Current Gastroenterology Reports

, Volume 9, Issue 4, pp 261–269 | Cite as

Type 1 diabetes and gastroparesis: Diagnosis and treatment

Article

Abstract

Patients with gastroparesis present with gastrointestinal symptoms and non-gastrointestinal manifestations in association with objective delays in gastric emptying. The condition complicates the course of many patients with type 1 diabetes mellitus, usually in those with longstanding poor glycemic control with other associated diabetic complications. The diagnosis is made by directed evaluation to exclude organic diseases that can mimic the clinical presentation of gastroparesis, coupled with verification of gastric retention. Current therapy relies on dietary modifications, medications to stimulate gastric evacuation, and agents to reduce vomiting. Endoscopic and surgical options are increasingly used in patients who are refractory to drug treatment.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Soykan, I, Sivri B, Saroseik I, et al.: Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci 1998, 43:2398–2404.PubMedCrossRefGoogle Scholar
  2. 2.
    Cutts TF, Luo J, Starkebaum W, et al.: Is gastric electrical stimulation superior to standard pharmacologic therapy in improving GI symptoms, healthcare resources, and long-term health care benefits? Neurogastroenterol Motil 2005, 17:35–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Hoogerwerf WA, Pasricha PJ, Kalloo AN, Schuster MM: Pain: the overlooked symptom in gastroparesis. Am J Gastroenterol 1999, 94:1029–1033.PubMedCrossRefGoogle Scholar
  4. 4.
    Bytzer P, Talley NJ, Leemon M, et al.: Prevalence of gastro-intestinal symptoms associated with diabetes mellitus. Arch Intern Med 2001, 161:1989–1996.PubMedCrossRefGoogle Scholar
  5. 5.
    Eisenberg B, Murata GH, Tzamaloukas AH, et al.: Gastroparesis in diabetics on chronic dialysis: clinical and laboratory associations and predictive features. Nephron 1995, 70:296–300.PubMedCrossRefGoogle Scholar
  6. 6.
    Hasler W, Coleski R, Chey WD, et al.: Selective intragastric pH profile impairment in diabetic vs. idiopathic gastroparesis: relation to degree of gastric stasis [abstract]. Neurogastroenterol Motil 2006, 18:741.Google Scholar
  7. 7.
    Gaddipati KV, Simonian HP, Kresge KM, et al.: Abnormal ghrelin and pancreatic polypeptide responses in gastroparesis. Dig Dis Sci 2006, 51:1339–1346.PubMedCrossRefGoogle Scholar
  8. 8.
    Jones KL, Russo A, Berry MK, et al.: A longitudinal study of gastric emptying and upper gastrointestinal symptoms in patients with diabetes mellitus. Am J Med 2002, 113:449–455.PubMedCrossRefGoogle Scholar
  9. 9.
    Ejskjaer NT, Bradley JL, Buxton-Thomas MS, et al.: Novel surgical treatment and gastric pathology in diabetic gastroparesis. Diabet Med 1999, 16:488–495.PubMedCrossRefGoogle Scholar
  10. 10.
    Jackson MW, Gordon TP, Waterman SA: Disruption of intestinal motility by a calcium channel-stimulating autoantibody in type 1 diabetes. Gastroenterology 2004, 126:819–828.PubMedCrossRefGoogle Scholar
  11. 11.
    He CL, Soffer EE, Ferris CD, et al.: Loss of interstitial cells of Cajal and inhibitory innervation in insulin-dependent diabetes. Gastroenterology 2001, 121:427–434.PubMedCrossRefGoogle Scholar
  12. 12.
    Forster J, Damjanov I, Lin Z, et al.: Absence of interstitial cells of Cajal in patients with gastroparesis and correlation with clinical findings. J Gastrointest Surg 2005, 9:102–108.PubMedCrossRefGoogle Scholar
  13. 13.
    Vittal H, Farrugia G, Pehlivanov ND, et al.: Neuropathological and genomic changes in the stomach of patients with human diabetic gastroparesis [abstract]. Gastroenterology 2006, 130:245.Google Scholar
