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Gastroparesis

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2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate

Persistent vomiting with dehydration, severe electrolyte disturbance, diabetic ketoacidosis, hypoglycaemia, haematemesis, faeculent vomit, sudden severe pain or suspected bezoar obstruction requires acute assessment. Check capillary glucose and ketones promptly in diabetes, give intravenous fluid and electrolyte replacement according to measured need, and exclude mechanical obstruction before any prokinetic. A distended food-filled stomach also creates substantial aspiration risk during sedation or anaesthesia, even after standard fasting.

Synopsis

Diagnose gastroparesis only after excluding mechanical obstruction, measure delayed gastric emptying with an appropriate test, restore nutrition and glycaemic stability, and use prokinetic or device treatment within current UK safety restrictions.

  • Gastroparesis is a symptom-compatible delay in gastric emptying without a mechanical blockage; symptoms alone and retained food at one endoscopy are insufficient for diagnosis.
  • Typical features are postprandial fullness, early satiety, nausea, vomiting, bloating and upper abdominal pain, but their severity correlates imperfectly with measured emptying delay.
  • Diabetes, vagal injury after upper-GI surgery, neurological or connective-tissue disease and medicines that slow motility are recognised causes; many cases remain idiopathic.

Key red flags

Diabetic instability

Longstanding diabetes with autonomic neuropathy, unpredictable post-meal glucose and recurrent early hypoglycaemia may reflect a mismatch between insulin action and delayed carbohydrate delivery. Check ketones during acute illness.

Investigation priorities

01
Upper-GI endoscopyFirst step

Exclude a mucosal, pyloric or duodenal mechanical cause and inspect retained contents.

Management branches

ConfirmSeparate delay from blockage

Chronic meal-related fullness, nausea or food vomiting raises suspicion of impaired gastric emptying.

  1. Take a detailed symptom, surgical, diabetes, eating-behaviour and medicine history, measure weight trajectory, hydration, glucose and electrolytes, and identify cancer or obstruction features.
  2. Exclude structural disease through endoscopy and appropriate imaging before arranging a standardised solid-meal gastric-emptying study under valid glucose and medicine conditions.

Key medicines

Metoclopramide for short-term nausea and vomitingThe adult licensed dose is 10 mg up to three times daily, maximum 30 mg or 0.5 mg/kg in 24 hours, for no longer than five days; gastroparesis use beyond the licence requires specialist governance.
Domperidone for short-term nausea and vomitingFor licensed adults and adolescents at least 12 years and 35 kg, use 10 mg up to three times daily, maximum 30 mg daily, usually for no longer than one week.
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Sources and review status5 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom