Digestive Diseases and Sciences

, Volume 44, Issue 6, pp 1061–1075 | Cite as

Diabetic Gastropathy (Gastric Neuromuscular Dysfunction in Diabetes Mellitus A Review of Symptoms, Pathophysiology, and Treatment)

  • Kenneth L. Koch


Diabetic gastropathy is a term that encompassesa number of neuromuscular dysfunctions of the stomach,including abnormalities of gastric contractility, tone,and myoelectrical activity in patients with diabetes. These abnormalities range fromtachygastrias to antral hypomotility and frankgastroparesis. Diabetic gastropathies may be acutelyproduced during hyperglycemia. Symptoms of chronicdiabetic gastropathy include chronic nausea, vague epigastricdiscomfort, postprandial fullness, early satiety, andvomiting. Because these symptoms are nonspecific, otherdisorders such as mechanical obstruction of thegastrointestinal tract, gastroesophageal reflux disease,cholecystitis, pancreatitis, mesenteric ischemia, anddrug effects should be considered. Neuromuscularabnormalities of the stomach may be assessednoninvasively with gastric emptying tests,electrogastrography, and ultrasound. Gastrokineticagents such as metoclopramide, cisapride, domperidone,and erythromycin increase fundic or antral contractionsand/or eradicate gastric dysrhythmias. Diet and glucose controlalso are important in the management of diabeticgastropathy. As the pathophysiology of diabeticgastropathy is better understood, more specific andimproved treatments will evolve.



