A Multicenter Placebo-controlled Clinical Trial of Oral Metoclopramide in Diabetic Gastroparesis

McCallum, Richard W.; Ricci, Dominick A.; Rakatansky, Herbert; Behar, José; Rhodes, James B.; Salen, Gerald; Deren, Julius J.; Ippoliti, Andrew; Olsen, Harvey W.; Falchuk, Kenneth R.; Hersh, Theodore

doi:10.2337/diacare.6.5.463

Cited by 127 publications

(80 citation statements)

References 25 publications

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“…The majority of the studies included patients with diabetic gastroparesis [9, 12, 13, 16, 24, 26, 27, 28, 29, 30, 31, 32, 33, 35, 36, 37, 38, 39], patients with diabetic and idiopathic gastroparesis [8, 10, 15, 17, 18, 20, 21, 23]or patients with only idiopathic gastroparesis [22, 25]. Two of the studies also included patients with gastroparesis due to a collagenosis [11, 34]; 2 papers did not provide information regarding the underlying etiology [14, 19].…”

Section: Resultsmentioning

confidence: 99%

“…Four studies using clonidine, renzapride, EM523L and levosulpiride were excluded because only one trial was done with each of these compounds, resulting in a patient number that was too low to achieve statistical significance [4, 5, 6, 7]. This left 32 studies involving a total of 496 patients eligible for further analysis [8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39]. Four of these 32 studies measured the influence of two different prokinetic agents on gastric emptying and symptom score and, because of this, were analyzed separately for each drug [14, 16, 20, 31].…”

Section: Methodsmentioning

confidence: 99%

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Prokinetics in Patients with Gastroparesis: A Systematic Analysis

et al. 1999

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Background: The relative potency of prokinetics in patients with gastroparesis has not been systematically studied. This study, therefore, aimed to assess the available data and to compare the effects of different prokinetics on symptoms and gastric emptying rates in patients with gastroparesis. Methods: A systematic search of the literature was performed, covering the period 1980 to March 1998. All identified studies were reviewed and the following data elements assessed: characteristics of study populations; sample sizes; treatment regimes; drug doses; study design; main outcome variables, and the validity of measurements. Results: In 36 studies, 514 patients were treated with prokinetics p.o. Most studies had methodological limitations (i.e. nonvalidated measurement of symptoms or unblinded treatment). The mean improvement in gastric emptying and the reduction in the symptom score was higher in the open trial group than in patients treated double-blind. Overall, erythromycin seems to have had the strongest effect on gastric emptying as compared to domperidone, cisapride or metoclopramide. Concerning gastrointestinal symptoms, the symptom scores appeared to improve more during treatment with erythromycin than with domperidone, metoclopramide or cisapride. Conclusions: Most of the available trials have methodological limitations; this limits the conclusions. However, the data suggest that the motilin-agonist erythromycin is superior with regard to the acceleration of gastric emptying, while both erythromycin and domperidone appear to be the most effective with regard to improvements in the symptom score. Additionally, there is a lack of association between changes in gastric emptying times and improvements in symptoms.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prokinetics in Patients with Gastroparesis: A Systematic Analysis

et al. 1999

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“…Furthermore, it is not certain whether the effects of these treatments on GI symptoms are related to improvements in gastric emptying time [8]. Metoclopramide, one of the more commonly used drugs with dopamine D 2 -receptor antagonistic effects, has been assessed in four placebo-controlled trials, with effects superior to placebo and with improvement in gastric emptying time [9][10][11][12]. Because of the well-known central nervous system side effects, tardive dyskinesia being the most feared, both the US Food and Drug Administration (FDA) and European Medicines Agency recommend that metoclopramide is for short-term use.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Treatment of gastrointestinal autonomic neuropathy

