A JAMA review has pulled together the epidemiology, diagnosis and treatment of gastroparesis, drawing on a US claims study covering 82.6 million patients and on the 2022 American College of Gastroenterology and 2025 American Gastroenterological Association guidance. Definite gastroparesis, meaning delayed emptying documented on testing, has a prevalence of 21.5 per 100,000. Type 2 diabetes was the single commonest cause at 51.7%, with type 1 diabetes a further 5.7%. Medication-induced cases made up 11.8%, postsurgical 15% and idiopathic 11.3%.
What that first number means in practice is that most gastroparesis is managed, or missed, in a diabetes clinic rather than a gastroenterology one. And the review lists glucagon-like peptide-1 (GLP-1) receptor agonists among the drugs to stop before anything else, alongside opioids, cannabis and anticholinergics. With incretin prescribing now routine, nausea, vomiting, early satiety and bloating are common complaints, and separating a drug effect from established autonomic neuropathy changes what you do next. One is reversible in weeks; the other is not.
Before ordering a gastric emptying study, take the medication history properly and confirm that mechanical obstruction has been excluded on upper endoscopy or computed tomography. The reference test is gastric emptying scintigraphy with more than 10% retention at four hours, graded mild at 10 to 15%, moderate at 16 to 35% and severe above 35%. Treatment follows the grade: a small particle diet low in fat and non-digestible fibre plus antiemetics for mild disease, prokinetics such as metoclopramide or erythromycin added for moderate, and a liquid diet or jejunal feeding for severe. In Indian practice, where scintigraphy access is limited outside larger centres and opioid use is lower, the medication review and glycaemic optimisation carry proportionally more of the weight.
- List every drug that delays gastric emptying before testing: opioids, cannabis, anticholinergics, GLP-1 receptor agonists.
- Confirm mechanical obstruction has been excluded, on upper endoscopy or computed tomography, before calling it gastroparesis.
- Grade the scintigraphy result and let it pick the treatment: 10 to 15% retention at four hours is mild, 16 to 35% moderate, above 35% severe.
- Record the specific symptoms, nausea, vomiting, early satiety, bloating, pain, rather than writing dyspepsia.
- Optimise glucose alongside any of this: hyperglycaemia itself slows gastric emptying.
The statistics, in plain English
The 21.5 per 100,000 prevalence counts only patients with documented delayed emptying, so it is a floor rather than a true rate: symptomatic patients who never get a scintigram are invisible to a claims database. The 51.7% figure is the share of gastroparesis cases caused by type 2 diabetes, not the risk of gastroparesis in type 2 diabetes, which is far lower. The female to male ratio is quoted as a range, 2:1 to 4:1, because it comes from several datasets that counted cases differently. The four-hour retention cut-offs are consensus thresholds rather than outcome-derived ones, so a patient at 16% and one at 34% both count as moderate despite a twofold difference in retention.
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