Gastroparesis

Overview

Gastroparesis is defined in the 2022 American College of Gastroenterology (ACG) guideline as symptoms suggesting retention of food in the stomach, with objective evidence of delayed gastric emptying of solid food, in the absence of mechanical obstruction of the gastric outflow. The guideline lists the chronic symptoms as postprandial fullness, nausea, vomiting and upper abdominal pain, often worse after eating (PubMed PMID: 35926490).

The term comes from the Greek gastro (stomach) and paresis (partial paralysis). Unlike pyloric stenosis or gastric outlet obstruction — where a physical blockage prevents emptying — gastroparesis is a functional disorder: the ACG guideline requires mechanical obstruction to be excluded by upper endoscopy or radiology before the diagnosis is made.

How common it is depends on how strictly it is defined. In Olmsted County, Minnesota, the age-adjusted prevalence of definite gastroparesis (delayed emptying on scintigraphy plus typical symptoms for more than 3 months) on 1 January 2007 was 37.8 per 100,000 women and 9.6 per 100,000 men, and incidence over 1996–2006 was 9.8 per 100,000 person-years in women versus 2.4 in men; overall survival was lower than expected for the population (PubMed PMID: 19249393). A large US insurance-claims analysis found a standardized prevalence of 267.7 per 100,000 adults for any coded gastroparesis, but 21.5 per 100,000 for "definite" gastroparesis diagnosed within 3 months of a scintigraphy test (PubMed PMID: 34624355). The ACG guideline notes increased hospitalizations, morbidity and mortality in people with gastroparesis.

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Causes and Risk Factors

Gastroparesis is classified by cause. In the US claims analysis, diabetes was the most frequently documented cause (57.4% of patients; type 1, 5.7%, type 2, 51.7%) (PubMed PMID: 34624355). In an older referral-centre series of 146 patients, the causes were 36% idiopathic, 29% diabetic, 13% after gastric surgery, 7.5% Parkinson's disease, 4.8% collagen vascular disorders, 4.1% intestinal pseudo-obstruction and 6% other; 82% of the patients were women (PubMed PMID: 9824125).

Diabetic Gastroparesis

• Acute hyperglycemia delays gastric emptying in people with diabetes, and in the long-term DCCT/EDIC type 1 diabetes cohorts delayed gastric emptying was associated with gastrointestinal symptoms and with measures of early and long-term hyperglycemia (as summarized in the ACG guideline, PubMed PMID: 35926490)
• The ACG guideline suggests optimal glucose control to reduce the future risk of worsening gastroparesis (conditional recommendation, low-quality evidence); it also notes one study in which 6 months of intensive therapy lowered HbA1c without changing gastric emptying half-time
• The scintigraphy consensus notes that some data suggest even modest hyperglycemia (≥144 mg/dL) slows gastric emptying, but that it is not clear what level produces clinically significant delay (PubMed PMID: 18028513)

Idiopathic Gastroparesis

• No identifiable systemic cause
• In the referral series above, 23% of idiopathic patients had a presentation consistent with a viral cause and 48% had very prominent abdominal pain (PubMed PMID: 9824125)
• The ACG guideline notes increasing attention to the possibility that gastroparesis and functional dyspepsia lie on one spectrum: on repeat scintigraphy, 42% of patients first diagnosed with gastroparesis and 37% of those diagnosed with functional dyspepsia were reclassified

Post-Surgical Gastroparesis

• A 2015 review notes that many operations originally associated with gastroparesis are performed less often today, while several more recent upper-abdominal procedures can be complicated by it (PubMed PMID: 25667024)
• In the referral series, 13% of cases followed gastric surgery

Neurological and Connective Tissue Causes

• The same review describes gastroparesis in neurological disorders ranging from Parkinson's disease to muscular dystrophy, and in several connective tissue disorders, with scleroderma the one most often linked to gut motility disorder (PubMed PMID: 25667024)

Medications

• Opioids — the ACG guideline states that opioids slow gastric emptying and affect pyloric function, that potent opioids were associated with worse gastroparesis, and that it recommends against treating gastroparesis pain with opioids, including tramadol and tapentadol
• Other drugs that alter emptying — before a gastric emptying test, the guideline describes the customary 48-hour stop of opioids, cannabinoids, prokinetics, antiemetics and neuromodulators because they can affect the result
• GLP-1 receptor agonists — in a randomized placebo-controlled trial in adults with obesity, liraglutide 3.0 mg delayed gastric emptying of solids, and nausea was the most common adverse event (12 of 19 on liraglutide vs 4 of 21 on placebo) (PubMed PMID: 28958851); in a 12-week trial in 20 women with polycystic ovary syndrome and obesity, semaglutide 1.0 mg weekly left 37% of a solid meal in the stomach at 4 hours, compared with no retention on placebo (PubMed PMID: 36511825)

