08/08/2026
✅Gastroparesis – Quick Clinical Summary:
■Gastroparesis is delayed gastric emptying without mechanical gastric outlet obstruction, resulting from impaired gastric motility.
■Common Causes:
●Diabetes mellitus (most common)
●Idiopathic (often post-viral)
●Post-surgical (vagal nerve injury)
●Medications:
□Opioids
□GLP-1 receptor agonists (e.g., semaglutide)
□Anticholinergics
●Neurological disorders (Parkinson's disease)
●Connective tissue diseases (e.g., scleroderma)
■Symptoms
●Nausea and vomiting
●Early satiety
●Postprandial fullness
●Bloating
●Upper abdominal pain
●Weight loss
●Poor glycemic control in diabetic patients
■Diagnosis
Exclude mechanical obstruction:
●Upper GI endoscopy
●CT scan if indicated
●Confirm delayed gastric emptying:
□Gastric emptying scintigraphy (4-hour study) – Gold standard
●13C gastric emptying breath
test (alternative)
●Wireless motility capsule (selected cases)
■Management
●Lifestyle and Diet
□Small, frequent meals (4–6/day)
□Low-fat, low-fiber diet
□Prefer soft or liquid meals
□Maintain hydration
□Optimize blood glucose (especially in diabetes)
●Medical Treatment
□Prokinetics (first-line)
□Metoclopramide 5–10 mg before meals and at bedtime (limit long-term use due to risk of tardive dyskinesia)
●Domperidone (where available; monitor QT interval)
●Erythromycin (short-term use due to tachyphylaxis)
●Antiemetics
□Ondansetron
□Prochlorperazine
□Promethazine (selected patients)
■Refractory Cases
●Gastric peroral endoscopic myotomy (G-POEM)
●Gastric electrical stimulation (selected patients)
●Jejunal feeding tube if severe malnutrition
●Surgical options (rare)
Important Points
Optimize diabetes control.
Review and discontinue medications that delay gastric emptying if
possible.
Correct dehydration and electrolyte abnormalities.
Assess nutritional status and involve a dietitian when needed.
■Key guideline:
The 2022 American College of Gastroenterology (ACG) guideline recommends confirming delayed gastric emptying with objective testing and using dietary modification plus prokinetic therapy as the mainstay of treatment, with G-POEM considered for carefully selected patients with refractory disease.
Dr .Najeeb Ullah Shirzad.
Internal Medicine specialist Fellowship of Gastroenterology & Endoscopy
