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Gastroparesis: Etiology, clinical manifestations, and diagnosis

Michael Camilleri, MD
Section Editor
Nicholas J Talley, MD, PhD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Normal gastrointestinal motor function is a complex series of events that requires coordination of the sympathetic and parasympathetic nervous systems, neurons and pacemaker cells (called interstitial cells of Cajal) within the stomach and intestine, and the smooth muscle cells of the gut. Abnormalities of this process can lead to a delay in gastric emptying (gastric stasis) [1].

This topic will review the etiology and diagnosis of gastroparesis. Our recommendations are largely consistent with guidelines by the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) [2,3]. The pathogenesis and treatment of gastroparesis are discussed separately. (See "Pathogenesis of delayed gastric emptying" and "Treatment of gastroparesis".)


Gastroparesis is a syndrome of objectively delayed gastric emptying in the absence of a mechanical obstruction and cardinal symptoms of nausea, vomiting, early satiety, bloating, and/or upper abdominal pain [3].


In one of the largest population-based studies that identified 3604 potential cases of gastroparesis of whom 83 fulfilled diagnostic criteria for definite gastroparesis, the age-adjusted incidence of gastroparesis was 2.4 per 100,000 person-years for men and 9.8 per 100,000 person-years for women [4]. The age-adjusted prevalence of definite gastroparesis was 9.6 per 100,000 persons for men and 38 per 100,000 persons for women. Overall survival was significantly lower than for the age- and sex-matched general population.


Although multiple conditions have been associated with gastroparesis, the majority of cases are idiopathic, diabetic, or postsurgical (figure 1).

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Literature review current through: Nov 2017. | This topic last updated: Jul 14, 2016.
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  1. Camilleri M. Clinical practice. Diabetic gastroparesis. N Engl J Med 2007; 356:820.
  2. Parkman HP, Hasler WL, Fisher RS, American Gastroenterological Association. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 2004; 127:1592.
  3. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol 2013; 108:18.
  4. 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; 136:1225.
  5. Soykan I, Sivri B, Sarosiek I, et al. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci 1998; 43:2398.
  6. Bytzer P, Talley NJ, Leemon M, et al. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med 2001; 161:1989.
  7. Janatuinen E, Pikkarainen P, Laakso M, Pyörälä K. Gastrointestinal symptoms in middle-aged diabetic patients. Scand J Gastroenterol 1993; 28:427.
  8. Enck P, Rathmann W, Spiekermann M, et al. Prevalence of gastrointestinal symptoms in diabetic patients and non-diabetic subjects. Z Gastroenterol 1994; 32:637.
  9. Maleki D, Locke GR 3rd, Camilleri M, et al. Gastrointestinal tract symptoms among persons with diabetes mellitus in the community. Arch Intern Med 2000; 160:2808.
  10. Jones KL, Russo A, Stevens JE, et al. Predictors of delayed gastric emptying in diabetes. Diabetes Care 2001; 24:1264.
  11. Kong MF, Horowitz M, Jones KL, et al. Natural history of diabetic gastroparesis. Diabetes Care 1999; 22:503.
  12. Horowitz M, Maddox AF, Wishart JM, et al. Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med 1991; 18:229.
  13. Choung RS, Locke GR 3rd, Schleck CD, et al. Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population. Am J Gastroenterol 2012; 107:82.
  14. Parkman HP, Yates K, Hasler WL, et al. Similarities and differences between diabetic and idiopathic gastroparesis. Clin Gastroenterol Hepatol 2011; 9:1056.
  15. Ordög T, Takayama I, Cheung WK, et al. Remodeling of networks of interstitial cells of Cajal in a murine model of diabetic gastroparesis. Diabetes 2000; 49:1731.
  16. Forster J, Damjanov I, Lin Z, et al. Absence of the interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings. J Gastrointest Surg 2005; 9:102.
  17. Vittal H, Farrugia G, Gomez G, Pasricha PJ. Mechanisms of disease: the pathological basis of gastroparesis--a review of experimental and clinical studies. Nat Clin Pract Gastroenterol Hepatol 2007; 4:336.
  18. Choi KM, Gibbons SJ, Nguyen TV, et al. Heme oxygenase-1 protects interstitial cells of Cajal from oxidative stress and reverses diabetic gastroparesis. Gastroenterology 2008; 135:2055.
