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Treatment

Chapter
Part of the Clinical Gastroenterology book series (CG)

Abstract

For the most part, there are no specific guidelines for the management of upper gastrointestinal symptoms and disorders in the diabetic patient. Given the impact of hyperglycemia on upper gastrointestinal motility, attention must always be paid to glycemic control. Conversely, the impact of poor oral intake and recurrent vomiting on blood sugar levels and overall nutritional status must, at all times, be borne in mind. In the assessment of the diabetic with GERD, the possible contribution of impaired motility to symptomatology and its implications for therapy must be remembered. Many options are available for the symptomatic and supportive management of diabetic gastroparesis; their efficacy is often supported by a slim evidence base.

Keywords

Diabetes Gastroparesis Esophageal dysmotility GERD Prokinetic Proton pump inhibitor Gastric electrical stimulation Pylorus 

Abbreviations

5-HT

5-Hydroxytryptamine

EndoFLIP®

Endoscopic functional luminal imaging probe

GERD

Gastroesophageal reflux disease

GES

Gastric electrical stimulation

HbA1c

Glycated hemoglobin

PPI

Proton pump inhibitor

References

  1. 1.
    George NS, Rangan V, Geng Z, Khan F, Kichler A, Gabbard S, et al. Distribution of esophageal motor disorders in diabetic patients with dysphagia. J Clin Gastroenterol. 2017;51:890–5.CrossRefGoogle Scholar
  2. 2.
    Gustafsson RJ, Littorin B, Berntorp K, Frid A, Thorsson O, Olsson R, et al. Esophageal dysmotility is more common than gastroparesis in diabetes mellitus and is associated with retinopathy. Rev Diabet Stud. 2011;8:268–75.CrossRefGoogle Scholar
  3. 3.
    Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol. 2013;108:308–28.CrossRefGoogle Scholar
  4. 4.
    Hershcovici T, Fass R. Management of gastroesophageal reflux disease that does not respond well to proton pump inhibitors. Curr Opin Gastroenterol. 2010;26:367–78.CrossRefGoogle Scholar
  5. 5.
    Hershcovici T, Jha LK, Gadam R, Cui H, Gerson L, Thomson S, et al. The relationship between type 2 diabetes mellitus and failure to proton pump inhibitor treatment in gastroesophageal reflux disease. J Clin Gastroenterol. 2012;46(8):662.CrossRefGoogle Scholar
  6. 6.
    Malfertheiner P, Kandulski A, Venerito M. Proton-pump inhibitors: understanding the complications and risks. Nat Rev Gastroenterol Hepatol. 2017;14:697–710.CrossRefGoogle Scholar
  7. 7.
    Moayyedi P, Lewis MA. Proton pump inhibitors and dementia: deciphering the data. Am J Gastroenterol. 2017;112:1809–11.CrossRefGoogle Scholar
  8. 8.
    Villafuerte-Gálvez JA, Kelly CP. Proton pump inhibitors and risk of Clostridium difficile infection: association or causation? Curr Opin Gastroenterol. 2018;34:11–8.CrossRefGoogle Scholar
  9. 9.
    Landi SN, Sandler RS, Pate V, Lund JL. No increase in risk of acute myocardial infarction in privately insured adults prescribed proton pump inhibitors vs histamine-2 receptor antagonists (2002-2014). Gastroenterology. 2017.  https://doi.org/10.1053/j.gastro.2017.10.042. [epub ahead of print].
  10. 10.
    Cheung KS, Chan EW, Wong AYS, Chen L, Wong ICK, Leung WK. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study. Gut. 2018;67:28–35.CrossRefGoogle Scholar
  11. 11.
    Crouch MA, Mefford IN, Wade EU. Proton pump inhibitor therapy associated with lower glycosylated hemoglobin levels in type 2 diabetes. J Am Board Fam Med. 2012;25:50–4.CrossRefGoogle Scholar
