Hunting for a diagnosis — and treatment — when your stomach won’t empty
The nightmare began each morning when Chris Drew woke up: vomiting and debilitating stomach pain. Staying home from her job as a paralegal offered no comfort; the stress of worrying about mounting tasks heightened the misery.
After nearly three weeks, the Chicago resident saw her primary care physician, who ultimately referred her to a gastroenterologist. First came the obligatory questions.
“Are you pregnant?” The doctor asked.
“I can assure you, I’m not,” Drew responded.
Then came the tests. For Crohn’s disease, gallbladder disease, cancer. All negative. All the boxes checked.
Except for one.
Enter the egg test. There are variations, but, in general, the test involves the patient eating scrambled eggs cooked with a radiopharmaceutical (“radioactive eggs” Drew calls them) and then lying under a camera for four hours. The cooked egg whites serve as a carrier for the radiopharmaceutical, allowing the camera to track how the food progresses — or doesn’t — through the stomach.
The test revealed the cause behind Drew’s pain and nausea.
“We know exactly where it’s getting stopped. We know exactly where it’s slowing down,” Drew’s doctor reported.
Her gut reaction? Relief at a diagnosis. “I’m so glad I have a name now,” she says.
The name, after five months of tests and a 50-pound weight loss: gastroparesis.
When the stomach slows down About 5 million people in the United States have gastroparesis, a potentially painful condition that causes delays in the stomach’s ability to empty itself.
“Gastroparesis means literally a paralysis of the stomach. But that’s not exactly what’s happening,” says Ashley Vareedayah, MD, gastroenterologist at UI Health.
What is happening, he says, is a complex interaction among the stomach nerves, muscles, and hormones. In simplest terms, the stomach doesn’t empty as it should. People with gastroparesis feel full for hours after eating, which can cause symptoms like bloating, abdominal discomfort, and vomiting. As a result, they may avoid eating. They may not get adequate nutrition and may lose weight.
Acid reflux, heartburn, constipation, and diarrhea are more common than gastroparesis, Vareedayah says. “But one thing I would share is that, in terms of severity of symptoms and how much it affects patients, it certainly takes a toll.”
The cause remains elusive. Diabetes tops the list of suspects, perhaps because diabetes damages nerves in the stomach, just as it damages other nerves throughout the body, Vareedayah says. “But there are plenty of people who have gastroparesis who don’t have diabetes, right? So, there’s obviously other phenomena.”
Other theories suggest a viral or infectious culprit, with some cases developing after viral infections.
“That’s a long-winded way of saying we don’t have a complete understanding of what causes the issue,” he says. And that’s frustrating: “Because we, as doctors, don’t totally understand the disease process.”
The gender factor
Drew isn’t diabetic and believes stress triggered the disease 10 years ago. At the time, she was 36 and living with two roommates. Her relationship with one of them deteriorated into open hostility.
Her medical team at Northwestern Medicine even referred her to a hypnotist to manage her anxiety. She had four sessions, and while she doesn’t think she was ever hypnotized, she says, “This is what I learned: So many people, specifically women, hold all their stress in their stomachs. That’s why it’s more prevalent for them to have gut issues.”
Gastroparesis is about four times as common in women as in men, according to one U.S. study — affecting 32 per 100,000 women compared with 10 per 100,000 men.
Yet, Kyle Staller, MD, director of the Gastrointestinal Motility Laboratory at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School, cautions against linking where women tend to carry stress to the condition. “I would avoid interpreting the female predominance as evidence that these symptoms are somehow psychological. These are real physiologic differences, even if we have not yet worked out all the mechanisms behind them.”
Staller was among eight doctors who developed guidelines for the diagnosis and treatment of gastroparesis for the American Gastroenterological Association (AGA), published in October 2025.
The gender difference could be because women’s stomachs tend to empty more slowly than men’s, even in healthy people, or because sex hormones such as estrogen and progesterone appear to influence gastrointestinal motility, Staller says.