  19. Choi KM, Kashyap PC, Dutta N, et al. CD206-positive M2 macrophages that express heme oxygenase-1 protect against diabetic gastroparesis in mice. Gastroenterology 2010; 138:2399.
  20. Gangula PR, Mukhopadhyay S, Ravella K, et al. Tetrahydrobiopterin (BH4), a cofactor for nNOS, restores gastric emptying and nNOS expression in female diabetic rats. Am J Physiol Gastrointest Liver Physiol 2010; 298:G692.
  21. Bharucha AE, Daley SL, Low PA, et al. Effects of hemin on heme oxygenase-1, gastric emptying, and symptoms in diabetic gastroparesis. Neurogastroenterol Motil 2016; 28:1731.
  22. Meeroff JC, Schreiber DS, Trier JS, Blacklow NR. Abnormal gastric motor function in viral gastroenteritis. Ann Intern Med 1980; 92:370.
  23. Sigurdsson L, Flores A, Putnam PE, et al. Postviral gastroparesis: presentation, treatment, and outcome. J Pediatr 1997; 131:751.
  24. Bityutskiy LP, Soykan I, McCallum RW. Viral gastroparesis: a subgroup of idiopathic gastroparesis--clinical characteristics and long-term outcomes. Am J Gastroenterol 1997; 92:1501.
  25. Naftali T, Yishai R, Zangen T, Levine A. Post-infectious gastroparesis: clinical and electerogastrographic aspects. J Gastroenterol Hepatol 2007; 22:1423.
  26. Oh JJ, Kim CH. Gastroparesis after a presumed viral illness: clinical and laboratory features and natural history. Mayo Clin Proc 1990; 65:636.
  27. Vassallo M, Camilleri M, Caron BL, Low PA. Gastrointestinal motor dysfunction in acquired selective cholinergic dysautonomia associated with infectious mononucleosis. Gastroenterology 1991; 100:252.
  28. Lobrano A, Blanchard K, Abell TL, et al. Postinfectious gastroparesis related to autonomic failure: a case report. Neurogastroenterol Motil 2006; 18:162.
  29. Jeong ID, Camilleri M, Shin A, et al. A randomised, placebo-controlled trial comparing the effects of tapentadol and oxycodone on gastrointestinal and colonic transit in healthy humans. Aliment Pharmacol Ther 2012; 35:1088.
  30. Bouras EP, Talley NJ, Camilleri M, et al. Effects of amitriptyline on gastric sensorimotor function and postprandial symptoms in healthy individuals: a randomized, double-blind, placebo-controlled trial. Am J Gastroenterol 2008; 103:2043.
  31. Foxx-Orenstein A, Camilleri M, Stephens D, Burton D. Effect of a somatostatin analogue on gastric motor and sensory functions in healthy humans. Gut 2003; 52:1555.
  32. Linnebjerg H, Park S, Kothare PA, et al. Effect of exenatide on gastric emptying and relationship to postprandial glycemia in type 2 diabetes. Regul Pept 2008; 151:123.
  33. Wright AB, McKelvey GM, Wood AK, Post EJ. Effects of promethazine on porcine gastroduodenal function: a sonographic study. Ultrasound Med Biol 1999; 25:241.
  34. Fich A, Neri M, Camilleri M, et al. Stasis syndromes following gastric surgery: clinical and motility features of 60 symptomatic patients. J Clin Gastroenterol 1990; 12:505.
  35. Samin KA, Alam I, Riaz S, et al. Gastro-ileal stenosis and gastroparesis after a biliopancreatic diversion. Obes Surg 2006; 16:1243.
  36. Salameh JR, Schmieg RE Jr, Runnels JM, Abell TL. Refractory gastroparesis after Roux-en-Y gastric bypass: surgical treatment with implantable pacemaker. J Gastrointest Surg 2007; 11:1669.
  37. Davion T, Delamarre J, Reix N, et al. Gastric bezoar: another side effect of endoscopic variceal sclerotherapy. Scand J Gastroenterol 1989; 24:818.
  38. Masclee AA, Lamers CB. Effect of endoscopic sclerotherapy of esophageal varices on vagus nerve integrity. J Hepatol 1994; 21:724.
  39. Radaelli F, Paggi S, Terreni N, et al. Acute reversible gastroparesis and megaduodenum after botulinum toxin injection for achalasia. Gastrointest Endosc 2010; 71:1326.
