Distinguishing Gastroenteritis from Gastroparesis by Symptoms
Gastroenteritis is an acute, self-limited condition with diarrhea as a hallmark feature, while gastroparesis is a chronic motility disorder characterized by delayed gastric emptying with nausea, vomiting, and early satiety but without diarrhea.
Key Symptom Differences
Gastroenteritis Symptoms
- Acute onset (hours to days) following infectious exposure
- Diarrhea is the defining feature (watery or bloody depending on pathogen)
- Nausea and vomiting present but typically resolve within 24-72 hours
- Abdominal cramping that is diffuse and colicky
- Fever and systemic symptoms (malaise, myalgias) are common
- Self-limited course, typically resolving within 3-7 days
Gastroparesis Symptoms
- Chronic or recurrent symptoms (weeks to months) 1, 2
- No diarrhea - this is a critical distinguishing feature
- Nausea - often the most prominent and persistent symptom 1
- Vomiting - may contain undigested food from hours earlier 1, 2
- Early satiety - inability to finish normal-sized meals 1, 2, 3
- Postprandial fullness - prolonged sensation of fullness after eating 1, 2, 3
- Bloating and upper abdominal distention 2, 3
- Upper abdominal pain - present in many patients, particularly those seen at tertiary centers 1
- Symptoms worsen with solid foods, especially high-fat and high-fiber meals 4
Physical Examination Findings
Gastroenteritis
- Diffuse abdominal tenderness without localization
- Hyperactive bowel sounds
- Signs of dehydration (dry mucous membranes, tachycardia, orthostatic hypotension)
- No succussion splash
Gastroparesis
- Succussion splash - audible fluid splashing sound when shaking the patient's abdomen, suggesting retained gastric contents 1
- Epigastric tenderness or distention 1
- Normal or hypoactive bowel sounds
- Signs of malnutrition or weight loss in chronic cases 1
- Look for underlying causes: digital ulcers and telangiectasia (scleroderma), signs of diabetes complications 1
Temporal Pattern
Gastroenteritis presents with sudden onset after exposure (contaminated food, sick contacts), peaks within 24-48 hours, and resolves within days. There is no chronicity.
Gastroparesis has either gradual onset (idiopathic, diabetic) or begins after a viral illness but then persists chronically 5. The key distinction is that symptoms continue beyond 2-3 weeks and become a chronic problem requiring ongoing management 1, 2.
Critical Diagnostic Pitfall
A viral gastroenteritis can trigger gastroparesis - approximately 82% of patients with idiopathic gastroparesis may have had a preceding viral illness, particularly enterovirus infection 5. However, the distinction is clear: if symptoms persist beyond 2-3 weeks with predominant nausea, vomiting, and early satiety (without diarrhea), this represents gastroparesis, not ongoing gastroenteritis 5.
When to Suspect Gastroparesis Over Gastroenteritis
- Symptoms persist beyond 2 weeks 1, 2
- Absence of diarrhea throughout the illness
- Vomiting of undigested food from meals eaten hours earlier 1
- Symptoms worsen specifically after solid meals 4
- Weight loss develops due to inability to maintain oral intake 1
- History of diabetes mellitus (20-40% of diabetics develop gastroparesis) 1
- Recent gastric or esophageal surgery 1, 3
Confirmation of Gastroparesis
Once gastroparesis is suspected based on chronic symptoms, diagnosis requires documentation of delayed gastric emptying via gastric emptying scintigraphy with a 4-hour test duration, which is the gold standard 1, 4, 2. The diagnosis cannot be made on symptoms alone, as there is significant overlap with functional dyspepsia 1.