Comparison of Metoclopramide and Erythromycin in the Treatment of Diabetic Gastroparesis

Erbaş, Tomris; Varoglu, Erhan; Erbaş, Belkıs; Taştekin, Güngör; Akalın, Sema

doi:10.2337/diacare.16.11.1511

Cited by 102 publications

(66 citation statements)

References 7 publications

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“…Erythromycin given as either a liquid or suppository also can be helpful. Erythromycin acts on the motilin receptor, ªthe sweeper of the gutº, and shortens gastric emptying time [111]. If medications fail and severe gastroparesis persists, jejunostomy placement into normally functioning bowel could be needed.…”

Section: Gastropathymentioning

confidence: 99%

Diabetic neuropathies

et al. 2000

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Diabetic neuropathy is a most common and troublesome complication of diabetes mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care [1,2]. It is the most common form of neuropathy in the developed countries of the world, accounts for more admission to hospital than all the other diabetic complications combined and is responsible for 50±75 % of non-traumatic amputations [2,3]. Diabetic neuropathy is a set of clinical syndromes that affect distinct regions of the nervous system, singly or combined. It can be silent and go undetected, while exercising its ravages, or be present with clinical symptoms and signs that although non-specific and insidious with slow progression also mimic those seen in many other diseases. It is, therefore, diagnosed by exclusion.Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting proximal and distal peripheral sensory and motor nerves as well as the autonomic nervous systems. For these reasons, it has been difficult to obtain precise estimates of the true prevalence and reports vary from 10 to 90 % in diabetic patients, depending on the criteria and methods used to define neuropathy [1±5]. From patients attending a diabetes clinic 25 % reported symptoms; 50 % were found to have neuropathy after a simple clinical test such as the ankle jerk or vibration perception test; almost 90 % tested positive to sophisticated tests of autonomic function or peripheral sensation [6]. Neurologic complications occur equally in Type I (insulin-dependent) and Type II (non-insulin-dependent) diabetes mellitus and additionally in various forms of acquired diabetes [5]. The major morbidity associated with somatic neuropathy is foot ulceration, the precursor of gangrene and limb loss. Neuropathy increases the risk of amputation 1.7-fold; 12-fold, if there is deformity (itself a consequence of neuropathy), and 36-fold, if there is a history of previous ulceration [7]. There are 65,000 amputations in the United States each year, one every 10 min, and neuropathy is considered to be the major contributor in 87 % of cases. It is also the most life-spoiling of the diabetic complications and has tremendous ramifications for the quality of life of the person with diabetes. Once autonomic neuropathy sets in, life can become quite dismal and the mortality rate approximates 25±50 % within 5±10 years [8,9]. In this review we present and discuss the most recent approaches to the diagnosis and treatment of diabetic neuropathy and the prospects on the horizon. ClassificationDiabetic neuropathy is not a single entity but a number of different syndromes, ranging from subclinical to clinical manifestations depending on the classes of nerve fibres involved. According to the San Antonio Convention [10], the main groups of neurologic disturbance in diabetes mellitus include: (1) subclinical neuropathy, determined by abnormalities in electrodiagnostic and quantitative sensory testing, (2) dif- Diabetologia (2000) 43:...

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Section: Gastropathymentioning

confidence: 99%

Diabetic neuropathies

et al. 2000

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“…In contrast, metoclopramide and erythromycin administration for 3 wks was equally effective for promoting gastric emptying in a randomized, crossover study involving 13 patients with diabetic gastroparesis. 45 With respect to order of administration, cisapride lost any trend toward significance compared with placebo but metoclopramide demonstrated significance compared with placebo. Moreover, metoclopramide significantly accelerated the onset of absorption compared with cisapride.…”

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confidence: 99%

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

MacLaren

Kuhl

Gervasio

et al. 2000

Critical Care Medicine

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“…It has shown similar effects but fewer adverse reactions compared with metoclopramide [13]. Erythromycin is a motilin receptor agonist that increases gastric emptying [14] and decreases symptoms, and these improvements are of the same order of magnitude as those observed with metoclopramide [15]. However, erythromycin has the obvious disadvantage of being an antibiotic, as over longer periods its symptom alleviating effects are subject to tachyphylaxia as a result of receptor downregulation.…”

Section: Pharmacological Treatmentmentioning

confidence: 83%

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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Comparison of Metoclopramide and Erythromycin in the Treatment of Diabetic Gastroparesis

Abstract: Erythromycin, a macrolide antibiotic and a motilin receptor agonist, appears to stimulate intestinal motility and seems to be an alternative agent for the treatment of gastroparesis caused by diabetic autonomic neuropathy.

Cited by 102 publications

References 7 publications

Diabetic neuropathies

Diabetic neuropathies

Sequential single doses of cisapride, erythromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: A randomized, placebo-controlled, crossover study

Treatment of gastrointestinal autonomic neuropathy

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