Jejunostomy Feeding in the Management of Gastroparesis Diabeticorum

Jacober, Scott J.; Narayan, Akshay; Strodel, William E.; Ai, Vinik

doi:10.2337/diacare.9.2.217

Cited by 33 publications

(24 citation statements)

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“…Two series contain a total of 6 patients, and the symptom assessment is subjective and unstructured. 8,9 Fontana and Barnett 10 retrospectively reviewed 26 patients with documented gastroparesis who were considered failures of medical management. Symptom assessment was subjective, with patients or their survivors rating various parameters including nausea and vomiting, hospitalizations, and overall perception of health as improved, worsened, or unchanged.…”

Section: Defining Diabetic Gastroparesismentioning

confidence: 99%

Management of Diabetic Gastroparesis

Jones

2004

Nut in Clin Prac

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Diabetic patients with nausea and vomiting need evaluation to determine symptom etiology; diabetic gastroparesis should never be the default diagnosis. If no other etiology for nausea and vomiting is found after an appropriate evaluation, treatment focuses on effectively relieving symptoms while maintaining adequate nutritional status. Therapy for patients with nausea and vomiting consists of restoring volume, glycemic, and electrolyte status and providing antiemetics generously in both a remittive and prophylactic fashion. Prokinetics are best used to treat gastric stasis or clinically significant delayed gastric emptying. A gastrostomy is rarely indicated, but a jejunostomy may be helpful in maintaining nutrition. Parenteral nutrition should generally be avoided because of high complication rates in this setting. Surgical intervention is essentially unstudied in this population and cannot be recommended. Gastric electrical stimulation is an interesting and novel therapy, but its efficacy beyond placebo remains to be conclusively shown.

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Section: Defining Diabetic Gastroparesismentioning

confidence: 99%

Management of Diabetic Gastroparesis

Jones

2004

Nut in Clin Prac

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“…However, in my opinion, this practice only increases the labor it takes to maintain two sites and puts the patient at risk for two sites of leakage and two sites for potential infection. While this debate continues, several studies have shown jejunal feeding to be successful [31][32][33][34][35][36]. The type of enteral access placed in a patient depends on the facility and the clinician.…”

Section: Enteral Accessmentioning

confidence: 99%

Nutrition concerns for the patient with gastroparesis

Parrish

2007

Curr Gastroenterol Rep

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Gastroparesis is a debilitating disease that is the consequence of a variety of conditions resulting in a significant loss of quality of life. Although many cases are mild, some patients have protracted nausea and vomiting, making it difficult, if not impossible, to maintain their hydration and nutritional status. Furthermore, therapeutic levels of medications, such as prokinetic and antiemetic agents, can be difficult to achieve. The intent of this article is to provide the clinician with suggestions to improve the nutritional status of patients with gastroparesis and offer strategies to deal with the nutritional insults that arise in these unfortunate patients.

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“…Jejunostomy is advocated as a means to maintain hydration, nutrition, improve symptoms and glycaemic control [272][273][274][275]. These can be placed surgically through either laparoscopic or open techniques or endoscopically.…”

Section: Gastrostomy/jejunostomymentioning

confidence: 99%

Current Concepts in Gastric Motility in Diabetes Mellitus

Block¹,

Leeuw²,

Pelckmans³

et al. 2006

CDR

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This review addresses the current concepts in our understanding of the epidemiology, mechanisms, symptoms, clinical consequences, diagnosis and treatment of delayed gastric emptying in patients with diabetes. Upper gastrointestinal symptoms, particularly postprandial fullness, nausea, vomiting and abdominal bloating, occur in 30-50% of patients with diabetes. The use of scintigraphic techniques, and more recently breath test, has shown that as many as 50% of diabetic patients have gastroparesis. Diabetic gastroparesis comprises a decrease in fundic and antral motor activity, a reduction or a lack of the interdigestive migrating motor complex, gastric dysrhythmias, and pylorospasms. The mechanisms involved include: autonomic neuropathy, acute hyperglycaemia, and abnormalities in gastrointestinal hormones and neuropeptides. Other possible contributing factors such as hypothyroidism and H. pylori infection are discussed as well. Because treatment is possible by means of dietary advise, prokinetics or surgical procedures, it is important to identify risk factors for and to diagnose gastroparesis to prevent morbidity by controlling gastrointestinal symptoms, and to enhance glucoregulation. Understanding the current advances is key to the development of novel therapeutic strategies and for making rational choices in the management of diabetic gastroparesis.

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Jejunostomy Feeding in the Management of Gastroparesis Diabeticorum

Cited by 33 publications

References 0 publications

Management of Diabetic Gastroparesis

Management of Diabetic Gastroparesis

Nutrition concerns for the patient with gastroparesis

Current Concepts in Gastric Motility in Diabetes Mellitus

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