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Pathophysiology: Interstitial Cells of Cajal and Vagal Neuropathy

Biopsy and electrical-mapping studies point to changes in the stomach's nerves, immune cells, connective tissue and interstitial cells of Cajal (ICC). The ACG guideline summarizes high-resolution electrical-mapping studies that found abnormal slow-wave initiation and conduction in gastroparesis and chronic unexplained nausea and vomiting, often at normal frequency, and a study in which patients whose biopsies showed more depleted ICC had significantly more tachygastria and higher symptom scores; it states that the clinical meaning of these measurements is not yet clear.

What Biopsies Show

• In full-thickness gastric body biopsies from 40 patients (20 diabetic) in the NIDDK Gastroparesis Clinical Research Consortium, histologic abnormalities were found in 83% (PubMed PMID: 21300066)
• The most common defects were loss of ICC (with injury to the remaining ICC), an abnormal immune infiltrate containing macrophages (increased CD45 and CD68 staining), and fewer nerve fibers
• Diabetic and idiopathic cases looked similar on light microscopy except for neuronal nitric oxide synthase (nNOS, the enzyme behind nitric-oxide-mediated relaxation), whose expression was decreased in more idiopathic (40%) than diabetic (20%) patients
• On electron microscopy, connective tissue stroma was markedly increased in both forms
• The ACG guideline, like the European consensus, reserves full-thickness biopsy for research rather than routine diagnosis

Vagal Neuropathy

• A referral-centre series found a poorer response to prokinetic drugs after gastric surgery, in connective tissue disease, and in a subgroup of people with diabetes (PubMed PMID: 9824125); the ACG guideline, quoting this work, names post-vagotomy patients and diabetics with evidence of vagal neuropathy among the poorer responders

Gastric Accommodation and Satiety

• A review of gastric motility and food intake describes gastric distension and accommodation as regulating satiation during a meal, with gastric emptying and the arrival of nutrients in the intestine taking over afterward (PubMed PMID: 21342212)

The Pylorus

• The ACG guideline reports that pyloric diameter and distensibility measurements are associated with greater gastric retention and may predict response to pyloric treatment, rating the evidence very low

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Symptoms and Complications

Cardinal Symptoms

• Nausea — in 159 patients in the NIDDK Gastroparesis Registry, 96% had nausea; it was the predominant symptom in 28%, severe or very severe in 41%, and related to meals in 71%; increasing nausea severity was related to lower quality of life (PubMed PMID: 27350152)
• Vomiting — present in 65% of the same registry patients and more common in diabetic (81%) than idiopathic (57%) gastroparesis; diabetic patients more often vomited in the morning before eating, at night, and when not eating
• Early satiety and postprandial fullness, bloating and upper abdominal pain — listed by the ACG guideline among the chronic symptoms

Severity Assessment

The Gastroparesis Cardinal Symptom Index (GCSI) is a patient-reported measure with three subscales — postprandial fullness/early satiety, nausea/vomiting, and bloating. In its validation study in 169 patients, internal consistency reliability was 0.84, test-retest reliability 0.76, and scores responded to change in symptoms rated by clinicians and patients (PubMed PMID: 12848636). Trials on this page, such as the G-POEM sham-controlled trial, use the GCSI as their primary outcome.

Complications and Course

• Nutrition — in the 146-patient referral series, 21% needed nutrition support with a feeding jejunostomy or periods of parenteral nutrition at some point; at follow-up 74% needed continuous prokinetic therapy, 5% had undergone gastrectomy and 7% had died (PubMed PMID: 9824125)
• Eating-disorder symptoms — the ACG guideline notes that avoidant/restrictive food intake disorder symptoms are frequent in patients with gastroparesis
• Healthcare burden — the guideline describes increased hospitalizations and associated economic costs
• Other gut regions — on wireless motility capsule testing, transit delays beyond the stomach were found in 45.6% of patients with suspected gastroparesis (as summarized in the ACG guideline)

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Diagnosis: Gastric Emptying Scintigraphy

The diagnosis requires objectively delayed gastric emptying after mechanical obstruction has been excluded by upper endoscopy or radiology (PubMed PMID: 35926490).

