Pathophysiology and management of diabetic gastropathy: a guide for endocrinologists.
Delayed gastric emptying is frequently observed in patients with long-standing type 1 and type 2 diabetes mellitus, and potentially impacts on upper gastrointestinal symptoms, glycaemic control, nutrition and oral drug absorption. The pathogenesis remains unclear and management strategies are currently suboptimal. Therapeutic strategies focus on accelerating gastric emptying, controlling symptoms and improving glycaemic control. The potential adverse effects of hyperglycaemia on gastric emptying and upper gut symptoms indicate the importance of normalising blood glucose if possible. Nutritional and psychological supports are also important, but often neglected. A number of recent pharmacological and non-pharmacological therapies show promise, including gastric electrical stimulation. As with all chronic illnesses, a multidisciplinary approach to management is recommended, but there are few data regarding long-term outcomes.
Discipline of Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Paul
P
Kuo
Christopher K
CK
Rayner
Karen L
KL
Jones
Michael
M
Horowitz
D000818:Animals; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004032:Diet; D018491:Dopamine Agonists / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000627:therapeutic use; D004558:Electric Stimulation; D004704:Endocrinology; D005746:Gastric Emptying / Q000502:physiology; D018589:Gastroparesis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D012702:Serotonin Antagonists / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D013038:Specialization
D018491:Dopamine Agonists; D018492:Dopamine Antagonists; D012702:Serotonin Antagonists; D017366:Serotonin Receptor Agonists