diabetic gastroparesis
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Epidemiology
- most common cause of gastroparesis
- 50% of patients with type 1 diabetes have evidence of delayed gastric emptying on scintigraphy; however, relatively few report symptoms
Pathology
- isolated or gut-wide neuropathy of the enteric or autonomic nervous system
Clinical manifestations
- nausea/vomiting
- bloating
- postprandial fullness with early satiety
- abdominal discomfort (50=90%)
- abdominal distension, abdominal tenderness
- diarrhea
- most patients have had diabetes mellitus for >= 10 years
- concomitant peripheral neuropathy is common
- concomitant nephropathy is common
- severity of symptoms does NOT correlate with severity of gastric emptying disorder
- improvement of gastric emptying with pharmacologic therapy does NOT improve symptoms
Management
- improved glycemic control can improve gastric emptying
- prokinetic drugs may alleviate symptoms
- diarrhea
- tetracycline may decrease diarrhea caused by bacterial overgrowth
- clonidine
- diphenoxylate/atropine (Lomotil)
- easy-to-mash & pureed foods may amelirate some symptoms[2]
More general terms
- gastroparesis
- autonomic dysfunction (dysautonomia)
- diabetes mellitus complication
- chronic gastrointestinal disease
Additional terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 16. American College of Physicians, Philadelphia 1998, 2012
- ↑ 2.0 2.1 Olausson EA et al. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: A randomized controlled trial. Am J Gastroenterol 2014 Mar; 109:375 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24419482