  12. 12.
    Laudenbach JM, Epstein JB. Treatment strategies for oropharyngeal candidiasis. Expert Opin Pharmacother. 2009;10:1413–21.CrossRefGoogle Scholar
  13. 13.
    O'Rourke A. Infective oesophagitis: epidemiology, cause, diagnosis and treatment options. Curr Opin Otolaryngol Head Neck Surg. 2015;23:459–63.CrossRefGoogle Scholar
  14. 14.
    Asayama N, Nagata N, Shimbo T, Nishimura S, Igari T, Akiyama J, et al. Relationship between clinical factors and severity of esophageal candidiasis according to Kodsis classification. Dis Esophagus. 2013;27:214–9.CrossRefGoogle Scholar
  15. 15.
    Bytzer P, Talley NJ, Leemon M, Young LJ, Jones MP, Horowitz M. Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med. 2001;161:1989–96.CrossRefGoogle Scholar
  16. 16.
    Bytzer P, Talley NJ, Hammer J, Young LJ, Jones MP, Horowitz M. GI symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications. Am J Gastroenterol. 2002;97:604–11.CrossRefGoogle Scholar
  17. 17.
    Marathe CS, Rayner CK, Jones KL, Horowitz M. Novel insights into the effects of diabetes on gastric motility. Expert Rev Gastroenterol Hepatol. 2016;10:581–93.CrossRefGoogle Scholar
  18. 18.
    Sharma D, Morrison G, Joseph F, Purewal TS, Weston PJ. The role of continuous subcutaneous insulin infusion therapy in patients with diabetic gastroparesis. Diabetologia. 2011;54:2768–70.CrossRefGoogle Scholar
  19. 19.
    Jones KL, Russo A, Berry MK, Stevens JE, Wishart JM, Horowitz M. A longitudinal study of gastric emptying and upper gastrointestinal symptoms in patients with diabetes mellitus. Am J Med. 2002;113:449–55.CrossRefGoogle Scholar
  20. 20.
    Chang J, Rayner CK, Jones KL, Horowitz M. Prognosis of diabetic gastroparesis—a 25-year evaluation. Diabet Med. 2013;30:e185–8.CrossRefGoogle Scholar
  21. 21.
    Bharucha AE, Kudva Y, Basu A, Camilleri M, Low PA, Vella A, et al. Relationship between glycemic control and gastric emptying in poorly controlled type 2 diabetes. Clin Gastroenterol Hepatol. 2015;13:466–76.CrossRefGoogle Scholar
  22. 22.
    Thazhath SS, Jones KL, Horowitz M, Rayner CK. Diabetic gastroparesis: recent insights into pathophysiology and implications for management. Expert Rev Gastroenterol Hepatol. 2013;7:127–39.CrossRefGoogle Scholar
  23. 23.
    Vanormelingen C, Tack J, Andrews CN. Diabetic gastroparesis. Br Med Bull. 2013;105:213–30.CrossRefGoogle Scholar
  24. 24.
    Bouras EP, Vazquez Roque MI, Aranda-Michel J. Gastroparesis: from concepts to management. Nutr Clin Pract. 2013;28:437–47.CrossRefGoogle Scholar
  25. 25.
    Stevens JE, Jones KL, Rayner CK, Horowitz M. Pathophysiology and pharmacotherapy of gastroparesis: current and future perspectives. Expert Opin Pharmacother. 2013;14:1171–86.CrossRefGoogle Scholar
  26. 26.
    Horváth VJ, Izbéki F, Lengyel C, Kempler P, Várkonyi T. Diabetic gastroparesis: functional/morphologic background, diagnosis, and treatment options. Curr Diab Rep. 2014;14:527.CrossRefGoogle Scholar
  27. 27.
    Khoo J, Rayner CK, Jones KL, Horowitz M. Pathophysiology and management of gastroparesis. Expert Rev Gastroenterol Hepatol. 2009;3:167–81.CrossRefGoogle Scholar
  28. 28.
    Pasricha PJ, Pehlivanov N, Sugumar A, Jankovic J. Drug insight: from disturbed motility to disordered movement—a review of the clinical benefits and medicolegal risks of metoclopramide. Nat Clin Pract Gastroenterol Hepatol. 2006;3:138–48.CrossRefGoogle Scholar
  29. 29.
    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. 1982;24:360–400.CrossRefGoogle Scholar
