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Gastroparesis in type 2 diabetes mellitus: Prevalence, etiology, diagnosis, and treatment

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Abstract

The worldwide epidemic of type 2 diabetes mellitus (T2DM) is a substantial economic and social burden. Although gastroparesis associated with type 1 diabetes mellitus (T1DM) has been recognized for years, only recently have studies shown that patients with T2DM also have high rates of gastroparesis. Individuals with T2DM constitute 90% to 95% of the diabetic population. Unique characteristics that distinguish this population are obesity, insulin resistance, and associated comorbidities. These features highlight the importance of investigating gastric emptying in individuals with T2DM and upper gastrointestinal symptoms. The purpose of this review is to examine the literature pertaining to diabetes and the effect of diabetes on gastric neuromuscular function, with a focus on T2DM. An understanding of gastric motility in T2DM is important to diagnose gastroparesis, to treat upper gastrointestinal symptoms, and to restore normal gastric motility, which may lead, in turn, to improved glucose control.

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References and Recommended Reading

  1. WHO Diabetes Fact Sheet http://www.who.int/mediacentre/factsheets/fs12/en/index.html Accessed February 6, 2007.

  2. CDC: National Diabetes Fact Sheet http://www.cdc.gov/diabetes/pubs/estimates05.htm#top Accessed February 6, 2007.

  3. Diagnosis and classification of diabetes mellitus. Diabetes Care 2006, 29(Suppl 1):S43–S48.

    Google Scholar 

  4. Rundles R: Diabetic neuropathy: general review with report of 125 cases. Medicine 1945, 24:111–160.

    Article  Google Scholar 

  5. Kassander P: Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958, 48:797–812.

    PubMed  CAS  Google Scholar 

  6. Wooten RL, Meriwether TW III: Diabetic gastric atony: a clinical study. JAMA 1961, 176:1082–1087.

    PubMed  CAS  Google Scholar 

  7. Feldman M, Schiller LR: Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 1983, 98:378–384.

    PubMed  CAS  Google Scholar 

  8. Schvarcz E, Palmer M, Ingberg CM et al.: Increased prevalence of upper gastrointestinal symptoms in long-term type 1 diabetes mellitus. Diabet Med 1996, 13:478–481.

    Article  PubMed  CAS  Google Scholar 

  9. Maleki D, Locke GR III, Camilleri M, et al.: Gastrointestinal tract symptoms among persons with diabetes mellitus in the community. Arch Intern Med 2000, 160:2808–2816.

    Article  PubMed  CAS  Google Scholar 

  10. Janatuinen E, Pikkarainen P, Laakso M, Pyorala K: Gastrointestinal symptoms in middle-aged diabetic patients. Scand J Gastroenterol. 1993, 28:427–432.

    PubMed  CAS  Google Scholar 

  11. Bytzer P, Talley NJ, Leemon M, et al.: Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med 2001, 161:1989–1996.

    Article  PubMed  CAS  Google Scholar 

  12. Enck P, Rathmann W, Spiekermann M, et al.: Prevalence of gastrointestinal symptoms in diabetic patients and non-diabetic subjects. Z Gastroenterol 1994, 32:637–641.

    PubMed  CAS  Google Scholar 

  13. Ko GT, Chan WB, Chan JC, et al.: Gastrointestinal symptoms in Chinese patients with Type 2 diabetes mellitus. Diabet Med 1999, 16:670–674.

    Article  PubMed  CAS  Google Scholar 

  14. Spangeus A, El-Salhy M, Suhr O, et al.: Prevalence of gastrointestinal symptoms in young and middle-aged diabetic patients. Scand J Gastroenterol 1999, 34:1196–1202.

    Article  PubMed  CAS  Google Scholar 

  15. Ricci JA, Siddique R, Stewart WF, et al.: Upper gastrointestinal symptoms in a U.S. national sample of adults with diabetes. Scand J Gastroenterol 2000, 35:152–159.

    Article  PubMed  CAS  Google Scholar 

  16. Leatherdale BA, Green DJ, Harding LK, et al.: Guar and gastric emptying in non-insulin dependent diabetes. Acta Diabetol Lat 1982, 19:339–343.

    Article  PubMed  CAS  Google Scholar 

  17. Sasaki H, Nagulesparan M, Dubois A, et al.: Hypergastrinemia in obese noninsulin-dependent diabetes: a possible reflection of high prevalence of vagal dysfunction. J Clin Endocrinol Metab 1983, 56:744–750.