Törnblom

2015

Diabetologia

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The symptoms caused by gastrointestinal autonomic neuropathy in diabetes mellitus is important to highlight since it affects a large proportion of people with diabetes, regardless of whether this is type 1 or type 2. Gastroparesis and general signs of bowel dysfunction, such as constipation, diarrhoea and abdominal pain are most often encountered and involve both pharmacological and non-pharmacological treatment options. This mini-review summarises a presentation given at the 'Diagnosis and treatment of autonomic diabetic neuropathy in the gut' symposium at the 2015 annual meeting of the EASD. It is accompanied by another mini-review on a topic from this symposium (by Azpiroz and Malagelada,

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“…Studies have shown these agents to increase gastric emptying by 25 to 75% and reduce the severity of symptoms by 25 to 68%. 10,11,12 When pain relief is required, tramadol and opiates should be avoided. These have inhibiting effects on motility.…”

Section: Managementmentioning

confidence: 99%

Case Report-The 46 year old man with a 5 month history of vomiting

Segula¹,

Mwandiambira²,

Howson³

et al. 2011

Mal. Med. J

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MalawiOn the 23rd of January 2011, we admitted a 46-year-old man to Queen Elizabeth Central Hospital (QECH) with a 5-month history of recurrent vomiting. This was associated with nausea. He would vomit at least 5 times per day. The vomitus was non-projectile, would usually take the colour of the food eaten and was never bilious. There was no history of abdominal pain, dysphagia, fever or headache. The colour of stools was normal but he had complained of constipation for 6 days prior to admission. He also admitted to weight loss, which could not be quantified. Prior to attending QECH he had been seen in several health facilities and had been treated with promethazine, but had had no relief of his symptoms. An endoscopy done at another hospital was documented as follows: 'endoscopy shows reflux oesophagitis and lax lower oesophageal sphincter' There was no comment on whether there were structural abnormalities at the level of the pylorus or duodenum. He had been diagnosed with type 2 diabetes mellitus in December 2010 on the basis of high random blood glucose readings. He had been prescribed glibenclamide but stopped as he felt it was making him vomit more, and was now only taking metformin. Blood glucose measurements since the start of treatment were not available so we do not know how well the diabetes had been controlled. He had a history of moderate alcohol consumption (< 20 units per week) but had not taken alcohol since the symptoms started. He had no history of smoking. He was HIV negative. He used to work as a foreman for a construction company but had stopped work owing to the severity of his symptoms. He was married with 3 children. There was no family history of diabetes. On examination, he was moderately cachexic and dehydrated. His blood pressure (BP) was 130/80 mmHg, temperature 37oC, pulse 92/minute, respiratory rate 28/minute. His conjunctivae were pink, there were no oral lesions and he had no lymphadenopathy, including Virchow's node. Chest examination was normal. Abdominal examination was normal except there were hard stools in the rectum. His fundoscopy showed dot and blot haemorrhages, consistent with background diabetic retinopathy. His random blood glucose concentration was 252mg/dl and there were no ketones in his urine. Blood potassium and sodium were 3.1 mmol/L (3.6 -5.0) and 127 mmol/L (135 -145) respectively. He had a normal blood creatinine and no proteinuria. Discussion 1) Causes of vomiting can be divided into gastrointestinal causes, central causes and metabolic causes. In this case the causes of vomiting that should be considered include gastrointestinal causes such as achalasia, gastric malignancy, pyloric stenosis, gastric or duodenal ulcer, gastroparesis and generalized motility disorders such as intestinal myopathies and neuropathies. Central causes include migraine, cyclical vomiting, psychogenic vomiting, space occupying lesions and labyrinthitis. Metabolic causes such as drugs, hypercalcaemia and hyponatraemia should also be considered. 2)A careful history and examination ar...

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A Multicenter Placebo-controlled Clinical Trial of Oral Metoclopramide in Diabetic Gastroparesis

Cited by 127 publications

References 25 publications

Prokinetics in Patients with Gastroparesis: A Systematic Analysis

Prokinetics in Patients with Gastroparesis: A Systematic Analysis

Treatment of gastrointestinal autonomic neuropathy

Case Report-The 46 year old man with a 5 month history of vomiting

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