GASTROENTEROLOGY ARTICLE OF THE WEEK
March 24, 2011
Camilleri M, Bharucha E, Farrugia G. Epidemiology, mechanisms and management of diabetic gastroparesis. Clin Gastroenterol Hepatol 2011;9:5-12.
1. Diabetic gastroparesis
a. is more common in type 2 diabetes compared to type 1
b. once gastroparesis is established, it persists despite normalization of glycemic control
c. incretin therapy for type 2 diabetes improves gastric emptying
d. the onset of gastroparesis in diabetes is associated with increased mortality
2. Epigastric pain in patients with gastroparesis
a. pain is the predominant symptom in up to 20% of patients
b. typically it is worsened by meals, is nocturnal and interferes with sleep
c. correlates with abnormalities in gastric emptying studies
d. is almost always associated with vomiting
True or False
3. Accelerated gastric emptying rarely causes nausea, usually causes upper GI discomfort
4. Injury to the vagus nerve during fundoplication may present as rapid gastric emptying with dumping and diarrhea
5. Erythromycin is ineffective even when used short term while providing a “drug-holiday” from metoclopramide
6. Approximately 20% of diabetics with upper GI symptoms have accelerated gastric emptying as the cause of their symptoms
7. Gastroparesis-associated abdominal pain responds only to narcotics
8. The normal repair mechanisms for the interstitial cells of Cajal is impaired in patients with diabetes
9. Intrapyloric botulinum toxin injection is an effective alternative for the therapy of gastroparesis
10. Accelerated gastric emptying is seen most commonly in type 2 diabetes, and often early after the diagnosis of diabetes.
11. The probability of tardive dyskenesia with prolonged metoclopramide use is likely much less than 1%
12. The degree of nausea and vomiting rarely correlates with abnromalities seen in gastric emptying studies
13. This paper advocates promethazine as a possibly effective measure in controlling nausea related to gastroparesis.