Purpose: Gastroparesis (GP) is a common problem with a relatively poor selection of therapeutic agents. Tegaserod, a selective 5-hydroxytryptamine-4 (5HT4) receptor agonist, is known to stimulate gastrointestinal transit, particularly in constipation predominant irritable bowel syndrome. There are suggestions that tegaserod may likewise be useful in the treatment of GP, however there are few published data describing its use in this disorder. We report here, our experience using tegaserod, by means of a gradual dose escalation strategy, to treat GP. Methods: GP patients treated with tegaserod were included for review if: (1) they received a diagnosis of GP based both on symptoms and abnormal gastric emptying times and (2) they agreed to undergo repeat gastric emptying scans. Tegaserod was initiated at 6mg TID with step-wise dose increases of an additional 6mg TID (max. 24mg TID), as necessary based on persistent symptoms. Gastric emptying studies were performed at the time of the initial consultation, within one week of each dose adjustment, and upon resolution of GP symptoms. Results: The 33 patients reviewed consisted of 25 women and 8 men with an average age of 45.4 years. GP was identified as idiopathic (n = 23) or secondary to diabetes (n = 6), vagal injury (n = 2), or scleroderma (n = 2). At the time of the initial consultation, 5 patients were receiving tegaserod 6mg TID and 28 were receiving no therapy. Baseline gastric emptying scans found the mean gastric emptying at 60 mins. to be 12.7% (range 0–37%) with estimated T½ emptying times ranging from 100 mins. to “infinitity.” All patients achieved symptom resolution using dose escalation over an average of 3.3 months (range 7 days to 10 months). Doses required to achieve symptom resolution were 6mg TID (n = 19), 12mg TID (n = 12) and 24mg TID (n = 2). Gastric emptying scans at the time of symptom resolution found the mean gastric emptying at 60 mins. to be 53.2% (range 25–100%) with estimated T½ emptying times ranging from 14 mins. to 110 mins. Normalization of gastric emptying (T½ < 90 mins.) occurred in 78.8% (26/33) of patients. No significant side-effects were noted during treatment. Conclusions: Our results suggest that tegaserod can be successfully used in the treatment of GP, a disorder which otherwise has few satisfactory therapies. A strategy of dose escalation, beyond standard doses used for irritable bowel syndrome, resulted in symptom resolution in 100% of patients and normalization of gastric emptying times in 78.8% of patients.