Management of diabetic gastroparesis

Abstract

Symptoms suggestive of gastroparesis occur in 5% to 12% of patients with diabetes. Such a complication can affect both prognosis and management of the diabetes; therefore, practicing clinicians are challenged by the complex management of such cases. Gastroparesis is a disorder characterized by a delay in gastric emptying after a meal in the absence of a mechanical gastric outlet obstruction. This article is an evidence-based overview of current management strategies for diabetic gastroparesis. The cardinal symptoms of diabetic gastroparesis are nausea and vomiting. Gastroesophageal scintiscanning at 15-minute intervals for 4 hours after food intake is considered the gold standard for measuring gastric emptying. Retention of more than 10% of the meal after 4 hours is considered an abnormal result, for which a multidisciplinary management approach is required. Treatment should be tailored according to the severity of gastroparesis, and 25% to 68% of symptoms are controlled by prokinetic agents. Commonly prescribed prokinetics include metoclopramide, domperidone, and erythromycin. In addition, gastric electrical stimulation has been shown to improve symptoms, reduce hospitalizations, reduce the need for nutritional support, and improve quality of life in several open-label studies.

Chinese Herbal Medicine Banxiaxiexin Decoction Treating Diabetic Gastroparesis: A Systematic Review of Randomized Controlled Trials

“…Most patients improved glycemic control and symptoms by conventional treatment of western medicine [16, 17]. However, these managements are far from clinical satisfaction [18].…”

“…Current pieces of research have found that smooth muscle degeneration in DGP is caused by multiple factors, including autonomic nervous dysfunction, hyperglycemia, gastrointestinal hormone secretion disorder, abnormalities of interstitial cells of Cajal (ICC), and vascular lesions [11–14]. Based on blood glucose control, the available treatment options of modern medical treatment include nutritional support, improvement of gastric emptying using prokinetics, symptom control, and use of a gastric electric stimulator [15, 16]. The increasing number of drugs under development with different mechanisms of action improves clinical symptoms, whereas they are far from clinical satisfaction [17].…”

Proton-Pump Inhibitor Use and Potential Drug Interactions in Outpatients

“…Patients with diabetes often complain of the symptoms of upper GI disorders without any apparent cause. Particular tests could show a delay in emptying the stomach or diabetic gastroparesis, which commonly occur in people with DM types 1 and 2 [9]. Gastroparesis itself has been defined as the delayed emptying of the stomach characterized by a rapidly satiated, full feeling in the stomach, nausea, vomiting, bloating, and upper abdominal pain.…”

Treatment of Diabetic Gastroparesis by Complementary and Alternative Medicines

“…Routine Western medicine therapy for gastroparesis includes prokinetic agents, gastric pacemaking, and surgery. However, side effects like extrapyramidal symptoms, cardiac arhythmia, local infection, malnutrition, and weight loss are inevitable [ 5 ]. Acupuncture, moxibustion and massage are complementary alternative medicine techniques with reliable efficacy and fewer side effects, and are quickly becoming more widely used world-wide.…”