Diabetic Gastroparesis: Principles and Current Trends in Management

Abstract

This article is a comprehensive review of diabetic gastroparesis, defined as delayed or disordered gastric emptying, including basic principles and current trends in management. This review includes sections on anatomy and physiology, diagnosis and differential diagnosis as well as management and current guidelines for treatment of diabetic gastroparesis. Diabetic gastroparesis (DGp) is a component of autonomic neuropathy resulting from long-standing poorly controlled type 1 and type 2 diabetes. The diagnostic workup of DGp first excludes obstruction and other causes including medications that may mimic delayed/disordered gastric emptying. Targeting nutrition, hydration, symptomatic relief and glycemic control are mainstays of treatment for DGp. Additionally, optimal treatment of DGp includes good glycemic management, often involving customizing insulin delivery using basal-bolus insulin and technology, including sensor-augmented pumps and continuous glucose monitoring systems. Prokinetic medications may be helpful in DGp symptoms, although only limited number of medications is currently available in the USA. Selected medication-refractory patients with DGp may benefit from gastric neuromodulation, and some from surgical interventions including pyloric therapies that can also be done endoscopically. As is true of any of the diabetic complications, prevention of DGp by early and optimal glycemic control is more cost-effective.Funding: Hansa Medcell, India.

PAN‐selective inhibition of cAMP‐phosphodiesterase 4 (PDE4) induces gastroparesis in mice

“…Digestion of food and emptying into the intestines is a complex process requiring the synchronized contraction of a series of muscles that is finely tuned and coordinated by sensory, hormonal, and enteric-and autonomic nervous system regulations. [61][62][63] How PDE4 inhibition induces gastroparesis at the tissue-, cell-and molecular level remains to be delineated. At the tissue level, increased accommodation of the fundus, impairment of antral motility or pyloric relaxation, as well as duodenal dysmotility, may all potentially contribute to the observed phenotype.…”

“…In humans, abnormal gastric retention of food is a well-established symptomatic disorder termed gastroparesis, which is defined by delayed gastric emptying in the absence of mechanical obstruction. [61][62][63] Patients present with a constellation of symptoms of which nausea (>90%), vomiting (>80%), and early satiety and post-prandial fullness (60%) are most frequent. [62][63][64][65][66] Although the cause of gastroparesis is idiopathic in the majority of cases, 67 diabetes, post gastric surgery (eg, vagal nerve injury), various neurologic (eg, Parkinson's disease), endocrine, and eating disorders, as well as medications such as opioids and anticholinergics, are established causes.…”

“…[62][63][64][65][66] Although the cause of gastroparesis is idiopathic in the majority of cases, 67 diabetes, post gastric surgery (eg, vagal nerve injury), various neurologic (eg, Parkinson's disease), endocrine, and eating disorders, as well as medications such as opioids and anticholinergics, are established causes. [61][62][63]68 Given the strong association of gastroparesis with nausea and emesis in humans, we further explored the abnormal gastric retention of food we observed in mice treated with PDE4 inhibitors under the premise that it may represent a useful correlate of nausea and emesis in humans and hence provide a tool to further delineate the role of individual PDE4s in mediating the established adverse effects of PDE4 inhibitors. All PDE inhibitors, Clonidine and Yohimbine were initially dissolved in DMSO, subsequently diluted into phosphatebuffered saline (PBS), pH 7.4, containing final concentrations of 5% DMSO and 5% Cremophor EL (Millipore Sigma, St. Louis, MO) and were applied by intraperitoneal injection (100 µL per 20 g body weight).…”

Domination of Gastric Complications Among Diabetic Patients

“…In the USA, an estimated 5 million patients suffer from some form of GP, and the female: male ratio is 4:1. Many patients with delayed GE are asymptomatic; others have dyspepsia (i.e., mild-moderate indigestion, with or without a mild delay in GE) or GP, which is a syndrome characterized by moderatesevere upper gastrointestinal symptoms and delayed GE that suggest, but are not accompanied by, gastric outlet obstruction [5] . GP can markedly impair quality of life and up to 50% of patients have significant anxiety and/or depression [1,[6][7][8] .…”

The efficacy and safety of acupoint injection for diabetic gastroparesis

“…Diabetic gastroparesis (DGP) is a common complication of diabetes characterized by delayed gastric emptying with associated upper gastrointestinal symptoms in the absence of any mechanical obstruction. [ 1 , 2 ] The main symptoms of DGP include prolonged postprandial fullness, early satiety, nausea, vomiting, anorexia, weight loss, with or without abdominal pain. [ 3 – 6 ] Due to delayed gastric emptying, DGP is easy to bring about impaired glycemic control, poor nutrition and hydration status, even worse frequent hospitalizations.…”