Der Diabetologe

, Volume 2, Issue 2, pp 132–138 | Cite as

Diabetische Gastroparese

Leitthema
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Zusammenfassung

Die Symptome der Gastroparese können postprandiales Völlegefühl, Brechreiz, Übelkeit, vorzeitiges Sättigungsgefühl, Aufstoßen oder epigastrische Schmerzen sein, aber auch der asymptomatische Verlauf ist häufig. Bei schwer einzustellendem Diabetes sollte immer auch an eine Störung der Magenentleerung gedacht werden. Die Diagnostik kann mit dem 13C-Atemtest nichtinvasiv für flüssige und feste Speisen durchgeführt werden, Goldstandard für die Messung der Magenentleerung ist jedoch die Szintigraphie, mit welcher die nichtinvasiven Methoden gut korrelieren. Grundlegende therapeutische Maßnahmen sind die normnahe Blutglukoseeinstellung und eine fett- und ballaststoffarme, leicht verdauliche Diät, die aus 4–6 kleinen Mahlzeiten bestehen sollte. In der Regel lässt sich die Gastroparese medikamentös behandeln, und zwar mit den Dopaminantagonisten Metoclopramid und Domperidon oder dem Motilid Erythromycin. Bei pharmakotherapierefraktären Gastroparesen, die mit starker Übelkeit und rezidivierendem Erbrechen einhergehen, wird oft eine stationäre Therapie notwendig, da eine parenterale Ernährung oder die Ernährung über eine Jejunalsonde angezeigt sind. Die Wertigkeit von elektrischen Magenschrittmachern auf Magenentleerung und spezifische Symptomenbesserung ist unklar und Gegenstand experimenteller Studien.

Schlüsselwörter

Gastroparese Diabetes mellitus Magenschrittmacher Diagnostik Therapie 

Diabetic gastroparesis

Abstract

Symptoms of gastroparesis include nausea and vomiting, early satiety, post-prandial fullness, bloating and abdominal pain, but it is also frequently be asymptomatic. Patients with difficult metabolic control should be considered to have a disordered gastric emptying. Nuclear scintigraphy is the gold standard for quantifying delayed gastric emptying, but noninvasive methods, such as 13C-octanoic acid breath tests, exhibit a highly significant positive correlation to scintigraphy. The main goal of treatment is to minimize the symptoms and accelerate gastric emptying. The basic measures for achieving this are improved glucose control and low fat/low fibre diets that are easy to digest. The prokinetic agents metoclopramide, domperidone and erythromycin are successful in controlling symptoms in the majority of patients with gastroparesis due to diabetes. Patients with persistent symptoms or intermittent but severe symptoms may require surgical techniques such as the gastrostomy and jejunostomy. The significance of gastric pacing devices on gastric emptying and specific symptom controls have to be elucidated in further studies.

Keywords

Gastroparesis Diabetes mellitus Gastric pacemaker Diagnostic Therapy 

Notes

Interessenkonflikt:

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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© Springer Medizin Verlag 2006

Authors and Affiliations

  1. 1.Psychosomatik und PsychotherapieInnere Medizin VI, Universitätsklinikum Tübingen
  2. 2.Psychosomatik und PsychotherapieInnere Medizin VI, UniversitätsklinikumTübingen

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