Diabetic gastroparesis: Therapeutic options

Abstract

Gastroparesis is a condition characterized by delayed gastric emptying and the most common known underlying cause is diabetes mellitus. Symptoms include nausea, vomiting, abdominal fullness, and early satiety, which impact to varying degrees on the patient’s quality of life. Symptoms and deficits do not necessarily relate to each other, hence despite significant abnormalities in gastric emptying, some individuals have only minimal symptoms and, conversely, severe symptoms do not always relate to measures of gastric emptying. Prokinetic agents such as metoclopramide, domperidone, and erythromycin enhance gastric motility and have remained the mainstay of treatment for several decades, despite unwanted side effects and numerous drug interactions. Mechanical therapies such as endoscopic pyloric botulinum toxin injection, gastric electrical stimulation, and gastrostomy or jejunostomy are used in intractable diabetic gastroparesis (DG), refractory to prokinetic therapies. Mitemcinal and TZP-101 are novel investigational motilin receptor and ghrelin agonists, respectively, and show promise in the treatment of DG. The aim of this review is to provide an update on prokinetic and mechanical therapies in the treatment of DG.

Diabetic gastroparesis - from diagnosis to gastric electrical stimulation treatment

“…Early in the course of the disease symptoms may be minimal, but as the dysfunction upwards they become more common. However, several symptoms do not always correlate to measures of gastric emptying 18 . General symptoms and signs include nausea, vomiting, bloating, postprandial fullness, upper abdominal pain and finally weight reduction 19 .…”

“…First-line interventions for DGP are dietary modifications accompanied with or without medical therapy 18 . According to nutrition guidelines 4-5 small, low-fat, low-fiber meals a day are recommended, since both fat and fiber can lead to delay in gastric emptying.…”

Functional Gastrointestinal Disorders: Select From the Point Prokinetic Comorbidity, Clinical Efficacy and Drug Safety

“…Одной из актуальных проблем медицинской прак-тики является диабетический гастропарез, развивающий-ся на фоне генерализованной диабетической полинейро-патии, когда в процесс вовлекается и нервный аппарат стенки желудка [50][51][52][53][54][55].…”

Domperidone-Associated Sudden Cardiac Death in the General Population and Implications for Use in Patients Undergoing Hemodialysis: A Literature Review

“…Diabetes accounts for 45% of patients starting dialysis, 3 and in up to 50% of these patients the diabetes is complicated by gastroparesis. 4 Prokinetic agents, such as domperidone and metoclopramide, are commonly used for relief of symptoms.…”

“…5 Given the more favourable side effect profile, many clinicians in European countries and in Canada prefer domperidone as a first-line agent. 4 Despite these advantages, domperidone is associated with cardiovascular concerns. Health Canada, 6 the European Medicines Agency, 7 and the US Food and Drug Administration 8 have issued advisory warnings to inform health care professionals of an associated increase in the risk of SCD among patients over the age of 60 years who are taking more than 30 mg of domperidone daily.…”