Diabetic gastroparesis: Pathophysiology, evaluation and management

Deparment of Gastroenterologym Shrewsbury and Telford Hospitals, NHS Trust, Princess Royal Hospital, Telfordm Shropshire TF1 6TF, UK.
British journal of hospital medicine (London, England: 2005) (Impact Factor: 0.38). 08/2012; 73(8):451-6. DOI: 10.12968/hmed.2012.73.8.451
Source: PubMed


As the incidence of diabetes mellitus inexorably rises, the burden of its complications is becoming increasingly problematic. Among the most bothersome, but often under-recognized, inadequately investigated and poorly managed, is diabetic gastroparesis.

Download full-text


Available from: Adam D Farmer
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: The wireless motility capsule (WMC) is a novel ambulatory technology that concurrently measures intraluminal pH, temperature, and pressure as it traverses the gastrointestinal tract. Objectives: We aim to provide a concise summary of the WMC, detailing the procedure for its administration and the parameters it records. We also review the evidence that has validated the WMC against other methods currently regarded as 'gold standard'. Conclusions: The WMC offers a number of advantages over and above current techniques, especially with respect to patient tolerability, safety, and standardization. The WMC represents a considerable enhancement of the researchers' and clinicians' investigatory armamentarium. If this technology becomes widely adopted, coupled with international consensus upon the interpretation of physiological data derived therein, it may herald a new and exciting era in gastrointestinal physiology.
    Full-text · Article · Dec 2013 · United European Gastroenterology Journal
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: Gastroparesis is a well-known complication to diabetes mellitus (DM). Dietary advice is considered to be of importance to reduce gastrointestinal (GI) symptoms in patients with diabetic gastroparesis, but no randomized controlled trials exist. Our aim was to compare GI symptoms in insulin treated DM subjects with gastroparesis eating a diet with small particle size ("intervention diet") with the recommended diet for DM ("control diet"). Methods: 56 subjects with insulin treated DM and gastroparesis were randomized to the intervention diet or the control diet. The patients received dietary advice by a dietitian at 7 occasions during 20 weeks. GI symptom severity, nutrient intake and glycemic control were measured before and after the intervention. Results: A significantly greater reduction of the severity of the key gastroparetic symptoms-nausea/vomiting (P=0.01), postprandial fullness (P=0.02) and bloating (P=0.006)-were seen in patients who received the intervention diet compared with the control diet, and this was also true for regurgitation/heartburn (P=0.02), but not for abdominal pain. Anxiety was reduced after the intervention diet, but not after the control diet, whereas no effect on depression or quality of life was noted in any of the groups. A higher fat intake in the intervention group was noted, but otherwise no differences in body weight, HbA1c or nutrient intake were seen. Conclusions: A small particle diet improves the key symptoms of gastroparesis in patients with diabetes mellitus. ( NCT01557296).
    Full-text · Article · Jan 2014 · The American Journal of Gastroenterology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Gastroparesis is a well-known diabetic complication. The pathogenesis is not fully understood. However, it is important to early diagnose these patients. This study evaluated the plasma glucose response after a test meal, and gastrointestinal (GI) symptom severity in patients with clinical suspicion of diabetic gastroparesis, and assessed its usefulness to predict gastroparesis. In all, 83 subjects with insulin-treated diabetes mellitus (DM) type 1 and 2 were included; 53 subjects had gastroparesis and 30 had normal gastric emptying determined by gastric scintigraphy. GI symptom severity during the preceding 2 weeks was evaluated with a validated questionnaire. The test meal consisted of 100 g meat, 40 g pasta, 150 g carrot, and 5 g oil. The subjects ingested the meal under fasting conditions, and plasma glucose was followed during 180 minutes. Patients with gastroparesis demonstrated a blunted plasma glucose response after a test meal versus patients with normal gastric emptying (P < .005), reflected by lower maximum increase in plasma glucose response and incremental area under the curve of the plasma glucose, but a similar time to the maximum plasma glucose level. All GI symptoms were more severe in patients with gastroparesis. GI symptom severity had the best discriminative value to identify patients with gastroparesis with an area under the receiver operating curve of 0.83 (optimal cutoff: sensitivity 87%, specificity 80%). Patients with diabetic gastroparesis have a blunted postprandial plasma glucose response. Combining this information with the presence of GI symptoms can help clinicians identify diabetic patients with gastroparesis.
    Full-text · Article · May 2014 · Journal of diabetes science and technology
Show more