Gender-Related Differences in Gastroparesis

Am J Med Sci. 2020 Nov;360(5):474-483. doi: 10.1016/j.amjms.2020.04.018. Epub 2020 Apr 25.


Gastroparesis is a disorder where the stomach empties contents too slowly into the small intestine with associated symptoms of nausea, vomiting, postprandial fullness, bloating, early satiety and/or abdominal pain. It is a well-established fact that the female gender is more susceptible to developing gastroparesis compared to males, although the significance and rationale behind this gender inequality remains an unresolved mystery. Several hypotheses have been proposed including an intrinsically slower stomach in females, elevated levels of sex steroid hormones, loss of neuronal nitric oxide (nNOS) expression, and possibly due to altered serotonergic signaling. Recently, our group investigated gender-associated differences in the number of interstitial cells of Cajal in the antral and pyloric smooth muscle of diabetic patients with severe refractory gastroparesis and found there was no significant difference between the 2 genders. Targeting these gender-specific mechanisms may lead towards future therapeutic options that might alleviate and/or prevent gastroparesis. Furthermore, a better-understanding of the sex-related differences in gastroparesis can allow medical practitioners to better tailor treatment options for their patients. This article will attempt to explain why females are more vulnerable to developing gastroparesis by examining the pathogenesis and molecular basis of gender-related factors that have been identified to play a role in the gender disparity of this entity.

Keywords: Estrogen; Female; Gastroparesis; Gender; Nitrergic dysfunction; Nitrergic system; Nitric oxide synthase; Progesterone; Serotonin; Sex differences.

Publication types

  • Review

MeSH terms

  • Estrogens / blood
  • Female
  • Gastric Emptying / physiology*
  • Gastroparesis / blood*
  • Gastroparesis / diagnosis
  • Gastroparesis / physiopathology*
  • Humans
  • Male
  • Nausea / blood
  • Nausea / diagnosis
  • Nausea / physiopathology
  • Progesterone / blood
  • Sex Characteristics*
  • Vomiting / blood
  • Vomiting / diagnosis
  • Vomiting / physiopathology


  • Estrogens
  • Progesterone