Gastroparesis Signs and Symptoms
Gastroparesis presents with a constellation of upper gastrointestinal symptoms dominated by nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain, occurring in the context of delayed gastric emptying without mechanical obstruction. 1
Cardinal Symptoms
The classic symptom complex includes:
- Nausea and vomiting - These are the predominant and most disabling symptoms in gastroparesis, particularly in medically refractory cases 1
- Early satiety - Inability to finish a normal-sized meal due to premature fullness 1, 2
- Postprandial fullness - Uncomfortable sensation of food remaining in the stomach after eating, which is the only symptom that significantly predicts delayed gastric emptying of solids 1
- Bloating - Sensation of abdominal distension 1, 3
- Upper abdominal pain - Epigastric discomfort or pain, though this symptom overlaps significantly with functional dyspepsia 1
Additional Clinical Manifestations
- Weight loss and malnutrition - Result from reduced oral intake and food aversion 1
- Anorexia - Loss of appetite contributing to nutritional deficiency 1
- Regurgitation - Particularly when esophageal dysfunction coexists 1
Diabetes-Specific Considerations
In diabetic patients, gastroparesis presents with unique features:
- Unpredictable blood glucose fluctuations - Delayed gastric emptying causes mismatch between nutrient absorption and insulin action 1, 4
- "Gastric" hypoglycemia - Unexplained hypoglycemia in insulin-treated patients due to delayed carbohydrate delivery 1
- Prevalence of 30-50% in outpatients with longstanding type 1 or type 2 diabetes 1
- Higher symptom burden with poor chronic glycemic control, as acute hyperglycemia increases perception of gastrointestinal sensations 1
Important Clinical Caveats
The relationship between symptoms and objective gastric emptying delay is weak - symptom severity does not reliably correlate with the degree of delayed emptying 1. This means:
- Symptoms alone are inadequate for diagnosis 5
- Only postprandial fullness appears to be a significant predictor of delayed gastric emptying 1
- Objective testing with gastric emptying scintigraphy for 4 hours is essential for diagnosis 5, 6
Symptom overlap with functional dyspepsia is extensive, making accurate diagnosis challenging without objective gastric emptying testing 1. Both conditions share nausea, vomiting, early satiety, bloating, postprandial fullness, and abdominal pain 1.
Women are affected more frequently than men, with an estimated prevalence of 37.8 per 100,000 for women versus 9.6 per 100,000 for men 1.
Symptom "turnover" occurs frequently - symptoms may fluctuate over time, and moderate gastroparesis does not appear to be rapidly progressive 1.
Pathophysiologic Contributors to Symptoms
Beyond delayed gastric emptying, multiple mechanisms contribute to symptom generation:
- Impaired gastric accommodation - Failure of fundic relaxation 1, 2
- Antral hypomotility - Reduced antral contractions 1, 7
- Pyloric dysfunction - Pylorospasm with prolonged intermittent contractions and increased baseline tone 1, 8
- Increased visceral perception - Hypersensitivity to gastric distension 1
- Altered central processing - Changes in how the brain interprets gastric signals 1
- Learned behaviors - Food aversion and disordered eating patterns 1
- Psychological distress - Symptoms occur more frequently in patients with markers of psychological disorders 1