Best Treatment for Gastroparesis: Gastric Bypass or Gastric Sleeve? Gastroparesis or delayed gastric emptying occurs when the stomach is paralyzed and gastric emptying is impaired. As a result, patients report bloating, nausea, vomiting, and pain. The underlying pathophysiology of gastroparesis is poorly understood. The cause of gastroparesis is also unknown. When patients with diabetes develop gastroparesis, the condition is called diabetic gastroparesis. It appears that in diabetic patients enteric nerve damage results in gastric dysmotility. However, the relationship between diabetes and gastroparesis is far more complex than a simple neuropathy. Normally, rising blood sugar levels halt gastric emptying as a protective measure against further nutrient passage into the intestines and sugar absorption. In type 2 diabetic patients abnormal gastric emptying may be the cause of diabetes rather than the result. In fact, type 2 Diabetes may be looked at as a gastro-intestinal motility disorder resulting in insulin resistance. Dr. Mason, the father of bariatric surgery, is an avid proponent of this theory. The early resolution of type 2 Diabetes immediately following gastric bypass and sleeve surgery is partly secondary to faster delivery of food to the distal small bowel. Gastric sleeve increases gastric emptying allowing food particles to reach the distal bowel to stimulate more L cells leading to increased GLP-1 secretion. L cells are specialized cells that react to glucose in ingested food and secrete several hormones like GLP-1 that affect glucose metabolism. GLP-1 stimulates insulin secretion and blocks glucagon secretion hence improving post-prandial blood sugar levels. Several studies have shown that gastric sleeve surgery increases gastric emptying. Few years ago, I used this concept to treat a severe case of diabetic gastroparesis in a 45-year-old male. I performed a longitudinal gastrectomy to mimic the effects of gastric sleeve and improve gastric emptying.