  30. 30.
    Leelakanok N, Holcombe A, Schweizer ML. Domperidone and risk of ventricular arrhythmia and cardiac death: a systematic review and meta-analysis. Clin Drug Investig. 2016;36:97–107.CrossRefGoogle Scholar
  31. 31.
    Peeters TL. Erythromycin and other macrolides as prokinetic agents. Gastroenterology. 1993;105:1886–99.CrossRefGoogle Scholar
  32. 32.
    Camilleri M. The current role of erythromycin in the clinical management of gastric emptying disorders. Am J Gastroenterol. 1993;88:169–71.PubMedGoogle Scholar
  33. 33.
    Potter TG, Snider KR. Azithromycin for the treatment of gastroparesis. Ann Pharmacother. 2013;47:411–5.CrossRefGoogle Scholar
  34. 34.
    Quigley EM. Cisapride: what can we learn from the rise and fall of a prokinetic? J Dig Dis. 2011;12:147–56.CrossRefGoogle Scholar
  35. 35.
    Sakamoto Y, Sekino Y, Yamada E, Ohkubo H, Higurashi T, Sakai E, et al. Mosapride accelerates the delayed gastric emptying of high-viscosity liquids: a crossover study using continuous real-time C breath test (BreathID System). J Neurogastroenterol Motil. 2011;17:395–401.CrossRefGoogle Scholar
  36. 36.
    Kawamura E, Enomoto M, Kotani K, Hagihara A, Fujii H, Kobayashi S, et al. Effect of mosapride citrate on gastric emptying in interferon-induced gastroparesis. Dig Dis Sci. 2012;57:1510–6.CrossRefGoogle Scholar
  37. 37.
    Bang CS, Kim JH, Baik GH, Kim HS, Park SH, Kim EJ, et al. Mosapride treatment for functional dyspepsia: a meta-analysis. J Gastroenterol Hepatol. 2015;30:28–42.CrossRefGoogle Scholar
  38. 38.
    Du Y, Su T, Song X, Gao J, Zou D, Zuo C, et al. Efficacy and safety of cinitapride in the treatment of mild to moderate postprandial distress syndrome-predominant functional dyspepsia. J Clin Gastroenterol. 2014;48:328–35.CrossRefGoogle Scholar
  39. 39.
    Stevens JE, Russo A, Maddox AF, Rayner CK, Phillips L, Talley NJ, et al. Effect of itopride on gastric emptying in longstanding diabetes mellitus. Neurogastroenterol Motil. 2008;20:456–63.CrossRefGoogle Scholar
  40. 40.
    Veldhuyzen Van Zanten SJ. Pitfalls in designing trials of functional dyspepsia: the ascent and demise of itopride. Gut. 2008;57:723–4.CrossRefGoogle Scholar
  41. 41.
    Matsunaga Y, Tanaka T, Yoshinaga K, Ueki S, Hori Y, Eta R, et al. Acotiamide hydrochloride (Z-338), a new selective acetylcholinesterase inhibitor, enhances gastric motility without prolonging QT interval in dogs: comparison with cisapride, itopride, and mosapride. J Pharmacol Exp Ther. 2011;336:791–800.CrossRefGoogle Scholar
  42. 42.
    Kusunoki H, Haruma K, Manabe N, Imamura H, Kamada T, Shiotani A, et al. Therapeutic efficacy of acotiamide in patients with functional dyspepsia based on enhanced postprandial gastric accommodation and emptying: randomized controlled study evaluation by real-time ultrasonography. Neurogastroenterol Motil. 2012;24:540–5.CrossRefGoogle Scholar
  43. 43.
    Nelson AD, Camilleri M, Acosta A, Busciglio I, Linker Nord S, Boldingh A, et al. Effects of ghrelin receptor agonist, relamorelin, on gastric motor functions and satiation in healthy volunteers. Neurogastroenterol Motil. 2016;28:1705–13.CrossRefGoogle Scholar
  44. 44.
    Camilleri M, McCallum RW, Tack J, Spence SC, Gottesdiener K, Fiedorek FT. Efficacy and safety of relamorelin in diabetics with symptoms of gastroparesis: a randomized, placebo-controlled study. Gastroenterology. 2017;153:1240–50.CrossRefGoogle Scholar
  45. 45.
