Diabetic gastroparesis is a complication of long-term diabetes characterized by delayed gastric emptying that is not associated with mechanical obstruction.
Epidemiology
Etiology
Pathophysiology
- Poor glycemic control, sustained hyperglycemia > 200 mg/dL → neuronal damage → impaired neural control of gastric function (e.g., interstitial cells of Cajal dysfunction, abnormal myenteric neurotransmission, smooth muscle dysfunction, vagal dysfunction) → antral motor coordination and function abnormalities (↓ antral contractions, pyloric spasms, abnormal antroduodenal contractions) → delayed gastric emptying
Clinical features
- Common symptoms
- Nausea and/or vomiting
- Bloating
- Upper abdominal pain
- Loss of appetite
- Early satiety
- Examination findings
- Abdominal distension
- Epigastric tenderness
- Succussion splash
Diagnostics
Treatment
Prokinetics
- Used to improve symptoms and gastric emptying
- First line: metoclopramide (Dopamine antagonist)
- Alternatives
- Motilin agonists (e.g., erythromycin, azithromycin)
- 5-HT4 agonists, e.g., prucalopride
Antiemetics
- Improve symptoms (nausea, vomiting) but do not improve gastric emptying.
- Options include 5-HT3 antagonists (e.g., ondansetron) and NK1 receptors antagonists (e.g., aprepitant)