Gastroparesis

Deep dive

Gastroparesis: complete reference

Gastroparesis is delayed gastric emptying in the absence of mechanical obstruction — the stomach takes longer than normal to empty its contents into the small intestine. Causes include diabetes (most common — diabetic gastroparesis from autonomic neuropathy), idiopathic, post-surgical, and medication-induced. Symptoms: early satiety, nausea, vomiting (especially of undigested food hours after eating), bloating, weight loss, glycemic instability. Diagnosis: gastric emptying scintigraphy (4-hour study) — diagnostic threshold ≥10% retention at 4 hours. GLP-1 receptor agonists slow gastric emptying as part of their mechanism, which is therapeutic в normal stomachs but problematic in patients with pre-existing gastroparesis. Pre-existing severe gastroparesis is generally a contraindication для GLP-1 therapy because the additive effect can cause severe symptoms (uncontrolled vomiting, weight loss, dehydration). Patients with mild gastric symptoms may still tolerate GLP-1s с careful monitoring; severe cases should avoid.

In practice

If you already have gastroparesis (especially from diabetes), starting Wegovy or Ozempic can dramatically worsen your symptoms — the stomach was already slow, the GLP-1 makes it slower.

Clinical context

Severe gastroparesis is a relative contraindication для GLP-1 therapy. Mild cases may proceed with monitoring.