The GLP-1 conversation
In recent years, the class of weight loss drugs known as GLP-1s have made gastroparesis more commonly known. The drugs have been on the market since 2005, but their rapid popularity growth since Ozempic came on the market in 2017 has coincided with an increase in gastroparesis — a known side effect. Today, GLP-1s “have changed the conversation around gastroparesis,” Staller says.
In its 2025 guidelines, the American Gastroenterological Association specifically urges clinicians to review such medications.
Staller describes patients who previously ate normally but developed symptoms of gastroparesis after starting a GLP-1 medication. It makes sense biologically, he says, because nausea, fullness, reduced appetite, and sometimes vomiting are well-recognized effects of these medications. “The first question should not necessarily be, ‘How do we treat your new disease?’” Staller says. “It should be, ‘Could the medication be contributing to this?’”
For doctors, the challenge is determining whether a GLP-1 receptor antagonists can slow gastric emptying and cause symptoms similar to those with gastroparesis, Vareedayah says. From there, they can determine how best to manage the symptoms.
Gastroparesis symptoms are a “feature, not a bug” of GLP-1s, says Michael Brown, MD, at Rush University Medical Center’s section of digestive diseases and nutrition. “They’re meant to make you feel fuller, uncomfortable if you overeat. All the features of gastroparesis are there. It’s kind of what they do.”
Finding relief
Regardless of the root cause, a person’s most powerful tool in managing symptoms is adopting a low-fat, low-fiber diet that’s heavy on lean proteins. It’s not just what to eat, but also how to eat it: small, frequent meals. “Graze,” Brown says.
Dietitians typically recommend about 1 to 1.5 cups of food per sitting, about six times per day, Brown says.
Vareedayah empathizes with patients’ frustrations. “I would be frustrated, because that’s not the way I would want to normally eat. Eating is not just a nutritional thing — it’s a social thing.”
Beyond diet, people can explore medical and surgical therapies. Metoclopramide and erythromycin top the American Gastroenterological Association’s list of recommended medicines. Metoclopramide is the only FDA-approved drug for gastroparesis, but doctors are careful when prescribing it because of side effects, specifically tardive dyskinesia, a disorder that can cause involuntary, repetitive movements. The American Gastroenterological Association recommends starting at a low dose and using “drug holidays” every eight to 12 weeks — but also says that the risk of tardive dyskinesia is low.
Procedural therapies are available for patients with more severe symptoms. Gastric peroral endoscopic myotomy, or G-POEM, is one. Doctors cut the pyloric muscle at the stomach’s outlet to help food pass more easily into the small intestine.
A different therapy, gastric electrical stimulation, is “almost like a pacemaker for your stomach,” Vareedayah says. The device delivers mild electrical pulses to the nerves and muscles in the lower stomach.
Both therapies should be reserved for patients with medically refractory gastroparesis, meaning persistent symptoms despite medical treatment, according to American Gastroenterological Association guidelines.
“You can live with this” Drew recalls using metoclopramide briefly, early in her treatment. Since then, she’s managed symptoms through diet. She knows what to avoid, including greasy foods and creamy dairy products. And she knows what she can safely enjoy: a turkey sandwich, chicken breast, or a bland chicken Caesar salad. Chewing a stick of peppermint gum can ward off nausea. She recalls only one or two bad episodes over the past seven years or so.
One occurred earlier this year after several weeks of mounting personal and professional stress. “I woke up one morning, and I immediately felt sick,” Drew says. Ten years ago, while doctors worked to diagnose her, she estimates that she missed about a month of work over the time she was going through the diagnosis process. This year, she missed four days.
Brown’s message to patients: “You can live a high quality of life with this.”
Drew’s message: Have patience.
“I know that’s really tough,” she says. “It’s like telling a stressed person to relax or to just breathe or whatever. But have patience with the process.”
Living with Gastroparesis — Eating Habits that May Help
- Eat small, frequent meals.
- Eat solid foods earlier in the day.
- Walk after meals to help the stomach empty.
- Stop eating two to three hours before bedtime. For a late-night snack, choose foods that empty more quickly, such as liquids, shakes, yogurt, or pudding.
