Diabetic gastroparesis is a complication of long-term diabetes characterized by delayed gastric emptying that is not associated with mechanical obstruction.

Epidemiology

Etiology

Pathophysiology

• Poor glycemic control, sustained hyperglycemia > 200 mg/dL → neuronal damage → impaired neural control of gastric function (e.g., interstitial cells of Cajal dysfunction, abnormal myenteric neurotransmission, smooth muscle dysfunction, vagal dysfunction) → antral motor coordination and function abnormalities (↓ antral contractions, pyloric spasms, abnormal antroduodenal contractions) → delayed gastric emptying

Clinical features

• Common symptoms
  • Nausea and/or vomiting
  • Bloating
  • Upper abdominal pain
  • Loss of appetite
  • Early satiety
• Examination findings
  • Abdominal distension
  • Epigastric tenderness
  • Succussion splash

Diagnostics

Treatment

Prokinetics

• Used to improve symptoms and gastric emptying
• First line: metoclopramide (Dopamine antagonist)
• Alternatives
  • Motilin agonists (e.g., erythromycin, azithromycin)
  • 5-HT4 agonists, e.g., prucalopride

Antiemetics

• Improve symptoms (nausea, vomiting) but do not improve gastric emptying.
• Options include 5-HT3 antagonists (e.g., ondansetron) and NK1 receptors antagonists (e.g., aprepitant)