Signs of Gastroparesis
Gastroparesis is characterized by nausea, vomiting, early satiety, bloating, postprandial fullness, abdominal pain, and weight loss due to delayed gastric emptying in the absence of mechanical obstruction. 1
Cardinal Symptoms
Gastroparesis presents with a constellation of upper gastrointestinal symptoms that reflect impaired gastric emptying:
- Primary symptoms:
- Nausea (often persistent)
- Vomiting (may contain undigested food consumed hours earlier)
- Early satiety (inability to finish normal-sized meals)
- Postprandial fullness (feeling excessively full after eating)
- Bloating
- Upper abdominal pain/discomfort
- Weight loss (in severe cases) 1
Clinical Presentation by Severity
The presentation of gastroparesis can be classified based on symptom severity:
Mild Gastroparesis
- Intermittent symptoms
- Manageable with dietary modifications
- Minimal impact on nutritional status
- Normal weight maintained
Moderate Gastroparesis
- More persistent symptoms
- Dietary restrictions necessary
- Some nutritional concerns
- May have weight loss
Severe Gastroparesis
- Refractory symptoms despite treatment
- Significant nutritional deficiencies
- Substantial weight loss
- Frequent hospitalizations for dehydration or malnutrition
- May require enteral or parenteral nutrition 1
Physical Examination Findings
Physical examination may reveal:
- Signs of dehydration (dry mucous membranes, poor skin turgor)
- Malnutrition (muscle wasting, loss of subcutaneous fat)
- Abdominal distension
- Succussion splash (audible splashing sound when the abdomen is shaken, indicating retained gastric contents)
- Epigastric tenderness 1
Objective Diagnostic Findings
While not symptoms per se, these findings confirm gastroparesis:
- Delayed gastric emptying on scintigraphy (gold standard)
- Delayed emptying on 13C breath testing
- Retained food in the stomach on endoscopy despite fasting
- Absence of mechanical obstruction 1
Distinguishing Features from Similar Conditions
It's important to differentiate gastroparesis from conditions with overlapping symptoms:
- Functional dyspepsia: Symptoms overlap significantly, but gastric emptying is normal
- Mechanical obstruction: Similar symptoms but with identifiable structural blockage
- Rumination syndrome: Effortless regurgitation of recently ingested food
- Cyclic vomiting syndrome: Episodes of intense vomiting followed by symptom-free periods 1
Common Pitfalls in Identifying Gastroparesis
- Misattribution to GERD: Many gastroparesis patients are initially misdiagnosed with reflux disease
- Overlooking medication causes: Opioids and GLP-1 agonists are common iatrogenic causes
- Inadequate gastric emptying testing: Short-duration emptying studies (less than 4 hours) may miss delayed emptying
- Failure to recognize diabetic gastroparesis: Symptoms may be attributed to poor glycemic control alone 1
Pathophysiological Mechanisms Contributing to Symptoms
Understanding the mechanisms helps explain symptom patterns:
- Antroduodenal hypomotility → early satiety, fullness
- Pylorospasm → delayed emptying, nausea, vomiting
- Impaired gastric accommodation → early satiety, fullness
- Visceral hypersensitivity → abdominal pain, nausea
- Gastric dysrhythmias → nausea, vomiting 1
Recognizing these signs and symptoms early allows for prompt diagnosis and management, potentially improving quality of life and reducing morbidity associated with gastroparesis.