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.
- Review opioids, antimuscarinics and GLP-1 receptor agonists among other medicines, while avoiding abrupt withdrawal when the original indication or metabolic benefit is important.
- Upper-GI endoscopy or anatomical imaging excludes obstruction; standardised solid-meal gastric-emptying scintigraphy is the conventional objective test for delayed emptying.
- Dietetic treatment uses smaller, more frequent and easier-to-empty meals with texture, fat and fibre adapted to symptoms while protecting energy, protein and micronutrient intake.
- Metoclopramide, domperidone and erythromycin all have major duration, licensing, neurological, cardiac or interaction limitations, so chronic repeat prescribing without specialist review is unsafe.
- Severe refractory disease may require jejunal feeding, venting, pylorus-directed therapy or gastric electrical stimulation through a specialist motility and nutrition MDT.
Key red flags
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.
A palpable succussion splash, focal transition on imaging, severe distension, faeculent vomiting or inability to tolerate liquids argues for mechanical obstruction or bezoar and prohibits reflex prokinetic treatment.
Investigation priorities
Exclude a mucosal, pyloric or duodenal mechanical cause and inspect retained contents.
Management branches
Chronic meal-related fullness, nausea or food vomiting raises suspicion of impaired gastric emptying.
- Take a detailed symptom, surgical, diabetes, eating-behaviour and medicine history, measure weight trajectory, hydration, glucose and electrolytes, and identify cancer or obstruction features.
- Exclude structural disease through endoscopy and appropriate imaging before arranging a standardised solid-meal gastric-emptying study under valid glucose and medicine conditions.
- Only apply the gastroparesis label when compatible symptoms, objective delay and absence of mechanical obstruction converge; reconsider functional dyspepsia or another vomiting disorder when they do not.