    Pasricha PJ, Yates KP, Sarosiek I, McCallum RW, Abell TL, Koch KL, et al. Aprepitant has mixed effects on nausea and reduces other symptoms in patients with gastroparesis and related disorders. Gastroenterology. 2018;154:65–76.e11.CrossRefGoogle Scholar
  46. 46.
    Parkman HP, Van Natta ML, Abell TL, McCallum RW, Sarosiek I, Nguyen L, et al. Effect of nortriptyline on symptoms of idiopathic gastroparesis: the NORIG randomized clinical trial. JAMA. 2013;310:2640–9.CrossRefGoogle Scholar
  47. 47.
    Bharucha AE, Daley SL, Low PA, Gibbons SJ, Choi KM, Camilleri M, et al. Effects of hemin on heme oxygenase-1, gastric emptying, and symptoms in diabetic gastroparesis. Neurogastroenterol Motil. 2016;28:1731–40.CrossRefGoogle Scholar
  48. 48.
    Tjeerdsma HC, Smout AJ, Akkermans LM. Voluntary suppression of defecation delaysgastric emptying. Dig Dis Sci. 1993;38:832–6.CrossRefGoogle Scholar
  49. 49.
    van der Sijp JR, Kamm MA, Nightingale JM, Britton KE, Granowska M, Mather SJ, et al. Disturbed gastric and small bowel transit in severe idiopathic constipation. Dig Dis Sci. 1993;38:837–44.CrossRefGoogle Scholar
  50. 50.
    Hoogerwerf WA, Pasricha PJ, Kalloo AN, Schuster MM. Pain: the overlooked symptom in gastroparesis. Am J Gastroenterol. 1999;94:1029–33.CrossRefGoogle Scholar
  51. 51.
    Cherian D, Sachdeva P, Fisher RS, Parkman HP. Abdominal pain is a frequent symptom of gastroparesis. Clin Gastroenterol Hepatol. 2010;8:676–81.CrossRefGoogle Scholar
  52. 52.
    Hasler WL, Wilson LA, Parkman HP, Koch KL, Abell TL, Nguyen L, et al. Factors related to abdominal pain in gastroparesis: contrast to patients with predominant nausea and vomiting. Neurogastroenterol Motil. 2013;25:427–38.CrossRefGoogle Scholar
  53. 53.
    Leeds AR, Ralphs DN, Ebied F, Metz G, Dilawari JB. Pectin in the dumping syndrome: reduction of symptoms and plasma volume changes. Lancet. 1981;1:1075–8.CrossRefGoogle Scholar
  54. 54.
    Tack J, Arts J, Caenepeel P, De Wulf D, Bisschops R. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol. 2009;6:583–90.CrossRefGoogle Scholar
  55. 55.
    Hieronymus L, Griffin S. Role of amylin in type 1 and type 2 diabetes. Diabetes Educ. 2015;41(1 Suppl):47S–56S.CrossRefGoogle Scholar
  56. 56.
    Chia CW, Egan JM. Role and development of GLP-1 receptor agonists in the management of diabetes. Diabetes Metab Syndr Obes. 2009;2:37.CrossRefGoogle Scholar
  57. 57.
    Boland BS, Edelman SV, Wolosin JD. Gastrointestinal complications of diabetes. Endocrinol Metab Clin N Am. 2013;42:809–32.CrossRefGoogle Scholar
  58. 58.
    Mearin F, Camilleri M, Malagelada JR. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology. 1986;90:1919–25.CrossRefGoogle Scholar
  59. 59.
    Arts J, Holvoet L, Caenepeel P, Bisschops R, Sifrim D, Verbeke K, Janssens J, Tack J. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007;26:1251–8.CrossRefGoogle Scholar
  60. 60.
    Ukleja A, Tandon K, Shah K, Alvarez A. Endoscopic botox injections in therapy of refractory gastroparesis. World J Gastrointest Endosc. 2015;7:790–8.CrossRefGoogle Scholar
  61. 61.
    Fraser R, Horowitz M, Dent J. Hyperglycaemia stimulates pyloric motility in normal subjects. Gut. 1991;32:475–8.CrossRefGoogle Scholar
  62. 62.
    Malik Z, Sankineni A, Parkman HP. Assessing pyloric sphincter pathophysiology using EndoFLIP in patients with gastroparesis. Neurogastroenterol Motil. 2015;27:524–31.CrossRefGoogle Scholar
  63. 63.
    Gourcerol G, Tissier F, Melchior C, Touchais JY, Huet E, Prevost G, Leroi AM, Ducrotte P. Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation. Aliment Pharmacol Ther. 2015;41:360–7.CrossRefGoogle Scholar