Gastric Emptying Scintigraphy — the Standard Test

• The ACG guideline calls scintigraphy the standard test and suggests measuring emptying of a solid meal over 3 hours or longer (strong recommendation, moderate-quality evidence), ideally up to 4 hours unless more than 90% of the meal has emptied at 3 hours
• The 2008 consensus protocol of two US societies uses a radiolabeled, low-fat egg-white meal (255 kcal, 2% fat) with imaging at 0, 1, 2 and 4 hours (PubMed PMID: 18028513)
• Upper limits of normal in that protocol: more than 90% retained at 1 hour, more than 60% at 2 hours, or more than 10% at 4 hours indicates delayed emptying
• The consensus grades the 4-hour value as mild (11–20% retained), moderate (21–35%), severe (36–50%) and very severe (>50%), and notes that a 4-hour study detected more abnormal emptying than a 2-hour study
• For people with diabetes, the consensus records blood glucose before the test and describes rescheduling or lowering glucose if it is above 275 mg/dL that morning
• The ACG guideline notes that the 10%-at-4-hours cut-off, based on this low-calorie, low-fat meal, may contribute to the overlap between gastroparesis and functional dyspepsia

Wireless Motility Capsule

• An ingestible capsule that records pH and pressure as it passes through the gut; the ACG guideline suggests it as an alternative to scintigraphy (conditional recommendation, low-quality evidence)
• Agreement with scintigraphy was 75.7% (kappa 0.42); the capsule found delayed emptying more often than scintigraphy in people without diabetes and less often in people with diabetes
• It also measures small-bowel and colonic transit and pressure activity

Stable Isotope Breath Test

• The ACG guideline calls the ¹³C-spirulina gastric emptying breath test reliable (conditional recommendation, low-quality evidence); it has been validated against simultaneous scintigraphy in patients and healthy controls
• In one validation study of 38 healthy volunteers and 129 patients, at 80% specificity, the 150- and 180-minute samples combined were 89% sensitive for delayed emptying

Tests the Guideline Does Not Support for Diagnosis

• Radiopaque markers — not suggested (conditional recommendation, very low-quality evidence)
• Retained food at endoscopy — in a study of 2,991 patients who also had scintigraphy, the positive predictive value of retained food for delayed emptying was 55% overall (32% without risk factors, 79% in type 1 diabetes), so the guideline states it is not diagnostic on its own

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Diet and Nutrition: What the Trials Found

Small-Particle Diet Trial

• In a randomized controlled trial, 56 people with insulin-treated diabetes and gastroparesis received dietitian advice on 7 occasions over 20 weeks, on either a small-particle-size diet or the standard diabetes diet (PubMed PMID: 24419482)
• The small-particle group had significantly greater reductions in nausea/vomiting, postprandial fullness, bloating and regurgitation/heartburn, but not abdominal pain; anxiety fell, while depression and quality of life did not change in either group
• Fat intake was higher in the small-particle group; body weight, HbA1c and other nutrient intake did not differ
• On this evidence the ACG guideline recommends a small-particle diet as part of dietary management (conditional recommendation, low-quality evidence)

What a Systematic Review Reported

• The ACG guideline summarizes a systematic review of 15 studies (524 subjects) in which small-particle, low-fat diets were better tolerated than the converse, and jejunal feeding before oral food improved oral intake and motility
• In more advanced cases, gastrostomy with jejunal extension had fewer reported symptoms than other enteral routes; exclusive long-term parenteral nutrition had a 68% survival rate at 15 years, and oral intake plus parenteral nutrition was associated with higher survival

Enteral and Parenteral Nutrition

• The 2022 ACG guideline, summarizing its 2013 predecessor, describes enteral nutrition by jejunostomy tube when oral intake is not adequate, and parenteral nutrition only rarely (PubMed PMID: 23147521; PubMed PMID: 35926490)
• Venting gastrostomy and feeding jejunostomy are listed among second-line approaches

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Medications and Prokinetics

The ACG guideline suggests considering drug treatment in idiopathic and diabetic gastroparesis to improve gastric emptying and symptoms, weighing benefits and risks (conditional recommendation, low-quality evidence). Prokinetics have the most clinical trials; antiemetics may control symptoms but do not improve gastric emptying (PubMed PMID: 35926490).

