Autonomic Dysfunction Linked to Delayed Gastric Emptying

Multimodal testing reveals autonomic dysfunction as a hidden driver of gastroparesis symptoms.

Published on Mar. 6, 2026

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A new study from Stanford Health found that multimodal physiologic testing, combining autonomic testing, body surface gastric mapping (BSGM), and gastric emptying assessments, revealed autonomic dysfunction in over half of patients with chronic gastroduodenal symptoms and normal upper endoscopy. Autonomic dysfunction was strongly associated with delayed gastric emptying, even when gastric myoelectrical function appeared normal on BSGM.

Why it matters

This research highlights the importance of comprehensive physiological evaluations that go beyond just gastric emptying testing to better understand the underlying causes of chronic gastroduodenal symptoms. Identifying autonomic dysfunction as a potential driver could lead to more personalized treatment approaches for patients suffering from gastroparesis and other gastric motility disorders.

The details

The study included 80 adults with chronic gastroduodenal symptoms and normal upper endoscopy. Over one-third (33.8%) had gastroparesis, defined as delayed gastric emptying plus cardinal symptoms. More than half (56.8%) of the 37 patients who underwent autonomic testing showed autonomic dysfunction. Autonomic dysfunction and abnormal BSGM were both more common in those with gastroparesis, but the overlap was limited, suggesting autonomic dysfunction may be a distinct pathophysiologic mechanism. Autonomic dysfunction was independently associated with delayed gastric emptying, even after accounting for patient demographics and gastric myoelectrical abnormalities. High principal gastric frequency on BSGM also showed a strong link to gastroparesis. When BSGM was normal, patients had higher levels of postprandial distress symptoms like early satiety, fullness, and heartburn.

  • The study was published online in the American Journal of Gastroenterology in 2026.

The players

Chris Varghese

The lead author of the study, from the Department of Surgery at the University of Auckland in New Zealand.

Stanford Health

The healthcare system where the prospective observational cohort study was conducted.

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What they’re saying

“[A]utonomic dysfunction likely contributes to chronic gastroduodenal symptoms, particularly in a large subset of gastroparesis patients where gastric myoelectrical function is normal. These findings underscore the need for comprehensive physiological evaluations that go beyond gastric emptying testing — including both autonomic function and gastric myoelectrical assessments — to more comprehensively subtype patients to inform personalized care.”

— Chris Varghese, Lead Author (American Journal of Gastroenterology)

What’s next

The researchers note that their analysis was not powered to evaluate specific autonomic and gastric myoelectrical metrics, so further studies are needed to better understand the relationships between these physiological measures and gastroduodenal symptom profiles.

The takeaway

This study highlights the importance of looking beyond just gastric emptying tests when evaluating patients with chronic gastroduodenal symptoms. Incorporating comprehensive physiological assessments, including autonomic function testing, can help identify distinct pathophysiological subgroups and inform more personalized treatment approaches for conditions like gastroparesis.