- •
Gastroparesis is delayed gastric emptying in the absence of obstruction, a complication that affects patients with type 2 as well as type 1 diabetes mellitus.
- •
Symptoms associated with gastroparesis are nonspecific, and the diagnoses should be confirmed with gastric emptying tests.
- •
Patients are often overweight and have nutritional deficiencies.
- •
Obstructive gastroparesis, a subset of gastroparesis, is caused by pyloric dysfunction, and botulinum toxin A injections may be helpful.
- •
Trending
Diabetic Gastroparesis
Section snippets
Key points
Epidemiology
A recent update reported that there are more than 36 million individuals with diabetes in North America and the Caribbean6 and most are cases of T2DM. The estimates of prevalence of gastroparesis in T1DM vary widely. Although in tertiary centers, up to 40% of patients with T1DM have gastroparesis,7 surveys in Olmsted County, Minnesota, indicated a prevalence of 5%.8
Similarly, in specialized centers, 10% to 30% of patients with T2DM have gastroparesis9; in Olmsted County, the prevalence was 1%.10
Normal postprandial gastric neuromuscular activity
The normal stomach performs a series of complex neuromuscular activities in response to the ingestion of solid foods.16 First, the fundus relaxes to accommodate the volume of ingested food (Fig. 1). Normal fundic relaxation requires an intact vagus nerve and is mediated by enteric neurons containing nitric oxide. The relaxation of the fundus allows food to be accommodated without excess stretch on the fundic walls.
Second, the corpus and antrum produce recurrent peristaltic waves that mix or
Gastric Neuropathy and Cajalopathy in Diabetic Gastroparesis
Full-thickness biopsies of the gastric corpus from patients with T1DM and T2DM and gastroparesis indicate that the disease is primarily a disease of gastric enteric neurons and ICCs.11, 12 We know that ICCs are depleted (<5/hpf compared with controls) in the diabetic gastroparesis stomach.11, 17 Gastric enteric neurons are decreased in numbers of cell bodies and processes are truncated. These neurons are surrounded by an immune infiltrate composed primarily of type 2 macrophages, suggesting a
Solid-Phase Gastric Emptying Test
Tests for gastroparesis and gastric dysrhythmias are nuclear medicine scintigraphy, wireless capsule endoscopy, and electrogastrography (EGG). These tests should be performed after upper endoscopy to rule out mechanical obstruction, which produces symptoms similar to gastroparesis. The most standardized test for gastric emptying is the technetium-labeled low-fat egg albumin-based meal.38, 39 The patient must stop prokinetic agents 7 days before the test, fast after midnight, and blood glucose
Acute dietary management of exacerbation of symptoms associated with gastroparesis
Patients who have frequent vomiting episodes that may lead to dehydration are coached to sip small volumes (Step 1 of Table 2; eg, 56.6 g [2 oz] over 30–60 minutes every hour) of electrolyte-containing liquids and bouillonlike soup broths throughout the day; this may be accomplished with commercially available sports drinks. The purpose is to restore hydration with salt and water. Nausea and vomiting often improve with hydration, and the patient may then advance to steps 2 and 3, as outlined in
References (61)
- et al.
IDF diabetes atlas. Diabetes in North America and the Caribbean: an update
Diabetes Res Clin Pract
(2014) - et al.
The incidence, prevalence, and outcomes of patients with gastroparesis in Olmstead County, Minnesota, from 1996 to 2006
Gastroenterology
(2009) - et al.
Delayed radionucleotide gastric emptying studies predict morbidity in diabetics with symptoms of gastroparesis
Gastroenterology
(2009) Integrated upper gastrointestinal response to food intake
Gastroenterology
(2006)- et al.
Proximal gastric compliance and perception of distension in type 1 diabetes mellitus: effects of hyperglycemia
Am J Gastroenterol
(2000) - et al.
Loss of interstitial cells of Cajal and inhibitory innervation in insulin-dependent diabetes
Gastroenterology
(2001) - et al.
Pyloric dysfunction in diabetics with recurrent nausea and vomiting
Gastroenterology
(1986) - et al.
Similarities and differences between diabetic and idiopathic gastroparesis
Clin Gastroenterol Hepatol
(2011) - et al.
Prevalence of symptoms suggestive of gastroparesis in a cohort of patients with diabetes mellitus
J Diabetes Complications
(2013) - et al.
Chronic abdominal wall pain: a frequently overlooked problem. Practical approach to diagnosis and management
Am J Gastroenterol
(2002)
Assessment of gastric emptying using a low fat meal: establishment of international control values
Am J Gastroenterol
The stimulation of antral motility by erythromycin is attenuated by hyperglycemia
Am J Gastroenterol
Clinical guideline: management of gastroparesis
Am J Gastroenterol
Diabetic gastroparesis: functional/morphologic background, diagnosis, and treatment options
Curr Diab Rep
Diabetic gastropathy: gastric neuromuscular dysfunction in diabetes mellitus. A review of symptoms, pathophysiology, and treatment
Dig Dis Sci
Coupling and propagation of normal and dysrhythmic gastric slow waves during acute hyperglycemia in healthy humans
Neurogastroenterol Motil
Hyperglycemia slows gastric emptying in type 1 diabetes mellitus
Diabetologia
Gastric emptying in diabetes: clinical significance and treatment
Diabet Med
Risk of gastroparesis in subjects with type 1 and type 2 diabetes in the general population
Am J Gastroenterol
Gastroparesis in type 2 diabetes mellitus: prevalence, etiology, diagnosis, and treatment
Curr Gastroenterol Rep
Cellular changes in diabetic and idiopathic gastroparesis
Gastroenterology
Ultrastructural differences between diabetic and idiopathic gastroparesis
J Cell Mol Med
The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT)
Diabetologia
Contrasting gastroparesis in type 1 (T1DM) vs. type 2 (T2DM) diabetes: clinical course after 48 weeks of follow-up and relation to comorbidities and health resource utilization
Gastroenterology
Gastric neuromuscular function and neuromuscular disorders
Abnormal initiation and conduction of slow wave activity in gastroparesis, defined by high-resolution electrical mapping
Gastroenterology
Electrogastrography for evaluation of patients with suspected gastroparesis
Interactions between gastric volume and duodenal nutrients in the control of liquid gastric emptying
Am J Physiol
Gastrointestinal satiety signals. I. An overview of gastrointestinal signals that influence food intake
Am J Physiol Gastrointest Liver Physiol
Effect of peptide YY3-36 on food intake in humans
Gastroenterology
Cited by (0)
Disclosures: 3 CPM Company, Shareholder; GlaxoSmithKline, Consultant (K.L. Koch, MD); The author has nothing to disclose (J. Calles-Escandón, MD).