Metoclopramide — the Only FDA-Approved Drug for Gastroparesis

• The US label states that metoclopramide stimulates upper gastrointestinal motility, increasing antral contractions, relaxing the pyloric sphincter and duodenal bulb, and accelerating gastric emptying; its antiemetic effect appears to come from blocking central and peripheral dopamine receptors (FDA label, DailyMed)
• Labeled regimen for diabetic gastroparesis: 10 mg 30 minutes before each meal and at bedtime for two to eight weeks; total therapy is not to exceed 12 weeks
• Boxed warning — tardive dyskinesia: the label states that metoclopramide can cause tardive dyskinesia, a serious and often irreversible movement disorder (most often involuntary movements of the tongue, face, mouth or jaw), that risk rises with duration and cumulative dose, that there is no known treatment, and that use beyond 12 weeks is to be avoided except in rare cases
• The label reports restlessness, drowsiness, fatigue and lassitude in about 10% of patients on 10 mg four times daily, and acute dystonic reactions in about 0.2% on 30–40 mg per day
• The ACG guideline suggests metoclopramide over no treatment for refractory symptoms (conditional, low-quality evidence) and cites estimates that the tardive dyskinesia risk is below 1%, while naming elderly women, people with diabetes, liver or kidney failure, and concurrent antipsychotic use as higher-risk groups

Domperidone

• The ACG guideline suggests domperidone where it is approved (conditional, low-quality evidence); in a consortium database, patients receiving it had moderately but significantly greater improvement in GCSI and quality-of-life scores than those not receiving it
• The FDA states that domperidone is not approved for sale in the US, is available only through an expanded-access program, and carries serious risks including cardiac arrhythmias, cardiac arrest and sudden death, related to blood levels (FDA: domperidone expanded access)

Erythromycin and Other Motilin Agonists

• Erythromycin, clarithromycin and azithromycin are used in gastroparesis, generally for 1–4 weeks because of tachyphylaxis (loss of effect with continued use), as the ACG guideline summarizes
• A network meta-analysis quoted in the guideline found macrolide use was not associated with arrhythmia or cardiovascular mortality

5-HT4 Agonists

• The ACG guideline suggests 5-HT4 agonists over no treatment to improve gastric emptying (conditional, low-quality evidence), noting inconsistent data for symptom improvement; prucalopride, felcisetrag and velusetrag are listed among agents in development for gastroparesis

Antiemetics and Central Neuromodulators

• Antiemetics are suggested for symptom control, but do not improve gastric emptying (conditional, low-quality evidence)
• Central neuromodulators are not recommended (strong recommendation, moderate-quality evidence); in the best-quality trial, nortriptyline was no better than placebo for global gastroparesis symptoms in idiopathic gastroparesis, though some improvement in abdominal pain was noted
• The guideline states that current data do not support ghrelin agonists or haloperidol for gastroparesis, and that herbal combination products it reviewed are not recommended

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Procedures and Advanced Therapies

Gastric Electrical Stimulation

• An implanted neurostimulator delivers high-frequency, low-energy pulses through electrodes in the muscle wall of the antrum, connected to a device in an abdominal-wall pocket
• In a 33-patient trial (17 diabetic, 16 idiopathic) with a 1-month double-blind ON/OFF crossover, vomiting frequency was significantly lower with stimulation ON; at 6 and 12 months unblinded, symptoms and quality of life improved, gastric emptying was only modestly accelerated, and 5 patients had the system removed or revised for infection or other complications (PubMed PMID: 12891544)
• In a larger randomized double-blind crossover trial in 172 patients with refractory vomiting (133 with gastroparesis), vomiting scores were better with the device ON in diabetic and non-diabetic patients, but gastric emptying was not accelerated and quality of life did not improve (PubMed PMID: 31647902)
• The device is FDA-approved as a humanitarian use device for medically refractory diabetic or idiopathic gastroparesis; the ACG guideline says it may be considered on that basis (conditional, low-quality evidence) and describes the crossover trials as mixed

Intrapyloric Botulinum Toxin Injection

• Endoscopic injection of botulinum toxin A into the pyloric sphincter, intended to reduce outflow resistance
• In a randomized, double-blind crossover trial of 23 mostly idiopathic patients, botulinum toxin was not superior to saline for symptoms or gastric emptying; both groups improved after the first injection (PubMed PMID: 17944739)
• In a 32-patient randomized placebo-controlled trial, 37.5% on botulinum toxin and 56.3% on placebo improved at 1 month; gastric emptying improved with the toxin but not more than with placebo (PubMed PMID: 18070232)
• On these trials the ACG guideline recommends against intrapyloric botulinum toxin (strong recommendation, moderate-quality evidence), while noting a large French multicenter study reporting benefit, particularly for vomiting, when patients were selected by pyloric distensibility measurement

