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diabetic gastroparesis
Epidemiology:
1) most common cause of gastroparesis
2) 50% of patients with type 1 diabetes have evidence of delayed gastric emptying on scintigraphy; however, relatively few report symptoms
Pathology:
- isolated or gut-wide neuropathy of the enteric or autonomic nervous system
Clinical manifestations:
1) nausea/vomiting
2) bloating
3) postprandial fullness with early satiety
4) abdominal discomfort (50=90%)
5) abdominal distension, abdominal tenderness
6) diarrhea
7) most patients have had diabetes mellitus for >= 10 years
8) concomitant peripheral neuropathy is common
9) concomitant nephropathy is common
10) severity of symptoms does NOT correlate with severity of gastric emptying disorder
11) improvement of gastric emptying with pharmacologic therapy does NOT improve symptoms
Management:
1) improved glycemic control can improve gastric emptying
2) prokinetic drugs may alleviate symptoms
a) metoclopramide
b) erythromycin
3) diarrhea
a) tetracycline may decrease diarrhea caused by bacterial overgrowth
b) clonidine
c) diphenoxylate/atropine (Lomotil)
4) easy-to-mash & pureed foods may amelirate some symptoms [2]
Related
diabetes mellitus
General
gastroparesis
autonomic dysfunction (dysautonomia)
diabetes mellitus complication
chronic gastrointestinal disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16.
American College of Physicians, Philadelphia 1998, 2012
- Olausson EA et al.
A small particle size diet reduces upper gastrointestinal
symptoms in patients with diabetic gastroparesis:
A randomized controlled trial.
Am J Gastroenterol 2014 Mar; 109:375
PMID: 24419482