  40. Jost WH. Gastrointestinal dysfunction in Parkinson's Disease. J Neurol Sci 2010; 289:69.
  41. Dhamija R, Tan KM, Pittock SJ, et al. Serologic profiles aiding the diagnosis of autoimmune gastrointestinal dysmotility. Clin Gastroenterol Hepatol 2008; 6:988.
  42. Pasha SF, Lunsford TN, Lennon VA. Autoimmune gastrointestinal dysmotility treated successfully with pyridostigmine. Gastroenterology 2006; 131:1592.
  43. Clark MB, Davis T. A pediatric case of severe pandysautonomia responsive to plasmapheresis. J Child Neurol 2013; 28:1716.
  44. Weston S, Thumshirn M, Wiste J, Camilleri M. Clinical and upper gastrointestinal motility features in systemic sclerosis and related disorders. Am J Gastroenterol 1998; 93:1085.
  45. Hoogerwerf WA, Pasricha PJ, Kalloo AN, Schuster MM. Pain: the overlooked symptom in gastroparesis. Am J Gastroenterol 1999; 94:1029.
  46. Hasler WL, Wilson LA, Parkman HP, et al. Bloating in gastroparesis: severity, impact, and associated factors. Am J Gastroenterol 2011; 106:1492.
  47. Camilleri M. Management of patients with chronic abdominal pain in clinical practice. Neurogastroenterol Motil 2006; 18:499.
  48. Cherian D, Sachdeva P, Fisher RS, Parkman HP. Abdominal pain is a frequent symptom of gastroparesis. Clin Gastroenterol Hepatol 2010; 8:676.
  49. KASSANDER P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48:797.
  50. Kim CH, Kennedy FP, Camilleri M, et al. The relationship between clinical factors and gastrointestinal dysmotility in diabetes mellitus. J Gastrointest Motil 1991; 3:268.
  51. Ziessman HA, Chander A, Clarke JO, et al. The added diagnostic value of liquid gastric emptying compared with solid emptying alone. J Nucl Med 2009; 50:726.
  52. Ziessman HA, Okolo PI, Mullin GE, Chander A. Liquid gastric emptying is often abnormal when solid emptying is normal. J Clin Gastroenterol 2009; 43:639.
  53. Sachdeva P, Kantor S, Knight LC, et al. Use of a high caloric liquid meal as an alternative to a solid meal for gastric emptying scintigraphy. Dig Dis Sci 2013; 58:2001.
  54. Camilleri M, Shin A. Novel and validated approaches for gastric emptying scintigraphy in patients with suspected gastroparesis. Dig Dis Sci 2013; 58:1813.
  55. Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 2000; 95:1456.
  56. Cremonini F, Mullan BP, Camilleri M, et al. Performance characteristics of scintigraphic transit measurements for studies of experimental therapies. Aliment Pharmacol Ther 2002; 16:1781.
  57. 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; 103:753.
  58. Camilleri M, Zinsmeister AR, Greydanus MP, et al. Towards a less costly but accurate test of gastric emptying and small bowel transit. Dig Dis Sci 1991; 36:609.
  59. Thomforde GM, Camilleri M, Phillips SF, Forstrom LA. Evaluation of an inexpensive screening scintigraphic test of gastric emptying. J Nucl Med 1995; 36:93.
  60. Guo JP, Maurer AH, Fisher RS, Parkman HP. Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis. Dig Dis Sci 2001; 46:24.
  61. Camilleri M, Iturrino J, Bharucha AE, et al. Performance characteristics of scintigraphic measurement of gastric emptying of solids in healthy participants. Neurogastroenterol Motil 2012; 24:1076.
  62. Schwizer W, Maecke H, Fried M. Measurement of gastric emptying by magnetic resonance imaging in humans. Gastroenterology 1992; 103:369.
  63. Kuo B, Viazis N, Bahadur S, et al. Non-invasive simultaneous measurement of intra-luminal pH and pressure: assessment of gastric emptying and upper GI manometry in healthy subjects. Neurogastroenterology 2004; 16:666.
  64. Kuo B, McCallum RW, Koch KL, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther 2008; 27:186.
  65. Agency for Healthcare Research and Quality (AHRQ). Wireless motility capsule versus other diagnostic technologies for evaluating gastroparesis and constipation: A comparative effectiveness review (No. 110). Available at: http://effectivehealthcare.ahrq.gov/ehc/products/392/1498/Constipation-gastroparesis-wireless-capsule-report-130520.pdf (Accessed on June 07, 2013).