  14. 14.
    Horvath VJ, Vittal H, Lorincz A, et al.: Reduced stem cell factor links smooth myopathy and loss of interstitial cells of Cajal in murine diabetic gastroparesis. Gastroenterology 2006, 130:759–770.PubMedCrossRefGoogle Scholar
  15. 15.
    Samsom M, Salet GA, Roelofs JM, et al.: Compliance of the proximal stomach and dyspeptic symptoms in patients with type I diabetes mellitus. Dig Dis Sci 1995, 40:2037–2042.PubMedCrossRefGoogle Scholar
  16. 16.
    Rathmann W, Enck P, Frieling T, Gries FA: Visceral afferent neuropathy in diabetic gastroparesis. Diabetes Care 1991, 14:1086–1089.PubMedCrossRefGoogle Scholar
  17. 17.
    Revicki DA, Rentz AM, Dubois D, et al.: Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther 2003, 18:141–150.PubMedCrossRefGoogle Scholar
  18. 18.
    de la Loge C, Trudeau E, Marquis P, et al.: Cross-cultural development and validation of a self-administered questionnaire to assess quality of life in upper gastrointestinal disorders: the PAGI-QOL. Qual Life Res 2004, 13:1751–1762.PubMedCrossRefGoogle Scholar
  19. 19.
    House A, Champion MC, Chamberlain M: National survey of radionuclide gastric emptying studies. Can J Gastroenterol 1997, 11:317–321.PubMedGoogle Scholar
  20. 20.
    Tougas G, Eaker EY, Abell TL, et al.: Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 2000, 95:1456–1462.PubMedCrossRefGoogle Scholar
  21. 21.
    Guo JP, Maurer AH, Fisher RS, Parkman HP: Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis. Dig Dis Sci 2001, 46:24–29.PubMedCrossRefGoogle Scholar
  22. 22.
    Galil MA, Critchley M, Mackie CR: Isotope gastric emptying tests in clinical practice: expectation, outcome, and utility. Gut 1993, 34:916–919.PubMedGoogle Scholar
  23. 23.
    Kuo B, McCallum RW, Koch KL, et al.: SmartPill, a novel ambulatory diagnostic test for measuring gastric emptying in health and disease [abstract]. Gastroenterology 2006, 130:M2205.Google Scholar
  24. 24.
    Gamilleri M, Malagelada J-R: Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Eur J Clin Invest 1984, 14:420–427.CrossRefGoogle Scholar
  25. 25.
    Chen JD, Lin Z, Pan J, McCallum RW: Abnormal gastric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci 1996, 41:1538–1545.PubMedCrossRefGoogle Scholar
  26. 26.
    Koch KL, Stern RM, Stewart WR, Vasey MW: Gastric emptying and gastric myoelectrical activity in patients with diabetic gastroparesis: effect of long-term domperidone treatment. Am J Gastroenterol 1989, 84:1069–1075.PubMedGoogle Scholar
  27. 27.
    Abell TL, Bernstein RK, Cutts T, et al.: Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil 2006, 18:263–283.PubMedCrossRefGoogle Scholar
  28. 28.
    Sturm A, Holtmann G, Goebell H, Gerken G: Prokinetics in patients with gastroparesis: a systematic analysis. Digestion 1999, 60:422–427.PubMedCrossRefGoogle Scholar
  29. 29.
    Parkman HP, Hasler WL, Fisher RS: American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 2004, 127:1592–1622.PubMedCrossRefGoogle Scholar
  30. 30.
    Ganzini L, Casey DE, Hoffman WF, McCall AL: The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders. Arch Intern Med 1993, 153:1469–1475.PubMedCrossRefGoogle Scholar
  31. 31.
    Ray WA, Murray KT, Meredith S, et al.: Oral erythromycin and the risk of sudden death from cardiac causes. N Engl J Med 2004, 351:1089–1096.PubMedCrossRefGoogle Scholar
  32. 32.
    Tougas G, Chen Y, Luo D, et al.: Tegaserod improves gastric emptying in patients with gastroparesis and dyspeptic symptoms [abstract]. Gastroenterology 2003, 124:A54.CrossRefGoogle Scholar