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  1. 1.
    Feldman M, Schiller LR: Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 98:378–384, 1983Google Scholar
  2. 2.
    Undeland KA, Hausken T, Svebak S, Aanderud S, Berstad A: Wide gastric antrum and low vagal tone in patients with diabetes mellitus type I compared to patients with functional dyspepsia and healthy individuals. Dig Dis Sci 41:9–16, 1996Google Scholar
  3. 3.
    Wooten RL, Meriwether TW: Diabetic gastric atony: A clinical study. JAMA 176:68–73, 1961Google Scholar
  4. 4.
    Horowitz M, Edelbroek M, Fraser R, Maddox A, Wishart J: Disordered gastric motor function in diabetes mellitus. Recent insights into prevalence, pathophysiology, clinical relevance, and treatment. Scand J Gastroenterol 26:673–684, 1991Google Scholar
  5. 5.
    Koch KL, Stern RM, Stewart WR, Vasey MW: Gastric emptying and gastric myoelectrical activity in patients with diabetic gastroparesis: Effect of long-term dompe ridone treatment. Am J Gastroenterol 84:1069–1075, 1989Google Scholar
  6. 6.
    Abell TL, Camilleri M, Hench VS, Malagelada J-R: Gastric electromechanical function and gastric emptying in diabetic gastroparesis. Eur J Gastroenterol Hepatol 3:163–167, 1991Google Scholar
  7. 7.
    Rothstein RD, Alavi A, Reynolds JC: Electrogastrography in patients with gastroparesis and effect of long-term cisapride. Dig Dis Sci 38:1518–1524, 1993Google Scholar
  8. 8.
    Malagelada J-R, Rees WDW, Mazzotta LJ, Go VLW: Gastric motor abnormalities in diabetic and postvagotomy gastropare-sis: Effect of metoclopramide and bethanechol. Gastroenterology 78:286–293, 1980Google Scholar
  9. 9.
    Lin HC, Hasler WL: Disorders of gastric emptying. In Textbook of Gastroenterology, 2nd ed. T Yamada (ed). Philadelphia, JB Lippincott, 1995, pp 1318–1346Google Scholar
  10. 10.
    Clouse RE, Lustman PJ: Gastrointestinal symptoms in diabetic patients: Lack of association with neuropathy. Am J Gastroenterol 84:868–872, 1989Google Scholar
  11. 11.
    Koch KL: Approach to the patient with nausea and vomiting. In Textbook of Gastroenterology, 2nd ed. T Yamada (ed). Philadelphia, JB Lippincott, 1995, pp 731–749Google Scholar
  12. 12.
    Koch KL: Stomach. In Atlas of Gastrointestinal Motility in Health and Disease. MM Schuster (ed). Baltimore, Williams and Wilkins, 1993, pp 158–176Google Scholar
  13. 13.
    Malagelada J-R, Azpiroz F, Mearin F: Gastroduodenal motor function in health and disease. In Gastrointestinal Disease: Pathophysiology/Diagnosis/Management, Vol 1. MH Sleisenger, JS Fordtran (eds). Philadelphia, WB Saunders, 1993, pp 486–508Google Scholar
  14. 14.
    Goyal RK, Hirano I: The enteric nervous system. N Engl J Med 334:1106–1115, 1996Google Scholar
  15. 15.
    Thuneberg L: Interstitial cells of Cajal. In Handbook of Phys-iology, The Gastrointestinal System, Sect 6, Vol 1, Part 1. JD Wood (ed). Bethesda, American Physiological Society, 1989, pp 349–386Google Scholar
  16. 16.
    Hinder RA, Kelly KA: Human gastric pacesetter potential. Site of origin, spread, and response to gastric transection and proximal gastric vagotomy. Am J Surg 133:29–33, 1978Google Scholar
  17. 17.
    Koch KL, Stern RM: Functional disorders of the stomach. Semin Gastrointest Dis 7:185–195, 1996Google Scholar
  18. 18.
    Koch KL, Stewart WR, Stern RM: Effect of barium meals on gastric electromechanical activity in man. A fluoroscopicele ctrogastrographic study. Dig Dis Sci 32:1217–1222, 1987Google Scholar
  19. 19.
    Kassander P: Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 48:797–812, 1958Google Scholar
  20. 20.
    Horowitz M, Harding PE, Maddox AF, Wishart JM, Akkermans LMA, Chatterton BE, Shearman DJC: Gastric and oesophageal emptying in patients with type 2 (non-insulindependent) diabetes mellitus. Diabetologia 32:151–159, 1989Google Scholar
  21. 21.
    Zitomer BR, Gramm HF, Kozak GP: Gastric neuropathy in diabetes mellitus: Clinical and radiographic observations. Metabolism 17:199–211, 1968Google Scholar
  22. 22.
    Hodges DS: Extrinsic nerve dysfunction causing gastrointestinal dysmotility. In Motility Disorders of the Gastrointestinal Tract: Principles and Practice. S Anuras (ed). New York, Raven Press, 1992, pp 255–297Google Scholar
  23. 23.
