Management of Dyspepsia and Gastroparesis in Patients with Diabetes. A Clinical Point of View in the Year 2021

Abstract

Diabetes mellitus is a widespread disease, and represents an important public health burden worldwide. Together with cardiovascular, renal and neurological complications, many patients with diabetes present with gastrointestinal symptoms, which configure the so-called diabetic enteropathy. In this review, we will focus on upper gastrointestinal symptoms in patients with diabetes, with particular attention to dyspepsia and diabetic gastroparesis (DG). These two clinical entities share similar pathogenetic mechanisms, which include autonomic neuropathy, alterations in enteric nervous system and histological abnormalities, such as interstitial cells of Cajal depletion. Moreover, the differential diagnosis may be challenging because of overlapping clinical features. Delayed gastric emptying should be documented to differentiate between DG and dyspepsia and it can be assessed through radioactive or non-radioactive methods. The clinical management of dyspepsia includes a wide range of different approaches, above all Helicobacter pylori test and treat. As regards DG treatment, a central role is played by dietary modification and glucose control and the first-line pharmacological therapy is represented by the use of prokinetics. A minority of patients with DG refractory to medical treatment may require more invasive therapeutic approaches, including supplemental nutrition, gastric electric stimulation, pyloromyotomy and gastrectomy.

Integrated Network Pharmacology and Gut Microbiota Study on the Mechanism of Huangqin Decoction in Treatment Diabetic Enteritis

“…Diabetes mellitus is a widespread disease. According to the International Diabetes Federation, it affects 463 million people worldwide with an increasing prevalence [ 1 ]. Diabetes is an important public health burden, mainly because of its cardiovascular, renal, and neurological complications.…”

Helicobacter pylori infection is associated with increased accumulation of advanced glycation end products in the skin in patients with type 1 diabetes: A preliminary study

“…16 Moreover, patients with DMT1 may show higher levels of HP colonization because of delayed gastric emptying and the occurrence of gastroparesis, as the result of autonomic neuropathy. 17 Chung et al demonstrated that the incidence of microalbuminuria was significantly higher in patients with DMT2 and coexisting HPI. 18 Similarly, in a study by Zizzi et al, it was found that HPI is associated with a higher incidence of proteinuria in patients with DMT2.…”

“…AST [U/L]19(16)(17)(18)(19)(20)(21)(22)(23)(24) ALT [U/L] 19(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) Creatinine[μmol/L] 79.6 (70.7-88.4) eGFR [mL/min/1.73 m 2 ] 87.6 (76.5-90) hsCRP [mg/dL] 1.5 (0.8-3.1) T-Ch [mmol/L] 48 (41.6-53.8) TAG [mmol/L] 1.1 (0.83-1.5) HDL-C [mmol/L] 1.6 (1.3-2) LDL-C [mmol/L] 2.6 (2.1-3.1) non-HDL-C [mmol/L] 3.1 (2.6-3.6) 25-OH vitamin D [mg/dL] 19 (13-29) VAI-K, n 1.8 (1.4-2.9) VAI-M, n 2.5 (1.6-4.1) eGDR [mg/kg/min] 8.2 (6-9.4) AGEs, SAF 2.2 (1.9-2.7) AGEs -advanced glycation end products; ALT -alanine aminotransferase; AST -aspartate aminotransferase; BMI -body mass index; DBP -diastolic blood pressure; DDI -daily dose of insulin; eGFR -estimated glomerular filtration rate; eGDR -estimated glucose disposal rate; HbA1c -glycated hemoglobin A1c; HC -hip circumference; HDL-C -…”

Smokers with Elevated Glycated Albumin Could Not Benefit from Dual Antiplatelet Therapy after Minor Stroke or Transient Ischemic Attack

“…However, smokers with diabetes could not benefit from dual antiplatelet therapy after AIS or TIA. Some underlying mechanisms may contribute to the abnormal pharmacokinetics of clopidogrel in patients with diabetes, such as decreased gastrointestinal drug absorption, increased prodrug and AM hydrolysis [8,27]. Moreover, the decreased efficacy of antiplatelet therapy is also related to platelet hyperactivity and the inhibition of the P2Y 12 signaling pathway in patients with diabetes [28].…”