    Article  PubMed  CAS  Google Scholar 

  18. Horowitz M, Harding PE, Maddox AF, et al.: Gastric and oesophageal emptying in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 1989, 32:151–159.

    Article  PubMed  CAS  Google Scholar 

  19. Chang CS, Kao CH, Wang YS, et al.: Discrepant pattern of solid and liquid gastric emptying in Chinese patients with type II diabetes mellitus. Nucl Med Commun 1996, 17:60–65.

    Article  PubMed  CAS  Google Scholar 

  20. Tung CF, Chang CS, Chen GH, et al.: Comprehensive gastric emptying study for type-II diabetes mellitus dyspeptic patients. Scand J Gastroenterol 1997, 32:884–887.

    PubMed  CAS  Google Scholar 

  21. Annese V, Bassotti G, Caruso N, et al.: Gastrointestinal motor dysfunction, symptoms, and neuropathy in noninsulin-dependent (type 2) diabetes mellitus. J Clin Gastroenterol 1999, 29(2):171–177.

    Article  PubMed  CAS  Google Scholar 

  22. Moldovan C, Dumitrascu DL, Demian L, et al.: Gastroparesis in diabetes mellitus: an ultrasonographic study. Rom J Gastroenterol 2005, 14:19–22.

    PubMed  Google Scholar 

  23. Aylett P: Gastric emptying and change of blood glucose level, as affected by glucagon and insulin. Clin Sci 1962, 22:171–178.

    PubMed  CAS  Google Scholar 

  24. MacGregor IL, Gueller R, Watts HD, Meyer JH: The effect of acute hyperglycemia on gastric emptying in man. Gastroenterology 1976, 70:190–196.

    PubMed  CAS  Google Scholar 

  25. Fraser RJ, Horowitz M, Maddox AF, et al.: Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1990, 33:675–680.

    Article  PubMed  CAS  Google Scholar 

  26. Schvarcz E, Palmer M, Aman J, et al.: Physiological hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus. Gastroenterology 1997, 113:60–66.

    Article  PubMed  CAS  Google Scholar 

  27. Velchik MG, Reynolds JC, Alavi A: The effect of meal energy content on gastric emptying. J Nucl Med 1989, 30:1106–1110.

    PubMed  CAS  Google Scholar 

  28. Jones KL, Horowitz M, Carney BI, et al.: Gastric emptying in early noninsulin-dependent diabetes mellitus. J Nucl Med 1996, 37:1643–1648.

    PubMed  CAS  Google Scholar 

  29. Iber FL, Parveen S, Vandrunen M, et al.: Relation of symptoms to impaired stomach, small bowel, and colon motility in long-standing diabetes. Dig Dis Sci 1993, 38:45–50.

    Article  PubMed  CAS  Google Scholar 

  30. Chang CS, Lien HC, Yeh HZ, et al.: Effect of cisapride on gastric dysrhythmia and emptying of indigestible solids in type-II diabetic patients. Scand J Gastroenterol 1998, 33:600–604.

    Article  PubMed  CAS  Google Scholar 

  31. 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.

    PubMed  CAS  Google Scholar 

  32. Horowitz M, O’Donovan D, Jones KL, et al.: Gastric emptying in diabetes: clinical significance and treatment. Diabet Med 2002, 19:177–194.

    Article  PubMed  CAS  Google Scholar 

  33. Zhao J, Frokjaer JB, Drewes AM, et al.: Upper gastrointestinal sensory-motor dysfunction in diabetes mellitus. World J Gastroenterol 2006, 12:2846–2857.

    PubMed  Google Scholar 

  34. Bytzer P, Talley NJ, Hammer J, et al.: GI symptoms in diabetes mellitus are associated with both poor glycemic control and diabetic complications. Am J Gastroenterol 2002, 97:604–611.

    Article  PubMed  Google Scholar 

  35. Rathmann W, Enck P, Frieling T, Gries FA: Visceral afferent neuropathy in diabetic gastroparesis. Diabetes Care 1991, 14:1086–1089.

    Article  PubMed  CAS  Google Scholar 

  36. Buysschaert M, Moulart M, Urbain JL, et al.: Impaired gastric emptying in diabetic patients with cardiac autonomic neuropathy. Diabetes Care 1987, 10:448–452.

    Article  PubMed  CAS  Google Scholar 

  37. Migdalis L, Thomaides T, Chairopoulos C, et al.: Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients. Clin Auton Res 2001, 11:259–263.

