Diabetic Gastroparesis: A Narrative Review of a Neglected Complication

Abstract

Diabetic gastroparesis is a form of autonomic neuropathy resulting in a complication of diabetes mellitus and characterized by delayed gastric emptying. The prevalence is estimated to be 5% among type 1 diabetics and 1% among type 2 diabetics. It is most commonly seen in people who have had diabetes for 10 years and have already developed other microvascular complications. The pathophysiology of diabetic gastroparesis is complex and not yet fully understood, but it is believed to involve several interrelated factors. One of the main contributing factors is damage to the nerves (diabetic neuropathy) that control the muscles of the stomach and intestines. This can lead to abnormal contractions and motility in the stomach, resulting in delayed gastric emptying and associated symptoms. The cardinal symptoms of gastroparesis include nausea, vomiting, postprandial fullness, early satiety, bloating, upper abdominal pain, and in severe cases, anorexia, and weight loss, with a characteristic cyclic pattern with periodic exacerbations. The diagnosis typically involves a combination of medical history, physical examination, and laboratory tests (i.e., scintigraphy, capsule endoscopy, and/or electrogastrography). The main targets of the management of gastroparesis include symptomatic control, correction of nutritional deficiencies, and maintenance of optimal weight. Pharmacological therapies aim to improve symptoms and include prokinetics, motilin agents, ghrelin agonists, 5HT4 receptor agonists, antiemetics, and neuromodulators. In order to ensure the successful management of diabetic gastroparesis, it is essential to achieve adequate glucose control with dietary and insulin intake modifications. Endoscopic therapies can be an effective alternative when conservative measures have failed to improve symptoms. Overall, diabetic gastroparesis is a debilitating and progressive disease that significantly affects a patient's quality of life and has limited treatments. This narrative review provides an updated overview of the medical approach to this multifaceted condition.