Diabetic gastroparesis.

DIABETIC GASTROPARESIS. Endocr Rev. 2019 May 13;: Authors: Bharucha AE, Kudva YC, Prichard DO Abstract This review covers the epidemiology, pathophysiology, clinical features, diagnosis, and management of diabetic gastroparesis, and more broadly diabetic gastroenteropathy, which encompasses all the gastrointestinal manifestations of diabetes mellitus (DM). Up to 50% of patients with type 1 and 2 DM and suboptimal glycemic control have delayed gastric emptying (GE), which can be documented with scintigraphy, 13 C-breath tests, or a wireless motility capsule; the remainder have normal or rapid GE. Many patients with delayed GE are asymptomatic; others have dyspepsia (i.e., mild-moderate indigestion, with or without a mild delay in GE) or gastroparesis, which is a syndrome characterized by moderate-severe upper gastrointestinal symptoms and delayed GE that suggest, but are not accompanied by, gastric outlet obstruction. Gastroparesis can markedly impair quality of life and up to 50% of patients have significant anxiety and/or depression. Often the distinction between dyspepsia and gastroparesis is based on clinical judgement rather than established criteria. Hyperglycemia, autonomic neuropathy, and enteric neuromuscular inflammation and injury are implicated in the pathogenesis of delayed GE. Vice versa, there are limited data to suggest that delayed GE may affect glycemic control. The management of diabetic gastroparesis is guided by t...
Source: Endocrine Reviews - Category: Endocrinology Tags: Endocr Rev Source Type: research