    Article  PubMed  CAS  Google Scholar 

  38. Yoshida MM, Schuffler MD, Sumi SM: There are no morphologic abnormalities of the gastric wall or abdominal vagus in patients with diabetic gastroparesis. Gastroenterology 1988, 94:907–914.

    PubMed  CAS  Google Scholar 

  39. Barnett JL, Owyang C: Serum glucose concentration as a modulator of interdigestive gastric motility. Gastroenterology 1988, 94:739–744.

    PubMed  CAS  Google Scholar 

  40. Fraser R, Horowitz M, Dent J: Hyperglycaemia stimulates pyloric motility in normal subjects. Gut. 1991, 32(5):475–478.

    PubMed  CAS  Google Scholar 

  41. Jebbink RJ, Samsom M, Bruijs PP, et al.: Hyperglycemia induces abnormalities of gastric myoelectrical activity in patients with type I diabetes mellitus. Gastroenterology 1994, 107:1390–1397.

    PubMed  CAS  Google Scholar 

  42. Sogabe M, Okahisa T, Tsujigami K, et al.: Ultrasonographic assessment of gastric motility in diabetic gastroparesis before and after attaining glycemic control. J Gastroenterol 2005, 40:583–590.

    Article  PubMed  Google Scholar 

  43. Holzapfel A, Festa A, Stacher-Janotta G, et al.: Gastric emptying in type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration. Diabetologia 1999, 42:1410–1412.

    Article  PubMed  CAS  Google Scholar 

  44. Smith U: Gastric emptying in type 2 diabetes: quick or slow? Diabet Med 1996, 13(Suppl 5):S31–S33.

    PubMed  CAS  Google Scholar 

  45. Phillips WT, Schwartz JG, McMahan CA: Rapid gastric emptying of an oral glucose solution in type 2 diabetic patients. J Nucl Med 1992, 33:1496–1500.

    PubMed  CAS  Google Scholar 

  46. Schwartz JG, Green GM, Guan D, et al.: Rapid gastric emptying of a solid pancake meal in type II diabetic patients. Diabetes Care 1996, 19:468–471.

    Article  PubMed  CAS  Google Scholar 

  47. Frank JW, Saslow SB, Camilleri M, et al.: Mechanism of accelerated gastric emptying of liquids and hyperglycemia in patients with type II diabetes mellitus. Gastroenterology 1995, 109:755–765.

    Article  PubMed  CAS  Google Scholar 

  48. Bertin E, Schneider N, Abdelli N, et al.: Gastric emptying is accelerated in obese type 2 diabetic patients without autonomic neuropathy. Diabetes Metab 2001, 27:357–364.

    PubMed  CAS  Google Scholar 

  49. Weytjens C, Keymeulen B, Van Haleweyn C, et al.: Rapid gastric emptying of a liquid meal in long-term type 2 diabetes mellitus. Diabet Med 1998, 15:1022–1027.

    Article  PubMed  CAS  Google Scholar 

  50. Parkman HP, Hasler WL, Fisher RS: American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 2004, 127:1592–1622.

    Article  PubMed  Google Scholar 

  51. 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.

    Article  PubMed  CAS  Google Scholar 

  52. Kuo B MR, Koch K, Chey WD, et al.: SmartPill, a novel ambulatory diagnostic test for measuring gastric emptying in health and disease [abstract]. Presented at Digestive Disease Week; Los Angeles, CA; May 20–25, 2006.

  53. Koch KL: Electrogastrography: physiological basis and clinical application in diabetic gastropathy. Diabetes Technol Ther 2001, 3:51–62.

    Article  PubMed  CAS  Google Scholar 

  54. Abell TL, Bernstein VK, Cutts T, et al.: Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil 2006, 18:263–283.

    Article  PubMed  CAS  Google Scholar 

  55. Kong MF, Horowitz M: Gastric emptying in diabetes mellitus: relationship to blood-glucose control. Clin Geriatr Med 1999, 15:321–338.

    PubMed  CAS  Google Scholar 

  56. Groop LC, Luzi L, DeFronzo RA, Melander A: Hyperglycaemia and absorption of sulphonylurea drugs. Lancet 1989, 2:129–130.

    Article  PubMed  CAS  Google Scholar 

  57. Schwartz JG, Guan D, Green GM, Phillips WT: Treatment with an oral proteinase inhibitor slows gastric emptying and acutely reduces glucose and insulin levels after a liquid meal in type II diabetic patients. Diabetes Care 1994, 17:255–262.

