• Maria Arini Lopez, PT, DPT, CSCS, CIMT, CMTPT

Dysautonomia and Gastroparesis

October 31, 2022 - Written By: Maria Arini Lopez, PT, DPT

Have you ever felt so full after eating only a couple of bites of food? Have you found yourself vomiting for no reason whatsoever? Do you have chronic unexplained nausea, abdominal pain or bloating, or decreased appetite?

These are symptoms that commonly present with gastroparesis which is yet another condition that can be caused by dysautonomia.

What is gastroparesis?

Gastroparesis is a condition caused by the slowed or stopped movement or contraction of your stomach muscles. Under normal circumstances, this automatic muscle movement breaks down or digests food within the stomach and then pushes food out of the stomach (called gastric emptying).

Dysautonomia affects the autonomic nervous system’s signaling to the stomach muscles to automatically contract, causing stomach dysfunction. Because this disrupts normal digestive processes, this can cause unexplained nausea, vomiting, feelings of fullness right after you take a few bites (early satiety), and abdominal pain and bloating.

How is Gastroparesis Diagnosed?

Several tests can help determine if you have gastroparesis, including:

  • Gastric emptying tests:

o Scintigraphy: This test involves you eating a light meal with radioactive markers in the food. These markers are tracked using a scanner placed over your abdomen to monitor how quickly the food enters and leaves your stomach. All medications that might interfere with the results of this study must be stopped prior to this testing.

o Breath tests: Samples of your breath are collected after you eat specific foods or liquids that can be identified in the samples. Over a period of several hours, this test is repeated and the amount of these identified substances in the breath are measured to determine how quickly the food has left your stomach and been absorbed by the body.

  • Upper gastrointestinal endoscopy: This test allows the doctor to see the structures like your esophagus, stomach, and the upper part of your intestines to determine if anything else might be causing your symptoms. These alternative diagnoses might include peptic ulcers, pyloric stenosis (a narrowing of the junction between your stomach and the first part of your small intestine).

  • Ultrasound: Sound waves are used to produce images of different structures in the body. It can help identify gallbladder or kidney problems that might explain your symptoms.

Delayed gastric emptying is associated with dysfunction of the parasympathetic nervous system (the rest and digest system) within the autonomic nervous system. Patients with autonomic dysfunction may also present with the reverse: rapid gastric emptying.

What makes gastroparesis worse?

Opioids, antidepressants, and medications for high blood pressure and allergies may make symptoms of gastroparesis worse because they also tend to slow down the digestive process, including gastric emptying.

What makes gastroparesis better?

Changes to diet, medications, and, in extreme cases, surgery may help improve the symptoms of gastroparesis.

Dietary changes might include:

  • Eating smaller meals more frequently throughout the day.

  • Eating soups or pureed foods so that the stomach doesn’t have to work as hard to digest the food you eat. They are also easier to swallow.

  • Chewing food thoroughly before swallowing. Again, this decreases the amount of work your stomach has to do because your teeth have already done it.

  • Avoid carbonated drinks, alcohol, and smoking.

  • Drink plenty of water (1 to 1.5 liters) every day.

  • Avoid fibrous fruits and vegetables and try to cook fruits and vegetables instead of eating them raw.

  • Exercising gently after eating, including walking, may aid in digestion.

Medications often prescribed to people with gastroparesis include:

  • Medications to activate the stomach muscles, such as metoclopramide (Reglan), erythromycin, and domperidone

  • Medications to alleviate nausea and vomiting, such as Benadryl, Zofran, and prochlorperazine (Compro).

Avoidance or limitation of medications that are known to worsen gastroparesis might also be beneficial. Talk with your doctor about safe alternatives that might not have as much of an impact on your digestive system.

In extreme cases, when people with gastroparesis are unable to keep any food or liquid down, doctors might suggest use of a feeding tube (jejunostomy) that bypasses the stomach and delivers food directly to the intestines. This is done to prevent severe malnutrition.

Bottom Line:

If you have been diagnosed with dysautonomia, it might be helpful to get assessed for gastroparesis if you have any of these digestive symptoms. A doctor who specializes in digestive system conditions (gastroenterologist) can help to diagnose gastroparesis with certain tests. Some dietary changes and medications may help with symptoms.

References and Resources

  1. Nguyen L, Wilson LA, Miriel L, et al. Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity. Neurogastroenterol Motil. 2020;32(8):e13810. doi:10.1111/nmo.13810

  2. Gastroparesis. Mayo Clinic. Accessed October 28, 2022.

  3. Gastroparesis: Diagnosis and treatment. Mayo Clinic. Accessed October 28, 2022.

Maria Arini Lopez, PT, DPT

Maria Arini Lopez, PT, DPT, CSCS, CIMT, CMTPT is a freelance medical writer and Doctor of Physical Therapy from Maryland. She has expertise in the therapeutic areas of orthopedics, neurology, chronic pain, gastrointestinal dysfunctions, and rare diseases, especially Ehlers Danlos Syndrome.

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