Updated: 12/11/2021

Diabetic Gastroparesis

Review Topic
  • Snapshot
    • A 56-year-old woman presents to the emergency clinic for recurrent nausea and vomiting for the past 3 weeks. On average, these episodes occur after food intake, which the patient reports, has significantly decreased in amount as she now feels full quickly. Her past medical history is significant for poorly-controlled diabetes for the past 10 years. A physical examination demonstrates epigastric distention and tenderness with no peritoneal signs.
  • Introduction
    • Clinical definition
      • syndrome of delayed gastric emptying in the absence of a mechanical obstruction and the presence of cardinal symptoms (e.g., nausea) secondary to diabetes mellitus (DM)
      • other causes of gastroparesis includes
        • idiopathic
        • viral infection (e.g., cytomegalovirus)
        • medications (e.g., tricyclic antidepressants)
        • postsurgical
  • Epidemiology
    • Demographics
      • DM is the most common systemic disease associated with gastroparesis
      • symptoms of gastroparesis are reported in 11-18% of patients with DM
    • Risk factors
      • typically occurs in patients who have had DM for over 5 years
      • chronic hyperglycemia (blood glucose > 200mg/dL)
    • Pathogenesis
      • abnormalities of antral motor function and coordination and postprandial proximal gastric accommodation and contraction
        • primarily due to autonomic dysfunction and/or abnormal intrinsic nervous system (e.g., interstitial cells of Cajal, the pacemaker of the gut)
        • other proposed contributing factors
          • hyperglycemia
          • vagal dysfunction
          • loss of neural nitric oxide synthase (nNOS) expression
          • oxidative stress
  • Presentation
    • Symptoms
      • nausea
      • vomiting
      • abdominal pain
      • early satiety
      • postprandial fullness
      • bloating
      • weight loss if severe
    • Physical exam
      • epigastric distension/tenderness
      • succession splash
      • other signs of autonomic dysfunction (e.g., orthostatic hypotension)
  • Studies
    • Diagnostic testing
      • diagnostic approach
        • diagnosis is based on clinical presentation and confirmed with gastric emptying studies
      • imaging
        • upper gastrointestinal endoscopy
          • initial test performed to exclude mechanical obstruction
          • alternative options include computed tomographic (CT) or magnetic resonance (MR) enterography
        • scintigraphic gastric emptying
          • most cost effective and widely available technique to confirm delayed gastric emptying
          • usually evaluates the gastric emptying of solids
      • studies
        • laboratory studies
          • HbA1c for assessment of glycemic control
          • other tests such as hemoglobin, TSH, ANA, and albumin for evaluation of other etiologies
  • Differential
    • Psychiatric disease
      • distinguishing factors
        • patients may have a history of psychiatric disease (e.g., bulimia)
        • some patients may have a normal scintigraphic emptying study
    • Cyclic vomiting syndrome
      • distinguishing factors
        • clinical presentation of intense vomiting episodes separated by symptom-free periods
        • history of cannabinoid use
  • Treatment
    • First-line
      • dietary modification (for patients with mild disease)
        • avoid foods that are fatty, acidic, spicy, and roughage-based
        • avoid alcohol and smoking
      • optimization of glycemic control
        • acute hyperglycemia has been demonstrated to slow gastric emptying
      • if continued symptoms, pharmacologic therapy with prokinetic and antiemetics
        • metoclopramide is the first-line prokinetic
        • second-line prokinetics includes domperidone, erythromycin, and cisapride
        • antiemetics include diphenhydramine, ondansetron, and prochlorperazine
    • Second-line
      • indicated in patients with refractory symptoms despite first-line therapy
      • endoscopic gastrostomy tube decompression and jejunal feeding tube
      • surgical treatments
      • tricyclic antidepressants (low-dose nortriptyline)
  • Complications
    • Electrolyte imbalance
    • Malnutrition

Please rate this review topic.

You have never rated this topic.

Thank you. You can rate this topic again in 12 months.

Flashcards (0)
1 of 0
Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Private Note