Pathophysiology and Management of Diabetic Gastropathy

Abstract

Delayed gastric emptying is frequently observed in patients with long-standing type 1 and type 2 diabetes mellitus, and potentially impacts on upper gastrointestinal symptoms, glycaemic control, nutrition and oral drug absorption. The pathogenesis remains unclear and management strategies are currently suboptimal. Therapeutic strategies focus on accelerating gastric emptying, controlling symptoms and improving glycaemic control. The potential adverse effects of hyperglycaemia on gastric emptying and upper gut symptoms indicate the importance of normalising blood glucose if possible. Nutritional and psychological supports are also important, but often neglected. A number of recent pharmacological and non-pharmacological therapies show promise, including gastric electrical stimulation. As with all chronic illnesses, a multidisciplinary approach to management is recommended, but there are few data regarding long-term outcomes.

Randomised clinical trial: ghrelin agonist TZP-101 relieves gastroparesis associated with severe nausea and vomiting - randomised clinical study subset data

“…9 In diabetic patients with gastroparesis, 10 severe nausea and vomiting can impact on glycaemic control and nutritional status. 11,12 Current management of refractory nausea and vomiting due to gastroparesis includes rehydration with IV fluids, intensive management of high glucose levels (in diabetic patients) and treatment with intravenously administered prokinetic and anti-emetic agents. 13 Currently available pharmaceutical options for patients with severe gastroparesis and frequent nausea and vomiting are insufficient, with a consequent need for lengthy stays in hospital, which may eventually require surgical or other invasive interventions (e.g.…”

The management of diabetic gastroparesis remains less than optimal, despite the use of a multidisciplinary approach

“…[1,3] It has often been attributed to the presence of irreversible autonomic neuropathy in patients with diabetes. [1,3] It has often been attributed to the presence of irreversible autonomic neuropathy in patients with diabetes.…”

“…[1,3] Marked hyperglycaemia (16-20 mmol/L), compared with euglycaemia (5-8 mmol/L), prolongs the lag phase and half emptying time of solids and liquids and increases the proportion of diabetic patients in the 'gastroparetic' range. [1,3] Marked hyperglycaemia (16-20 mmol/L), compared with euglycaemia (5-8 mmol/L), prolongs the lag phase and half emptying time of solids and liquids and increases the proportion of diabetic patients in the 'gastroparetic' range.…”

Faces of ghrelin – research for the 21st century

“…4 Reduced GI transit contributes to poor oral drug absorption and nutrition and poor glycemic control. 5 A further unresolved issue, however, is postoperative inhibition of motility and ileus , 6 which can be severe after surgery for, for example, abdominal aortic aneurysm and radical cystectomy. Here again, this reduces the individualÕs ability to keep up to their metabolic needs and increase the risk for protein wasting and metabolic derangements.…”