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Gastroparesis: Recognizing and Managing a Commonly Missed Diagnosis

by SOFHA
Monday, Aug 25, 2025

By Andrew Garrett, MD, FACS

August is Gastroparesis Awareness Month, offering an important opportunity to revisit this frequently underdiagnosed condition that significantly impacts patients’ quality of life. Below is a concise clinical update to help guide frontline management and referral.

Etiology and Symptoms

Gastroparesis is defined as delayed gastric emptying without mechanical obstruction. Common causes include:

  • Diabetes mellitus
  • Post-surgical vagal nerve injury
  • Medications (opioids, anticholinergics)
  • Idiopathic (35% of cases)

Symptoms include early satiety, bloating, nausea, postprandial fullness, vomiting, and epigastric pain. These often overlap with functional GI disorders, delaying diagnosis.

Of increasing relevance, GLP-1 receptor agonists (e.g., semaglutide, liraglutide) used for diabetes and obesity have been associated with delayed gastric emptying and may exacerbate or mimic gastroparesis symptoms. There is growing evidence that a small portion of patients will not experience reversal of symptoms with cessation of the GLP-1 receptor agonist. Always review medication history in new cases of unexplained nausea or fullness.

Time to Diagnosis and Recommended Workup

Patients typically experience symptoms for over 5 years before receiving a definitive diagnosis.

  • The gold standard test is a solid-phase gastric emptying scintigraphy, which should be performed over 4 hours to increase diagnostic sensitivity
  • Mechanical obstruction must be excluded via upper endoscopy or upper GI series.
Medical Management
  • Dietary: Small, frequent, low-fat, low-fiber meals
  • Pharmacologic:
    • Metoclopramide (FDA-approved) but carries a black box warning. Use ideally limited to less than 3 months.
    • Erythromycin, domperidone (compounded) but subject to tachyphylaxis
    • Antiemetics as needed
  • Glycemic control is key in diabetic patients

Unfortunately, many patients either fail or cannot tolerate these treatments, prompting consideration for surgical options.

Surgical Management – When Medical Therapy Fails

Surgical interventions are reserved for refractory cases and are tailored based on symptom profile:

  • Gastric Pyloroplasty: This procedure improves gastric emptying by widening the pyloric outlet and is particularly helpful for pain, bloating, and fullness. Gastric per oral endoscopic myotomy has equivalent outcomes but not available in our area.
  • Gastric Electrical Stimulation (GES): GES reduces nausea and vomiting through low-energy impulses delivered by an implanted device. Gastric pacemaker insertion is now available at Franklin Woods Community Hospital for eligible patients.
  • Feeding Tubes: Considered a last resort. Options include:
    • Jejunostomy feeding tubes for nutrition
    • Gastrostomy tubes for gastric decompression
Takeaway for Primary Care Providers
  • Keep gastroparesis on your radar in patients with persistent nausea, fullness, or postprandial discomfort—especially diabetics and those on GLP-1 agonists.
  • Refer for gastric emptying scintigraphy (4-hour study) if symptoms persist despite conservative measures.
  • Consider early surgical referral for refractory or nutritionally compromised cases.

Timely diagnosis and individualized therapy can significantly improve quality of life and reduce hospitalizations for this often-misunderstood condition.

Posted in Health & Wellness