  66. Cassilly D, Kantor S, Knight LC, et al. Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil 2008; 20:311.
  67. Thumshirn M, Bruninga K, Camilleri M. Simplifying the evaluation of postprandial antral motor function in patients with suspected gastroparesis. Am J Gastroenterol 1997; 92:1496.
  68. Ghoos YF, Maes BD, Geypens BJ, et al. Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology 1993; 104:1640.
  69. Braden B, Adams S, Duan LP, et al. The [13C]acetate breath test accurately reflects gastric emptying of liquids in both liquid and semisolid test meals. Gastroenterology 1995; 108:1048.
  70. Lee JS, Camilleri M, Zinsmeister AR, et al. A valid, accurate, office based non-radioactive test for gastric emptying of solids. Gut 2000; 46:768.
  71. Maes BD, Ghoos YF, Rutgeerts PJ, et al. [*C]octanoic acid breath test to measure gastric emptying rate of solids. Dig Dis Sci 1994; 39:104S.
  72. Szarka LA, Camilleri M, Vella A, et al. A stable isotope breath test with a standard meal for abnormal gastric emptying of solids in the clinic and in research. Clin Gastroenterol Hepatol 2008; 6:635.
  73. US Food and Drug Administration (FDA) news release. FDA approves breath test to aid in diagnosis of delayed gastric emptying. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm441370.htm (Accessed on April 07, 2015).
  74. Perri F, Bellini M, Portincasa P, et al. (13)C-octanoic acid breath test (OBT) with a new test meal (EXPIROGer): Toward standardization for testing gastric emptying of solids. Dig Liver Dis 2010; 42:549.
  75. O'Brien MD, Bruce BK, Camilleri M. The rumination syndrome: clinical features rather than manometric diagnosis. Gastroenterology 1995; 108:1024.
  76. Chial HJ, Camilleri M, Williams DE, et al. Rumination syndrome in children and adolescents: diagnosis, treatment, and prognosis. Pediatrics 2003; 111:158.
  77. Attri N, Ravipati M, Agrawal P, et al. Rumination syndrome: an emerging case scenario. South Med J 2008; 101:432.
  78. Allen JH, de Moore GM, Heddle R, Twartz JC. Cannabinoid hyperemesis: cyclical hyperemesis in association with chronic cannabis abuse. Gut 2004; 53:1566.
  79. Camilleri M, Hasler WL, Parkman HP, et al. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology 1998; 115:747.
  80. Sha W, Pasricha PJ, Chen JD. Correlations among electrogastrogram, gastric dysmotility, and duodenal dysmotility in patients with functional dyspepsia. J Clin Gastroenterol 2009; 43:716.
  81. Friesen CA, Lin Z, Hyman PE, et al. Electrogastrography in pediatric functional dyspepsia: relationship to gastric emptying and symptom severity. J Pediatr Gastroenterol Nutr 2006; 42:265.
  82. Kuiken SD, Samsom M, Camilleri M, et al. Development of a test to measure gastric accommodation in humans. Am J Physiol 1999; 277:G1217.
  83. Bouras EP, Delgado-Aros S, Camilleri M, et al. SPECT imaging of the stomach: comparison with barostat, and effects of sex, age, body mass index, and fundoplication. Single photon emission computed tomography. Gut 2002; 51:781.
  84. Bredenoord AJ, Chial HJ, Camilleri M, et al. Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms. Clin Gastroenterol Hepatol 2003; 1:264.
  85. Fidler J, Bharucha AE, Camilleri M, et al. Application of magnetic resonance imaging to measure fasting and postprandial volumes in humans. Neurogastroenterol Motil 2009; 21:42.
  86. Grover M, Bernard CE, Pasricha PJ, et al. Clinical-histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium. Neurogastroenterol Motil 2012; 24:531.
  87. Abell TL, Familoni B, Voeller G, et al. Electrophysiologic, morphologic, and serologic features of chronic unexplained nausea and vomiting: lessons learned from 121 consecutive patients. Surgery 2009; 145:476.
  88. Harberson J, Thomas RM, Harbison SP, Parkman HP. Gastric neuromuscular pathology in gastroparesis: analysis of full-thickness antral biopsies. Dig Dis Sci 2010; 55:359.
  89. Pasricha PJ, Pehlivanov ND, Gomez G, et al. Changes in the gastric enteric nervous system and muscle: a case report on two patients with diabetic gastroparesis. BMC Gastroenterol 2008; 8:21.