    Article  PubMed  CAS  Google Scholar 

  58. Phillips WT, Schwartz JG, McMahan CA: Reduced postprandial blood glucose levels in recently diagnosed non-insulin-dependent diabetics secondary to pharmacologically induced delayed gastric emptying. Dig Dis Sci 1993, 38:51–58.

    Article  PubMed  CAS  Google Scholar 

  59. Gonlachanvit S, Hsu CW, Boden GH, et al.: Effect of altering gastric emptying on postprandial plasma glucose concentrations following a physiologic meal in type-II diabetic patients. Dig Dis Sci 2003, 48:488–497.

    Article  PubMed  CAS  Google Scholar 

  60. Thompson RG, Gottlieb A, Organ K, et al.: Pramlintide: a human amylin analogue reduced postprandial plasma glucose, insulin, and C-peptide concentrations in patients with type 2 diabetes. Diabet Med 1997, 14:547–555.

    Article  PubMed  CAS  Google Scholar 

  61. Willms B, Werner J, Holst JJ, et al.: Gastric emptying, glucose responses, and insulin secretion after a liquid test meal: effects of exogenous glucagon-like peptide-1 (GLP-1)-(7–36) amide in type 2 (noninsulin-dependent) diabetic patients. J Clin Endocrinol Metab 1996, 81:327–332.

    Article  PubMed  CAS  Google Scholar 

  62. Gentilcore D, Chaikomin R, Jones KL, et al.: Effects of fat on gastric emptying of and the glycemic, insulin, and incretin responses to a carbohydrate meal in type 2 diabetes. J Clin Endocrinol Metab 2006, 91:2062–2067.

    Article  PubMed  CAS  Google Scholar 

  63. Monnier L, Lapinski H, Colette C: Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes Care 2003, 26:881–885.

    Article  PubMed  Google Scholar 

  64. Talley NJ: Diabetic gastropathy and prokinetics. Am J Gastroenterol 2003, 98:264–271.

    Article  PubMed  Google Scholar 

  65. Petrakis IE, Vrachassotakis N, Sciacca V, et al.: Hyperglycaemia attenuates erythromycin-induced acceleration of solid-phase gastric emptying in idiopathic and diabetic gastroparesis. Scand J Gastroenterol 1999, 34:396–403.

    Article  PubMed  CAS  Google Scholar 

  66. Ueno N, Inui A, Asakawa A, et al.: Erythromycin improves glycaemic control in patients with type II diabetes mellitus. Diabetologia 2000, 43:411–415.

    Article  PubMed  CAS  Google Scholar 

  67. Asakawa H, Hayashi I, Fukui T, Tokunaga K: Effect of mosapride on glycemic control and gastric emptying in type 2 diabetes mellitus patients with gastropathy. Diabetes Res Clin Pract 2003, 61:175–182.

    Article  PubMed  CAS  Google Scholar 

  68. Horowitz M, Jones KL, Harding PE, Wishart JM: Relationship between the effects of cisapride on gastric emptying and plasma glucose concentrations in diabetic gastroparesis. Digestion 2002, 65:41–46.

    Article  PubMed  CAS  Google Scholar 

  69. Lehmann R, Honegger RA, Feinle C, et al.: Glucose control is not improved by accelerating gastric emptying in patients with type 1 diabetes mellitus and gastroparesis, a pilot study with cisapride as a model drug. Exp Clin Endocrinol Diabetes 2003, 111:255–261.

    Article  PubMed  CAS  Google Scholar 

  70. Koch KL: Nausea and vomiting. In Therapy of Digestive Disorders. Edited by Wolfe MM. Philadelphia: WB Saunders Company; 2006:1003–1016.

    Google Scholar 

  71. 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 Diabetes. 2005, 113:38–42.

    Article  PubMed  CAS  Google Scholar 

  72. Rees DA, Alcolado JC: Animal models of diabetes mellitus. Diabet Med 2005, 22, 359–370.

    Article  PubMed  CAS  Google Scholar 

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  1. Section on Gastroenterology, Wake Forest University Medical Center, Nutrition Building, E-115, Medical Center Boulevard, Winston-Salem, NC, 27157, USA

    Kenneth L. Koch MD

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  1. Nicolas Intagliata BA
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Intagliata, N., Koch, K.L. Gastroparesis in type 2 diabetes mellitus: Prevalence, etiology, diagnosis, and treatment. Curr Gastroenterol Rep 9, 270–279 (2007). https://doi.org/10.1007/s11894-007-0030-3

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