In gastroparesis the stomach empties too slowly even though nothing is blocking it. Diabetes is the most common known cause, along with viral illness, prior surgery and drugs such as opioids and GLP-1 agonists.
Key symptoms
- Nausea and vomiting of food eaten hours earlier
- Feeling full after only a few bites
- Bloating and upper belly discomfort
- Weight loss and poor appetite
- Swinging blood sugar in people with diabetes
What you find on exam
- Signs of dehydration: dry mouth, fast pulse, low pressure on standing
- Upper belly distension; a succussion splash may be heard
- Weight and nutrition status
- Signs of diabetic nerve damage, such as reduced foot sensation
Tests
- Upper endoscopy first to rule out blockage or ulcer
- Gastric emptying scintigraphy over 4 hours to confirm slow emptying
- Glucose and HbA1c, electrolytes, kidney function
- Review medicines that slow the stomach, such as opioids and GLP-1 agonists
Treatment basics
- Small, frequent, low-fat and low-fiber meals; liquid calories if needed
- Tight blood sugar control
- Metoclopramide for short periods; watch for movement side effects
- Antiemetics such as ondansetron; stop opioids when possible
- Severe cases: feeding tube into the small bowel or gastric electrical stimulation
Red flags
- Unable to keep any fluids down, with signs of dehydration
- Ongoing weight loss or malnutrition
- Vomiting with severe pain or a hard belly (possible obstruction)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.