Judge rules gastroparesis claims in GLP-1 litigation need objective stomach-emptying testing

Judge Karen S. Marston, who oversees the consolidated federal GLP-1 stomach-injury cases in Philadelphia, ruled on August 15, 2025 that anyone alleging gastroparesis in the litigation has to back the diagnosis with a properly conducted gastric emptying study ^[1]. The order, docketed as Doc. 468, also threw out testimony from two of the plaintiffs' diagnostic experts and applies to cases involving both Novo Nordisk and Eli Lilly products ^[1].

The court's wording, quoted later by Novo Nordisk: "Any Plaintiff claiming to suffer (or have suffered) from gastroparesis[] must show that their diagnosis is based on a properly performed gastric emptying study (scintigraphy, breath test, or WMC)" ^[2]. One tracker describes it as a 78-page decision issued after 3,700-plus pages of briefing and evidentiary hearings ^[3].

Gastroparesis is the single biggest injury group in the docket — roughly three out of four complaints raise it, compared with 18 percent for ileus and 8 percent for gallbladder injuries ^[3]. Products named across the litigation include Ozempic, Wegovy and Rybelsus, all semaglutide from Novo Nordisk, and Mounjaro, Zepbound and Trulicity from Eli Lilly ^[3].

Novo Nordisk has since used the order as a springboard. In a May 19, 2026 roadmap brief supporting five motions to exclude plaintiff causation experts plus a summary judgment request, the company argued judgment should follow in any gastroparesis case lacking objective emptying-study evidence, "whether characterized as drug-induced gastroparesis, delayed gastric emptying, or any other label" ^[2]. The same filing says Novo is not seeking to exclude testimony that the drugs can cause transient delayed gastric emptying, since slowed emptying is the medicines' known and labeled mechanism ^[2].

Elsewhere in 2025, the court dismissed design-defect and several other theories with leave to amend, narrowing the litigation mainly to failure to warn ^[1]. How many cases have been dismissed or withdrawn because of the testing requirement has not been reported.

Trackers disagree on docket size. One reports 3,928 pending cases in MDL 3094 as of the Judicial Panel on Multidistrict Litigation's August 1, 2026 count ^[1]. Another puts the figure at 4,022 pending and 4,056 filed as of September 2026 ^[3]. Both agree nothing has been settled and no verdict has been reached, and no court or jury has found these medications caused anyone's injury ^[1][3][4].

Why it matters for patients

What a patient described to a doctor matters less here than what a test recorded. A gastric emptying study has the patient eat a meal carrying a trace of radioactive material while imaging measures how quickly the stomach clears; the National Institute of Diabetes and Digestive and Kidney Diseases puts the diagnostic threshold at more than 10 percent retention after four hours ^[3]. A gastroparesis diagnosis reached without that testing — or through a method outside the three the court listed — becomes harder to carry forward ^[1][2].

The ruling does not alter how these medications work or how they are prescribed. Delayed stomach emptying is part of semaglutide's intended effect and is described on the label ^[3]. What remains contested is whether the effect can persist after the drug is stopped or become severe. In October 2025, the Ozempic label was revised to say it "is not recommended in patients with severe gastroparesis" ^[3].

Claims over NAION, a form of sudden vision loss, belong to a separate proceeding, MDL 3163, also before Judge Marston, which held about 200 cases as of the August 2026 count ^[1][3].

What happens next

The next major test in MDL 3094 is a hearing on whether expert testimony about general causation may be heard, set for September 14–18, 2026, with briefing closed in early August 2026 ^[1]. The deadline for expert-evidence challenges, known as Daubert motions, passed on April 28, 2026, and summary judgment briefing ran through July 2026 ^[3]. The two trackers part ways on trials: one anticipates bellwether trials around mid-2026 and views mass settlements as unlikely before late 2027 ^[3], while the other reports no trials scheduled ^[1].