  33. 33.
    Stacher G, Schernthaner G, Francesconi M, et al.: Cisapride versus placebo for 8 weeks on glycemic control and gastric emptying in insulin-dependent diabetes: a double blind cross-over trial. J Clin Endocrinol Metab 1999, 84:2357–2362.PubMedCrossRefGoogle Scholar
  34. 34.
    Lossos IS, Mevorach D, Oren R: Thiethylperazine treatment of gastroparesis diabeticorum. Ann Pharmacother 1992, 26:1016.PubMedGoogle Scholar
  35. 35.
    Prakash C, Lustman PJ, Freedland KE, Clouse RE: Tricyclic antidepressants for functional nausea and vomiting. Dig Dis Sci 1998, 43:1951–1956.PubMedCrossRefGoogle Scholar
  36. 36.
    Sawhney MS, Prakash C, Lustman PJ, Clouse RE: Tricyclic antidepressants for persistent or recurrent vomiting in diabetic persons [abstract]. Gastroenterology 2001, 120:A243.CrossRefGoogle Scholar
  37. 37.
    Kim SW, Shin IS, Kim JM, et al.: Mirtazepine for severe gastroparesis unresponsive to conventional prokinetic treatment. Psychosomatics 2006, 47:440–442.PubMedCrossRefGoogle Scholar
  38. 38.
    Wang L: Clinical observation on acupuncture treatment in 35 cases of diabetic gastroparesis. J Tradit Chin Med 2004, 24:163–165.PubMedGoogle Scholar
  39. 39.
    Lacy BE, Crowell MD, Schettler-Duncan A, et al.: The treatment of diabetic gastroparesis with botulinum toxin injection into the pylorus. Diabetes Care 2004, 27:2341–2347.PubMedCrossRefGoogle Scholar
  40. 40.
    Bromer MQ, Friedenberg F, Miller LS, et al.: Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. Gastrointest Endosc 2005, 61:833–839.PubMedCrossRefGoogle Scholar
  41. 41.
    Coleski R, Hasler W: Clinical and gastric functional predictors of symptom response to pyloric injection of botulinum toxin in patients with gastroparesis [abstract]. Neurogastroenterol Motil 2005, 17:628.Google Scholar
  42. 42.
    McCallum RW, Chen JD, Lin Z, et al.: Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology 1998, 114:456–461.PubMedCrossRefGoogle Scholar
  43. 43.
    Abell TL, Van Cutsem E, Abrahamsson H, et al.: Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion 2002, 66:204–212.PubMedCrossRefGoogle Scholar
  44. 44.
    van der Voort IR, Becker JC, Dietl KH, et al.: Gastric electrical stimulation results in improved metabolic control in diabetic patients suffering from gastroparesis. Exp Clin Endocrinol Diab 2005, 113:38–42.CrossRefGoogle Scholar
  45. 45.
    Abell, T, McCallum, R, Hocking, M, et al.: Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 2003, 125:421–428.PubMedCrossRefGoogle Scholar
  46. 46.
    Watkins PJ, Buxton-Thomas MS, Howard ER: Long-term outcome after gastrectomy for intractable diabetic gastroparesis. Diabet Med 2003, 20:58–63.PubMedCrossRefGoogle Scholar
  47. 47.
    Cashion AK, Holmes SL, Hathaway DK, Gaber AO: Gastroparesis following kidney/pancreas transplant. Clin Transplant 2004, 18:306–311.PubMedCrossRefGoogle Scholar
  48. 48.
    Fontana RJ, Barnett JL: Jejunostomy tube placement in refractory diabetic gastroparesis: a retrospective review. Am J Gastroenterol 1996, 91:2174–2178.PubMedGoogle Scholar
  49. 49.
    Clouse RE, Lustman PJ. Gastrointestinal symptoms in diabetic patients: lack of association with neuropathy. Am J Gastroenterol 1989, 84:868–872.PubMedGoogle Scholar
  50. 50.
    Murray CD, Martin NM, Patterson M, et al.: Ghrelin enhances gastric emptying in diabetic gastroparesis: a double blind, placebo controlled, crossover study. Gut 2005, 54:1693–1698.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Division of GastroenterologyUniversity of Michigan Health SystemAnn ArborUSA

Personalised recommendations