    Yoshida MM, Schuffler MD, Sumi SM: There are no morphologic abnormalities of the gastric wall or abdominal vagus in patients with diabetic gastroparesis. Gastroenterology 94:907–914, 1988Google Scholar
  24. 24.
    Koch KL, Stern RM: Electrogastrography. In An Illustrated Guide to Gastrointestinal Motility, 2nd ed. D Kumar, D Wingate (eds). London, Churchhill Livingstone, 1993, pp 290–307Google Scholar
  25. 25.
    Stern RM, Koch KL, Stewart WR, Vasey MW: Electrogastrography: Current issues in validation and methodology. Psychophysiology 24:55–64, 1987Google Scholar
  26. 26.
    Jebbink HJA, Bruijs PPM, Bravenboer B, Akkermans LMA, van Berge-Henegouwen GP, Smout AJPM: Gastric myoelectrical activity in patients with Type I diabetes mellitus and autonomic neuropathy. Dig Dis Sci 39:2376–2383, 1994Google Scholar
  27. 27.
    Cucchiara S, Minella R, Riezzo G, Vallone G, Vallone P, Castellone F, Auricchio S: Reversal of gastric electrical dysrhythmias by cisapride in children with functional dyspepsia.Report of three cases. Dig Dis Sci 37:1136–1140, 1992Google Scholar
  28. 28.
    Hausken T, Berstad A: Wide gastric antrum in patients with non-ulcer dyspepsia. Effect of cisapride. Scand J Gastroenterol 27:427–432, 1992Google Scholar
  29. 29.
    Mearin F, Camilleri M, Malagelada J-R: Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology 90:1919–1925, 1986Google Scholar
  30. 30.
    Undeland KA, Hausken T, Aanderud S, Berstad A: Lower postprandial gastric volume response in diabetic patients with vagal neuropathy. Neurogastroenterol Motil 9:19–24, 1997Google Scholar
  31. 31.
    Koch KL, Stern RM, Vasey MW, Seaton JF, Demers LM, Harrison TS: Neuroendocrine and gastric myoe lectrical re-sponses to illusory self-motion in humans. Am J Physiol 258:E304–E310, 1990Google Scholar
  32. 32.
    Stoddard CJ, Smallwood RH, Duthie HL: Electrical arrhythmias in the human stomach. Gut 22:705–712, 1981Google Scholar
  33. 33.
    Hasler WL, Soudah HC, Dulai G, Owyang C: Mediation of hype rglycemia-evoked gastric slow-wave dysrhythmias by endogenous prostaglandins. Gastroenterology 108:727–736, 1995Google Scholar
  34. 34.
    Fraser R, Horowitz M, Dent J: Hype rglycaemia stimulates pyloric motility in normal subjects. Gut 32:475–478, 1991Google Scholar
  35. 35.
    Fraser RJ, Horowitz M, Maddox AF, Harding PE, Chatterton BE, Dent J: Hyperglycaemia slows gastric emptying in Type I ( insulin-dependent) diabetes mellitus. Diabetologia 33:675–680, 1990Google Scholar
  36. 36.
    Schvarcz E, Palmer M, Åman J, Horowitz M, Stridsberg M, Berne C: Physiological hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus. Gastroenterology 113:60–66, 1997Google Scholar
  37. 37.
    Keshavarzian A, Iber FL, Vaeth J: Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol 82:29–35, 1987Google Scholar
  38. 38.
    Keshavarzian A, Iber FL: Gastrointestinal involvement in insulin-requiring diabetes mellitus. J Clin Gastroenterol 9:685–692, 1987Google Scholar
  39. 39.
    Parkman HP, Fisher RS: Gastroparesis. In Consultations in Gastroenterology. WJ Snape, Jr (ed). Philadelphia, WB Saunders, 1996, pp 269–279Google Scholar
  40. 40.
    Zarich S, Waxman S, Freeman RT, Mittleman M, He garty P, Nesto RW: Effect of autonomic nervous system dysfunction on the circadian pattern of myocardial ischemia in diabetes mellitus. JACC 24:956–962, 1994Google Scholar
  41. 41.
    Nilsson P-H: Diabetic gastroparesis: A review. J Diab Comp 10:113–122, 1996Google Scholar
  42. 42.
    Weber FH, McCallum RW: Gastric motor disorders. In Consultations in Gastroenterology. WJ Snape, Jr (ed). Philadelphia, WB Saunders, 1996, pp 247–259Google Scholar
  43. 43.
    Barbara L, Camilleri M, Corinaldesi R, Crean GP, Heading RC, Johnson AG, Malagelada J-R, Stanghellini V, Wienbeck M: Definition and investigation of dyspepsia. Consensus of an international ad hoc working party. Dig Dis Sci 34:1272–1276, 1989Google Scholar
  44. 44.
    Rydall AC, Rodin GM, Olmsted MP, Devenyi RG, Daneman D: Disorde red eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med 336:1849–1854, 1997Google Scholar
  45. 45.
    Parkman HP, Harris AD, Krevsky B, Urbain J-LC, Maurer AH, Fisher RS: Gastroduodenal motility and dysmotility: An update on techniques available for evaluation. Am J Gastroenterol 90:869–892, 1995Google Scholar
  46. 46.
    Ghoos YF, Maes BD, Geypens BJ, Mys G, Hiele MI, Rutgeerts PJ, Vantrappen G: Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology 104:1640–1647, 1993Google Scholar
