A 4-yr-old cheetah (Acinonyx jubatus) with a 2-yr history of chronic intermittent vomiting and spiral bacteria–associated gastritis presented with dramatically increased vomiting frequency and marked intermittent abdominal distention. Physical examination revealed loss of muscle mass and poor fur coat quality. Contrast radiography was consistent with delayed gastric emptying due to presumed gastric outlet obstruction. Both Y-U pyloroplasty and incisional gastropexy were performed, and no subsequent vomiting has been observed for 3 yr with the exception of three episodes during the immediate postoperative period. The cause of delayed gastric emptying was not determined, although a gastric motility disorder associated with gastric bacterial infection and elevated gastrin levels was suspected.