Gastroparesis

Also called Delayed gastric emptying, Paralysed stomach

A stomach that empties too slowly. Commonest in long-standing diabetes, and the food advice is the opposite of usual healthy eating.

What it is

A condition in which the stomach empties too slowly, without any physical blockage, because the nerves or muscles controlling it are not working.

The commonest identified cause in the UK is long-standing type 1 or type 2 diabetes, where high glucose over years damages the vagus nerve. Others include surgery involving the vagus nerve, Parkinson's disease, scleroderma, and medicines, particularly opioids and some diabetes drugs. In many people no cause is found.

There is a vicious circle in diabetes that is worth understanding: unpredictable emptying makes blood glucose swing wildly, and high glucose slows emptying further. Improving glucose control improves the stomach, and vice versa.

The dietary advice inverts the usual: **low fibre and low fat**, because both slow emptying further. Somebody following standard healthy-eating advice with wholegrains, salads and pulses will be making themselves considerably worse, and they are rarely told.

Small frequent meals, liquid and blended food during flares, and eating the main meal earlier in the day all help.

Weight loss and malnutrition are common and need dietetic input from the start.

Signs you might notice

Feeling full very quickly, and staying full for hours.

Nausea, and vomiting food eaten hours or even a day earlier.

Bloating, upper abdominal pain, heartburn.

Loss of appetite and weight loss.

Erratic blood glucose in diabetes, with unexpected lows after eating followed by later highs.

Urgent: persistent vomiting with dehydration; vomiting blood; severe abdominal pain; inability to keep fluids down; or unexplained rapid weight loss.

The symptoms overlap with obstruction and with stomach cancer, so this diagnosis should only be made after those have been excluded, usually by endoscopy and a gastric emptying study.

How it can affect day-to-day life

The unpredictability is the hardest part: the same meal produces different results on different days, which makes insulin dosing and social eating genuinely difficult.

Eating becomes something to dread, and people lose weight while being told to eat more.

Nutrition support is the priority rather than an afterthought: liquid nutrition during flares, and sometimes feeding tubes in severe disease.

Several standard medicines make it worse and are often continued: opioids, anticholinergics, and GLP-1 agonists used for diabetes and weight loss, which deliberately slow gastric emptying.

Anti-sickness medicines have limitations: metoclopramide is restricted to short courses because of movement side effects, and domperidone has cardiac restrictions. Long-term management needs specialist input rather than repeat prescriptions.

For people with diabetes, adjusting insulin timing so it matches actual absorption rather than mealtimes is a specialist task worth asking for.

Supporting someone well

Eat small amounts often, five or six times a day rather than three meals.

Reduce fibre and fat during symptoms, which is the opposite of standard advice and is correct here.

Blend food or move to liquid nutrition during flares; a milkshake often stays down when a plate does not.

Sit upright during and for an hour after eating, and eat the largest meal earlier in the day.

Ask for a dietitian at diagnosis.

Review medicines: opioids, anticholinergics and GLP-1 agonists all slow the stomach.

Work with the diabetes team on insulin timing rather than dose alone.

Weigh regularly and report loss early.

Get persistent vomiting or dehydration assessed rather than managed at home.

Where to get help

A GP practice for referral to gastroenterology, and the diabetes team where relevant.

A dietitian, ideally one experienced in gastroparesis.

Urgent care for persistent vomiting, dehydration or severe pain.

Guts UK and Diabetes UK both publish information on this.