MDL 3094 court requires objective gastric emptying testing for gastroparesis claims

Judge Karen S. Marston, who oversees the consolidated federal GLP-1 litigation in Philadelphia, ruled on August 15, 2025 that any plaintiff claiming gastroparesis must show the diagnosis rests on a properly performed gastric emptying study. The order, entered as Docket 468 in MDL 3094, also excluded two diagnostic experts offered by plaintiffs ^[1].

The court's language is narrow and specific. As quoted in a later defense filing, the order states that "[a]ny 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)" — the last referring to a wireless motility capsule ^[2]. The ruling came after more than 3,700 pages of briefing and evidentiary hearings, and ran 78 pages ^[3].

The decision applies across the whole docket, which covers both Novo Nordisk products (Ozempic, Wegovy, Rybelsus) and Eli Lilly products (Mounjaro, Zepbound, Trulicity) ^[3]. That matters because gastroparesis is the dominant claim: roughly 75% of complaints in MDL 3094 allege gastroparesis or "stomach paralysis," with about 18% alleging ileus and 8% gallbladder injuries ^[3]. The MDL was created in February 2024 and has grown steadily — from 1,331 pending cases in January 2025 to 3,928 by August 2026, according to monthly statistics from the Judicial Panel on Multidistrict Litigation ^[1][3].

Defendants have since used the order aggressively. In a May 19, 2026 brief, Novo Nordisk argued that under the Issue #1 order, summary judgment is appropriate in any case alleging gastroparesis — "whether characterized as drug-induced gastroparesis, delayed gastric emptying, or any other label" — without objective evidence from a properly performed gastric emptying study ^[2]. Notably, Novo said it is not seeking to exclude testimony that GLP-1 medicines can cause transient drug-induced delayed gastric emptying, because slowed stomach emptying is part of how the drugs work and appears on the label ^[2]. The fight is over whether the effect can persist after the drug clears the body ^[2].

Why it matters for patients

Gastroparesis is often diagnosed on symptoms alone — severe nausea, vomiting, bloating, feeling full quickly. The standard objective test is a gastric emptying study, most commonly scintigraphy, in which a person eats a meal containing a small amount of radioactive material and imaging tracks how fast it leaves the stomach; the threshold generally cited is more than 10% retention at four hours ^[3]. Many people who reported severe stomach symptoms on a GLP-1 drug were never sent for that test, and this ruling means a chart note saying "gastroparesis" is not enough to keep a claim alive in this court ^[1][2].

The ruling is a procedural gatekeeping decision, not a scientific finding. No court or jury has found that these medications caused anyone's injury, and no GLP-1 lawsuit has settled ^[1][4]. Separately, the FDA updated the Ozempic label in October 2025 to say the drug "is not recommended in patients with severe gastroparesis" ^[3], and vision-loss (NAION) claims were split into a separate proceeding, MDL 3163, created in December 2025 and also assigned to Judge Marston ^[1][3].

Sources differ slightly on the size of the docket depending on the reporting date: one tracker cites 3,928 pending cases as of the August 2026 JPML report, while another reports 4,022 pending as of September 2026 ^[1][3].

What happens next

Expert depositions wrapped in April 2026, with a Daubert motions deadline of April 28, 2026 and summary judgment briefing running through July 2026 ^[3]. A Rule 702 hearing on general causation — the question of whether these drugs are capable of causing the alleged injuries at all — is set for September 14–18, 2026 ^[1]. Bellwether trial selection has been expected around mid-2026, with first trials possible in late 2026, though nothing has been scheduled ^[1][3]. Whether any individual claim qualifies depends on that person's own medical records and state law ^[1].