnosis. You will eat a light meal, such as eggs and toast, that contains a small, harmless amount of radioactive material called a tracer. After you finish eating, a scanner takes images of your abdomen. The radiologist watches the movements of the radioactive tracer on a monitor to see how food travels through your stomach. Additional images are taken over the next few hours, usually at 1, 2, and 4 hours after the first image. This test takes about four hours total.^[7]

Breath tests: For these tests, you consume a solid or liquid food that has a substance your body absorbs. Over time, the substance shows up in your breath. Your healthcare team collects samples of your breath over a few hours to measure the amount of the substance. The amount of substance in your breath shows how fast your stomach empties.^[7]

Upper gastrointestinal (GI) endoscopy: This procedure uses a tiny camera on the end of a long, flexible tube to see inside your esophagus, stomach, and the beginning of the small intestine. This test can diagnose other conditions that can have symptoms similar to impaired gastric emptying, such as peptic ulcer disease.^[7]

Ultrasound: This test uses high-frequency sound waves to make images of structures within the body. It can help determine whether problems with the gallbladder or kidneys could be causing symptoms.^[7]

Treatment Options

There is no cure for impaired gastric emptying, but various treatments can help relieve symptoms and improve quality of life. How doctors treat the condition depends on the cause, how severe your symptoms are, and how well you respond to different treatments.^[1][9]

Treating the Underlying Cause

Sometimes, treating the cause may stop gastroparesis. If diabetes is causing your condition, your healthcare professional will work with you to help control your blood sugar levels. High blood sugar can further delay the emptying of food from your stomach, so keeping blood sugar stable is critical.^[9]

If medications are causing slow stomach emptying, and it’s safe to do so, your doctor may adjust or stop those medications.^[16]

Dietary Changes

Changing your eating habits is one of the most important ways to control impaired gastric emptying and make sure you get the right amount of nutrients, calories, and liquids. Your doctor may recommend that you:^[9][13]

• Eat five or six small, nutritious meals a day instead of two or three large meals
• Eat foods low in fat and fiber, as these can slow digestion further
• Chew your food thoroughly
• Eat soft, well-cooked foods
• Avoid carbonated (fizzy) beverages
• Avoid alcohol
• Drink plenty of water or liquids that contain glucose and electrolytes, such as low-fat broths, clear soups, naturally sweetened low-fiber fruit juices, sports drinks, or oral rehydration solutions
• Do some gentle physical activity after a meal, such as taking a walk
• Avoid lying down for 2 hours after a meal
• Take a multivitamin each day

If your symptoms are moderate to severe, your doctor may recommend drinking only liquids or eating well-cooked solid foods that have been processed into very small pieces or paste in a blender. Incorporating softer foods and smoothies can make digestion easier and provide many nutrients in one meal.^[9][13]

Medications

Your doctor may prescribe medicines that help the muscles in the wall of your stomach work better. These are called prokinetic agents. Your doctor may also prescribe medicines to control nausea and vomiting and reduce pain.^[9]

If you have diabetes and impaired gastric emptying, you may need to adjust your insulin regimen. Your doctor may recommend taking insulin more often, changing the type of insulin you take, taking insulin after meals instead of before, or checking your blood sugar levels more frequently after eating.^[9]

Advanced Treatments

When dietary changes and medications don’t provide enough relief, more advanced treatments may be considered. These can include procedures to help your stomach empty or, in severe cases, nutritional support through feeding tubes. Your doctor will discuss these options with you if they become necessary.^[9]

Possible Complications

People with impaired gastric emptying can experience uncomfortable symptoms during digestion, and they can also have longer-lasting side effects. They might have low appetite and trouble meeting their nutritional needs, or trouble controlling their blood sugar levels if they have diabetes.^[2]

When food stays in the stomach for too long, it may not pass completely and may leave some behind. This can develop into a hardened, solid mass called a bezoar. A bezoar may lead to a dangerous blockage that prevents food from passing into your small intestine.^[2][6]

In severe cases, impaired gastric emptying can result in difficulty absorbing essential nutrients from foods and key ingredients from medications, as well as dehydration. These complications underscore the importance of proper management and treatment.^[10]

Living With Impaired Gastric Emptying

Living with impaired gastric emptying requires careful management of your diet and symptoms. Many people find it helpful to work with a dietitian who can develop a personalized low-fat, low-fiber eating plan that minimizes symptoms. The best approach is typically to eat six to seven small meals each day rather than three large ones.^[16][20]

Keeping track of what foods work well for you and which ones cause problems can be very helpful. You may need to become something of an active researcher, taking notes on what does or doesn’t help you feel more comfortable. Planning ahead for meals and snacks can help ensure you have the foods that work for you available.^[19][20]

Stress can sometimes make stomach issues worse, so practicing relaxation techniques like deep breathing, meditation, and yoga can help. Gentle movement like walking and stretching can lower stress, but also helps improve stomach movement and digestion. Getting enough sleep (aiming for 7 to 9 hours) can also help lower stress and improve your nutritional habits.^[13][20]

While there is no cure for impaired gastric emptying, and the nerve damage can sometimes be permanent, many people are able to manage their symptoms and maintain a good quality of life through careful management of their diet and working closely with their healthcare team.^[16]