A case of severe, refractory diabetic gastroparesis managed by prolonged use of aprepitant.
BACKGROUND
A 31-year-old woman with an 11-year history of poorly controlled type 1 diabetes mellitus was admitted with severe vomiting and ketoacidosis. The patient had been admitted to hospital on 14 occasions in the past 3 years for diabetic ketoacidosis precipitated by intractable vomiting, and she had been diagnosed with gastroparesis 2 years previously.


METHODS
Assessment of the patient's response to standard treatments for diabetic gastroparesis. These approaches involved tight glycemic control that included subcutaneous insulin infusion via a pump, correction of electrolyte disturbances, use of standard antiemetic and promotility agents, somatostatin-analog treatment, intrapyloric injection of botulinum toxin, and insertion of a percutaneous jejunal feeding tube.


METHODS
Severe diabetic gastroparesis refractory to standard treatments.


RESULTS
The neurokinin-receptor antagonist aprepitant was started and her vomiting stopped within 24 h. This treatment was successfully continued for 4 months until a gastric electrical stimulation device was inserted, which enabled aprepitant treatment to be withdrawn and the percutaneous jejunostomy feeding tube to be removed. This successful treatment led to a substantial improvement in the patient's quality of life and overall glycemic control.
Chong
Kiang
K
Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospital National Health Service Foundation Trust, Norwich, Norfolk NR4 7UY, UK.
Dhatariya
Ketan
K
D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D000077608:Aprepitant; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy; D005260:Female; D018589:Gastroparesis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D009025:Morpholines / Q000627:therapeutic use*; D016896:Treatment Outcome
D000932:Antiemetics; D009025:Morpholines; D000077608:Aprepitant