• Chronic GI disorder characterized by delayed gastric emptying without mechanical obstruction
  • More common in women, presumed due to elevated progesterone
  • Symptoms overlap with functional dyspepsia

Causes of Non-Obstructive Delayed Gastric Emptying

Clinical Features

Differential Diagnosis

Nausea and vomiting




Gastroparesis (by organ system)


  • Definitive diagnosis of gastroparesis not typically made in ED
    • Gold standard is gastric emptying scintigraphy of a solid-phase meal
    • Other studies assessing emptying: tests, upper GI barium study, ultrasound for changes in antral area
  • ED workup to exclude alternative diagnoses and complications (e.g. dehydration, Electrolyte abnormalities)
  • CBC, BMP, LFTs, lipase
  • Urinalysis, uHCG
  • Consider:
    • ECG (if >50 or at risk for cardiac disease)
    • RUQ US
    • Acute abdominal series including an upright CXR (if risk for perforated ulcer)
    • CT abdomen/pelvis to rule out obstruction
    • Upper endoscopy or radiographic upper GI series to exclude mechanical obstruction or ulcer disease


ED Management

  • IVF, Electrolyte repletion
  • Antiemetics
  • Prokinetic agents: enhance gut contractility
    • Metoclopramide
      • Also has antiemetic properties
      • PRN and/or standing dose prior to meals and bedtime
    • Erythromycin 125-350mg TID or QID
  • Refractory disease:
    • Nasogastric tube to decompress stomach
    • Advanced therapies (not in ED) may include: placement of jejunostomy and/or gastrostomy tube, pyloric injection of botulinum toxin, [[Gastric pacemaker complication|gastric electric stimulation]
  • Prevention of future exacerbations:
    • Review medications, opioids, anticholinergics, PPIs may worsen or trigger symptoms
    • Avoid carbonated beverages, alcohol, and tobacco
    • Optimize glycemic control in patients with diabetes (hyperglycemia alone can delay gastric emptying)
    • Dietary: smaller but more frequent meals, minimize fat/fiber, increase liquid nutrient component



  • Discharge with outpatient follow up unless:
    • Inability to tolerate PO
    • Need for ongoing IV rehydration, electrolyte correction, and/or glycemic control

See Also


  1. Parkman HP, Hasler WL, Fisher RS. American Gastroenterlogical Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004; 127(5): 1592-1622.
  2. Ramirez R, Stalcup P, Croft B, Darracq MA. Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department. Am J Emerg Med. 2017;35(8):1118-1120. doi:10.1016/j.ajem.2017.03.015
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