Gastric Peroral Endoscopic Pyloromyotomy (G-POEM)

• An endoscopic procedure, built on the same principles as esophageal POEM, in which the pyloric muscle is cut endoscopically (pyloromyotomy); the ACG guideline reports symptom control comparable to surgical myotomy, with fewer complications and shorter hospital stays
• In the first multicenter series (30 refractory patients), the procedure was completed in all; clinical response was seen in 26 (86%) over a median 5.5 months, and repeat emptying scans normalized in 8 of 17 and improved in 6; 2 adverse events occurred (PubMed PMID: 27354102)
• In a randomized sham-controlled trial of 41 patients with severe gastroparesis, treatment success (GCSI fall of at least 50% at 6 months) was 71% after G-POEM versus 22% after sham; 4-hour gastric retention fell from a median 22% to 12% after G-POEM and did not change after sham; enrolment stopped early after an interim analysis, and the authors called results in idiopathic and postsurgical cases not entirely conclusive (PubMed PMID: 35470243)
• The ACG guideline suggests pyloromyotomy over no treatment for symptoms refractory to medical therapy (conditional, low-quality evidence); it notes most open-label studies lasted only 3–6 months and that a 12-month study found 56% improved at 1 year

Surgical Pyloroplasty

• Heineke-Mikulicz pyloroplasty cuts the pylorus lengthwise and closes it crosswise, dividing both muscle layers
• In a retrospective review of 28 patients, mean gastric emptying half-time fell from 320 to 112 minutes and normalized in 71%; nausea, vomiting, bloating and abdominal pain scores improved at 1 and 3 months, and 83% reported improvement at 1 month (PubMed PMID: 21720926)
• In a single-institution series of 177 patients, gastric emptying improved in 86% and normalized in 77%; overall morbidity was 6.8%, including two confirmed leaks (PubMed PMID: 26293794)
• The ACG guideline states that partial gastrectomy and pyloroplasty are used rarely, in carefully selected patients, and have been largely replaced by G-POEM

Feeding and Venting Tubes

• Venting gastrostomy and feeding jejunostomy are listed by the ACG guideline among second-line approaches; a jejunostomy can be placed directly by percutaneous endoscopic jejunostomy
• Parenteral nutrition is described as used rarely, when enteral feeding is not adequate

