Novel surgical treatment and gastric pathology in diabetic gastroparesis

Ejskjær, Niels; Bradley, J. L.; Buxton-Thomas, M.; Edmonds, M E; Howard, Emma; Purewal, TS; Thomas, P. K.; Watkins, P J

doi:10.1046/j.1464-5491.1999.00086.x

Cited by 104 publications

(79 citation statements)

References 32 publications

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“…Prior studies in idiopathic gastroparesis failed to show abnormalities in the smooth muscle or myenteric plexus [34,35]. More recently, however, muscular atrophy was described in one small series of patients with diabetic gastroparesis undergoing gastric resection [36] and one case report of idiopathic gastroparesis [37].…”

Section: Discussionmentioning

confidence: 99%

Gastric Neuromuscular Pathology in Gastroparesis: Analysis of Full-Thickness Antral Biopsies

et al. 2009

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This study shows several pathologic abnormalities in the gastric tissue in some patients with refractory gastroparesis. An inflammatory infiltrate was present in nearly half of the patients with diabetic gastroparesis. There was a reduction in nerve cell bodies in both idiopathic and diabetic gastroparesis. A reduced number of ICCs were found in the myenteric plexus. Thus, histologic abnormalities in gastroparesis are heterogeneous and include myenteric inflammation, decreased innervation, and reduction of ICCs.

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Section: Discussionmentioning

confidence: 99%

Gastric Neuromuscular Pathology in Gastroparesis: Analysis of Full-Thickness Antral Biopsies

et al. 2009

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“…However, in humans with diabetic gastroparesis as a group, there is also a reduction in antral contractions and impaired antroduodenal coordination, while an increase in pyloric activity is not invariably observed (28). One group has reported a gastric myopathic process in patients with severe diabetic gastroparesis (29). Moreover, attempts to accelerate gastric emptying with sildenafil in diabetic gastroparesis have hitherto been disappointing (30).…”

Section: Translation Of Animal Findings To Human Diabetesmentioning

confidence: 99%

Gastrointestinal motility and glycemic control in diabetes: the chicken and the egg revisited?

Rayner

Horowitz

2006

Journal of Clinical Investigation

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“…Other surgical options have focused on improving GE with pyloroplasty and antrectomy (8). Total gastrectomy remains the ultimate surgical option (9).…”

mentioning

confidence: 99%

Treatment of Diabetic Gastroparesis by High-Frequency Gastric Electrical Stimulation

Lin

Forster²,

Sarosiek³

et al. 2004

Diabetes Care

171

153

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OBJECTIVE -To investigate the long-term efficacy of high-frequency gastric electrical stimulation (GES) for treating diabetic gastroparesis. RESEARCH DESIGN AND METHODS-This is a retrospective review of 48 adult diabetic patients with refractory gastroparesis who had a GES system implanted surgically and had follow-up evaluations at 6 and 12 months. The outcome measures were total symptom score (TSS), derived from six upper gastrointestinal (GI) symptom subscores; health-related quality of life (HQOL), including physical composite score (PCS) and mental composite score (MCS) assessed by SF-36 questionnaire, radionuclide gastric emptying test, nutritional status, HbA 1c , and adverse events.RESULTS -In comparison with baseline, TSS, all six upper GI symptom subscores, PCS, and MCS were significantly improved at 6 months, with the improvement sustained at 12 months. Of 13 patients receiving nutritional support at baseline by tube feeding, only 5 required supplemental enteral feeding at 12 months, and none of the 9 on total parenteral nutrition continued this support. The mean number of hospitalization days during the year after GES was significantly reduced by 52 days compared with the prior year. HbA 1c levels were significantly reduced at 12 months. Gastric emptying was only minimally and not significantly faster. Because of infections at the pulse generator pocket site, four patients had their GES systems removed 3-17 months postsurgery.CONCLUSIONS -In diabetic patients with refractory gastroparesis, high-frequency GES by a permanently implanted system significantly improved upper GI symptoms, HQOL, nutritional status, glucose control, and hospitalizations with an acceptably low complication rate.

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Novel surgical treatment and gastric pathology in diabetic gastroparesis

Abstract: Satisfactory relief of intractable vomiting from diabetic gastroparesis was achieved by a novel radical surgical procedure. Histopathological findings suggest that gastromyopathy may contribute to the production of this syndrome.

Cited by 104 publications

References 32 publications

Gastric Neuromuscular Pathology in Gastroparesis: Analysis of Full-Thickness Antral Biopsies

Gastric Neuromuscular Pathology in Gastroparesis: Analysis of Full-Thickness Antral Biopsies

Gastrointestinal motility and glycemic control in diabetes: the chicken and the egg revisited?

Treatment of Diabetic Gastroparesis by High-Frequency Gastric Electrical Stimulation

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