  64. 64.
    Mancini SA, Angelo JL, Peckler Z, Philp FH, Farah KF. Pyloroplasty for refractory gastroparesis. Am Surg. 2015;81:738–46.PubMedGoogle Scholar
  65. 65.
    Shada AL, Dunst CM, Pescarus R, Speer EA, Cassera M, Reavis KM, Swanstrom LL. Laparoscopic pyloroplasty is a safe and effective first-line surgical therapy for refractory gastroparesis. Surg Endosc. 2016;30:1326–32.CrossRefGoogle Scholar
  66. 66.
    Benias PC, Khashab MA. Gastric peroral endoscopic pyloromyotomy therapy for refractory gastroparesis. Curr Treat Options Gastroenterol. 2017;15:637–47.CrossRefGoogle Scholar
  67. 67.
    Rodriguez JH, Haskins IN, Strong AT, Plescia RL, Allemang MT, Butler RS, Cline MS, et al. Per oral endoscopic pyloromyotomy for refractory gastroparesis: initial results from a single institution. Surg Endosc. 2017;31:5381–8.CrossRefGoogle Scholar
  68. 68.
    Lacy BE, Weiser K. Gastric motility, gastroparesis, and gastricstimulation. Surg Clin North Am. 2005;85:967–87.CrossRefGoogle Scholar
  69. 69.
    Abell T, McCallum R, Hocking M, Koch K, Abrahamsson H, Leblanc I, et al. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology. 2003;125:421–8.CrossRefGoogle Scholar
  70. 70.
    Levinthal DJ, Bielefeldt K. Systematic review and meta-analysis: gastricelectrical stimulation for gastroparesis. Auton Neurosci. 2017;202:45–55.CrossRefGoogle Scholar
  71. 71.
    Davis BR, Sarosiek I, Bashashati M, Alvarado B, McCallum RW. The long-term efficacy and safety of pyloroplasty combined with gastric electrical stimulation therapy in gastroparesis. J Gastrointest Surg. 2017;21:222–7.CrossRefGoogle Scholar
  72. 72.
    Jayanthi NV, Dexter SP, Sarela AI, Leeds Gastroparesis Multi-Disciplinary Team. Gastric electrical stimulation for treatment of clinically severe gastroparesis. J Minim Access Surg. 2013;9:163–7.CrossRefGoogle Scholar
  73. 73.
    Papasavas PK, Ng JS, Stone AM, Ajayi OA, Muddasani KP, Tishler DS. Gastric bypass surgery as treatment of recalcitrant gastroparesis. Surg Obes Relat Dis. 2014;10:795–9.CrossRefGoogle Scholar
  74. 74.
    Bhayani NH, Sharata AM, Dunst CM, Kurian AA, Reavis KM, Swanstrom LL. End of the road for a dysfunctional end organ: laparoscopic gastrectomy for refractory gastroparesis. J Gastrointest Surg. 2015;19:411–7.CrossRefGoogle Scholar
  75. 75.
    Li J-Z, Li J-Y, Wu T-F, Xu J-H, Huang C-Z, Chen D, et al. Helicobacter pylori infection is associated with type 2 diabetes, not type 1 diabetes: an updated meta-analysis. Gastroenterol Res Pract. 2017;2017:5715403.PubMedPubMedCentralGoogle Scholar
  76. 76.
    Wei F, Lin X. Diabetes increases morbidity and mortality rates in peptic ulcer bleeding: an updated systematic review and meta-analysis. Turk J Gastroenterol. 2016;27:304–11.CrossRefGoogle Scholar
  77. 77.
    Leontiadis GI, Molloy-Bland M, Moayyedi P, Howden CW. Effect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and meta-analysis. Am J Gastroenterol. 2013;108:331–45.CrossRefGoogle Scholar
  78. 78.
    Thomsen RW, Riis A, Christensen S, Nørgaard M, Sørensen HT. Diabetes and 30-day mortality from peptic ulcer bleeding and perforation: a Danish population-based cohort study. Diabetes Care. 2006;29:805–10.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Lynda K. and David M. Underwood Center for Digestive Disorders, Division of Gastroenterology and HepatologyHouston Methodist HospitalHoustonUSA

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