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Key Research Papers

1. Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L. "Clinical guideline: management of gastroparesis." Am J Gastroenterol. 2013;108(1):18–37. — PubMed PMID: 23147521
2. Camilleri M, Kuo B, Nguyen L, et al. "ACG Clinical Guideline: Gastroparesis." Am J Gastroenterol. 2022;117(8):1197–1220. — PubMed PMID: 35926490 (Editorial note: replaces an entry, "Parkman HP, Gastroparesis: clinical presentation, diagnosis, and management, Clin Gastroenterol Hepatol 2016," that could not be found in PubMed or Crossref.)
3. Soykan I et al. "Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis." Dig Dis Sci. 1998;43(11):2398–2404. — PubMed PMID: 9824125
4. Grover M, Farrugia G, Lurken MS, et al. "Cellular changes in diabetic and idiopathic gastroparesis." Gastroenterology. 2011;140(5):1575–1585.e8. — PubMed PMID: 21300066 (Editorial note: replaces "Grover M, Diabetic and idiopathic gastroparesis, Curr Gastroenterol Rep 2011," which could not be found.)
5. Revicki DA, Rentz AM, Dubois D, et al. "Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index." Aliment Pharmacol Ther. 2003;18(1):141–150. — PubMed PMID: 12848636
6. Abell T, McCallum R, Hocking M, et al. "Gastric electrical stimulation for medically refractory gastroparesis." Gastroenterology. 2003;125(2):421–428. — PubMed PMID: 12891544 (Editorial note: previously listed as JAMA 2003;289(2):178–186; title and journal corrected.)
7. Arts J, Holvoet L, Caenepeel P, et al. "Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis." Aliment Pharmacol Ther. 2007;26(9):1251–1258. — PubMed PMID: 17944739
8. Khashab MA, Ngamruengphong S, Carr-Locke D, et al. "Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video)." Gastrointest Endosc. 2017;85(1):123–128. — PubMed PMID: 27354102 (Editorial note: replaces "Khashab MA, EUS-guided gastric peroral endoscopic myotomy … first U.S. clinical experience, Endoscopy 2015," which could not be found.)
9. Janssen P, Vanden Berghe P, Verschueren S, et al. "Review article: the role of gastric motility in the control of food intake." Aliment Pharmacol Ther. 2011;33(8):880–894. — PubMed PMID: 21342212
10. Jung HK, Choung RS, Locke GR 3rd, et al. "The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006." Gastroenterology. 2009;136(4):1225–1233. — PubMed PMID: 19249393 (Editorial note: replaces "Navas CM, Gastroparesis and related disorders, Gastroenterol Clin North Am 2014," which could not be found.)
11. Ducrotte P, Coffin B, Bonaz B, et al. "Gastric Electrical Stimulation Reduces Refractory Vomiting in a Randomized Crossover Trial." Gastroenterology. 2020;158(3):506–514.e2. — PubMed PMID: 31647902 (Editorial note: replaces "Friedenberg FK, The current state of gastric electrical stimulation …, Neurogastroenterol Motil 2006," which could not be found.)
12. Shada AL, Dunst CM, Pescarus R, et al. "Laparoscopic pyloroplasty is a safe and effective first-line surgical therapy for refractory gastroparesis." Surg Endosc. 2016;30(4):1326–1332. — PubMed PMID: 26293794 (Editorial note: replaces "Pasricha PJ, Surgical treatment of refractory gastroparesis using laparoscopic pyloroplasty, Gastroenterology 2014," which could not be found.)
13. Friedenberg FK, Palit A, Parkman HP, Hanlon A, Nelson DB. "Botulinum toxin A for the treatment of delayed gastric emptying." Am J Gastroenterol. 2008;103(2):416–423. — PubMed PMID: 18070232
14. Olausson EA, Störsrud S, Grundin H, et al. "A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial." Am J Gastroenterol. 2014;109(3):375–385. — PubMed PMID: 24419482
15. Martinek J, Hustak R, Mares J, et al. "Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomised, sham-controlled trial." Gut. 2022;71(11):2170–2178. — PubMed PMID: 35470243
16. Hibbard ML, Dunst CM, Swanström LL. "Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement." J Gastrointest Surg. 2011;15(9):1513–1519. — PubMed PMID: 21720926
17. Ye Y, Yin Y, Huh SY, et al. "Epidemiology, Etiology, and Treatment of Gastroparesis: Real-World Evidence From a Large US National Claims Database." Gastroenterology. 2022;162(1):109–121.e5. — PubMed PMID: 34624355
18. Parkman HP, Hallinan EK, Hasler WL, et al. "Nausea and vomiting in gastroparesis: similarities and differences in idiopathic and diabetic gastroparesis." Neurogastroenterol Motil. 2016;28(12):1902–1914. — PubMed PMID: 27350152
19. Abell TL, Camilleri M, Donohoe K, et al. "Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine." Am J Gastroenterol. 2008;103(3):753–763. — PubMed PMID: 18028513
20. Quigley EM. "Other forms of gastroparesis: postsurgical, Parkinson, other neurologic diseases, connective tissue disorders." Gastroenterol Clin North Am. 2015;44(1):69–81. — PubMed PMID: 25667024
21. Halawi H, Khemani D, Eckert D, et al. "Effects of liraglutide on weight, satiation, and gastric functions in obesity: a randomised, placebo-controlled pilot trial." Lancet Gastroenterol Hepatol. 2017;2(12):890–899. — PubMed PMID: 28958851
22. Jensterle M, Ferjan S, Ležaič L, et al. "Semaglutide delays 4-hour gastric emptying in women with polycystic ovary syndrome and obesity." Diabetes Obes Metab. 2023;25(4):975–984. — PubMed PMID: 36511825

PubMed Topic Searches

1. PubMed: Gastroparesis guidelines
2. PubMed: G-POEM randomized trials
3. PubMed: Gastric electrical stimulation trials
4. PubMed: Gastroparesis diet studies

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Connections

• Gastroenterology
• Nausea & Vomiting: The Body’s Eject Button — interactive animation
• Peristalsis: How Food Actually Moves Through You — interactive animation
• Functional Dyspepsia
• GERD
• Type 2 Diabetes
• Parkinson's Disease
• Vitamin B1 — Thiamine
• Magnesium
• Achalasia
• Ginger for Digestion & Gastroparesis

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