August is Gastroparesis Awareness Month!

Gastroparesis Awareness Month is a valuable opportunity, not just for public education, but also for healthcare providers to reexamine a condition that often goes undiagnosed, particularly in patients with chronic, complex illnesses.

Gastroparesis is defined as delayed stomach emptying without a physical blockage. It sits at the intersection of gastrointestinal dysfunction and neurological impairment. For physicians, recognizing this connection is critical, not only for symptom relief but also for maintaining quality of life and stabilizing blood sugar, especially in people with diabetes.

Not One-Size-Fits-All

Gastroparesis isn’t a uniform disease. It varies widely and often begins with vague symptoms like bloating, early fullness, or occasional nausea, complaints that are easy to dismiss. But in patients with autonomic nerve damage, these symptoms can be severe and ongoing, rooted in deeper neurological problems.

This isn’t just a case of slow digestion, it’s a breakdown in communication between the brain and the gut, particularly in the systems that regulate automatic body functions, the autonomic nervous system.. For patients with diabetes, that breakdown can further destabilize an already delicate balance.

The Nerve Connection: Autonomic Neuropathy

The most common known cause of gastroparesis is diabetic autonomic neuropathy (DAN), which leads to damage of the vagus nerve. This is the nerve responsible for signaling the movement of food through the stomach and intestines. When the vagus nerve is impaired, gastric contractions slow down, causing food to remain in the stomach for an abnormally long time.

This leads to symptoms including:

Nausea

Vomiting

Bloating

Abdominal pain

And it’s a vicious cycle: erratic stomach emptying disrupts insulin timing and blood glucose control. Even well-managed diabetes becomes unpredictable.

It’s Not Just Diabetes

While diabetes is the most familiar cause, many other conditions can lead to vagus nerve dysfunction and gastroparesis. These include:

Amyloidosis

Parkinson’s disease and other neurodegenerative disorders

Autoimmune diseases

Paraneoplastic syndromes

Post-viral autonomic dysfunction (including long COVID)

In some cases, gastroparesis may be one of the first signs of a broader neurological or systemic issue.

What to Look For

Patients with autonomic neuropathy–related gastroparesis tend to have:

More severe and persistent GI symptoms

Symptoms that worsen with blood sugar swings

Other signs of autonomic dysfunction (e.g., orthostatic hypotension which is a rapid blood pressure drop when standing up, resting fast heart rate, erectile dysfunction)

The degree of vagal nerve dysfunction often correlates with how delayed the gastric emptying is. In diabetes, parasympathetic nerve damage (especially involving the vagus nerve) can occur early, sometimes before other autonomic symptoms develop.

Takeaways

Gastroparesis isn’t just a GI disorder, it’s often a warning sign of deeper neurological issues.

In diabetic patients, persistent GI complaints should trigger evaluation for autonomic neuropathy and adjustments in insulin regimens.

In non-diabetic patients, new gastroparesis symptoms may warrant a broader neurological or autoimmune workup.

Treatment should go beyond medications that promote motility. A well-rounded approach includes:

Dietary changes

Optimizing blood glucose

Considering neuromodulatory therapies when appropriate, especially where peripheral neuropathy also exists.

Ultimately, recognizing the gut–nerve connection can lead to better care, fewer unnecessary tests, and more precise treatment.

What’s more, peripheral neuropathy, which causes numbness, tingling, or weakness in the hands and feet, can sometimes predict problems with the autonomic nervous system. This is especially common in people with diabetes, where long-term high blood sugar can damage many types of nerves over time. When the same nerve damage that affects the feet and hands starts to impact the nerves that control automatic body functions, it can lead to more serious issues. It’s a red flag that the nerve damage is no longer staying in one place and it’s time to take action before more systems are affected.

Dr Paul "Gastro Aware " Betschart

The Foot Book Doctor

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