  47. 47.
    Berstad A, Hausken T, Gilja OH, Hveem K, Nesje LB, Ødegaard S: Ultrasonography of the human stomach. Scand J Gastroenterol 31( suppl 220):75–82, 1996Google Scholar
  48. 48.
    Schwizer W, Fraser R, Borovicka J, Asal K, Crelier G, Kunz P, Boesiger P, Fried M: Measurement of proximal and distal gastric motility with magnetic resonance imaging. Am J Physiol 271:G217–G222, 1996Google Scholar
  49. 49.
    Quigley EMM: Intestinal manome try-Technical advances, clinical limitations. Dig Dis Sci 37:10–13, 1992Google Scholar
  50. 50.
    Koch KL: Dyspepsia of unknown origin: Pathophysiology, diagnosis, and treatment. Dig Dis 15:316–329, 1997Google Scholar
  51. 51.
    Albibi R, McCallum RW: Metoclopramide: Pharmacology and clinical application. Ann Intern Med 98:86–95, 1983Google Scholar
  52. 52.
    Brogden RN, Carmine AA, Heel RC, Speight TM, Avery GS: Domperidone: A review of its pharmacological activity, pharmacokinetics and therapeutic efficacy in the symptomatic treatment of chronic dyspepsia and as an antiemetic. Drugs 24:360–400, 1982Google Scholar
  53. 53.
    Horowitz M, Harding PE, Chatterton BE, Collins PJ, Shear-man DJC: Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy. Dig Dis Sci 30:1–9, 1985Google Scholar
  54. 54.
    Silvers D, Kipnes M, Broadstone V, Patterson D, Quigley EMM, McCallum R, Joslyn A: Domperidone significantly im-proves gastrointestinal symptoms associated with diabetic gastroparesis. Gastroenterology 112( suppl):A826, 1997Google Scholar
  55. 55.
    Patterson D, Abell T, Rothstein RD, Koch K, Barnett J, Long J: A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic gastroparesis. Gastroenterology 106:A554, 1994Google Scholar
  56. 56.
    Soykan I, Sarosiek I, McCallum RW: The effect of chronic oral domperidone therapy on gastrointestinal symptoms, gastric emptying, and quality of life in patients with gastroparesis. Am J Gastroenterol 92:976–980, 1997Google Scholar
  57. 57.
    Wiseman LR, Faulds D: Cisapride. An updated review of its pharmacology and therapeutic efficacy as a prokinetic agent in gastrointestinal motility disorders. Drugs 47:116–152, 1994Google Scholar
  58. 58.
    Horowitz M, Maddox A, Harding PE, Maddern GJ, Chatterhorn BE, Wishart J, Shearman DJC: Effect of cisapride on gastric and esophageal emptying in insulin-dependent diabetes mellitus. Gastroenterology 92:1899–1907, 1987Google Scholar
  59. 59.
    Camilleri M, Malagelada J-R, Abell TL, Brown ML, Hench V, Zinsmeister AR: Effect of six weeks of treatment with cisapride in gastroparesis and intestinal pseudoobstruction. Gastroenterology 96:704–712, 1989Google Scholar
  60. 60.
    Janssens J, Peeters TL, Vantrappen G, Tack J, Urbain JL, De Roo M, Muls E, Bouillon R: Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. N Engl J Med 322:1028–1031, 1990Google Scholar
  61. 61.
    Richards RD, Davenport K, McCallum RW: The treatment of idiopathic and diabetic gastroparesis with acute intravenous and chronicoral erythromycin. Am J Gastroenterol 88:203–207, 1993Google Scholar
  62. 62.
    Koch KL, Bingaman S, Xu L, Stern RM, Muth E: Acute effects of acustimulation at Neiguan point on nausea and gastric myoelectrical activity in patients with chronic nausea. Gastroenterology 112(suppl):A763, 1997Google Scholar
  63. 63.
    GEMS Study Group: Report of a multicenter study on electrical stimulation for the treatment of gastroparesis. Gastroenterology 112(suppl):A735, 1997Google Scholar
  64. 64.
    Evans AT, Samuels SN, Marshall C, Bertolucci L E: Suppression of pregnancy-induced nausea and vomiting with sensory afferent stimulation. J Reprod Med 8:603–606, 1993Google Scholar
  65. 65.
    Dundee JW, Ghaly RG, Bill KM, Chestnutt WN, Fitzpatrick KTJ, Lynas AGA: Effect of stimulation of the P6 antiemetic point on postoperative nausea and vomiting. Br J Anaesth 63:612–618, 1989Google Scholar
  66. 66.
    Dundee JW, Yang J, McMillan C: Non-invasive stimulation of the P6 (Neiguan) antiemetic acupuncture point in cancer che-motherapy. J R Soc Med 84:210–212, 1991Google Scholar

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© Plenum Publishing Corporation 1999

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  • Kenneth L. Koch

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