Diabetic gastroparesis

Nausea and vomiting Gastric dysmotility (surgery, anticholinergic drugs, diabetic gastroparesis) Rapid infusion of hyperosmolar formula... 

Metoclopramide is used for its antiemetic properties in patients with diabetic gastroparesis and with dexamethasone for prophylaxis of delayed nausea and vomiting associated with chemotherapy administration. 

Diabetic gastroparesis 10 mg 30 minutes before each meal and at bedtime for 2 to 8 weeks. 

Erythromycin is an antibiotic in the macrolide family (see Chapter 47) that also has promotility effects because it is a motilin agonist. Erythromycin is used (off-label indication) to accelerate gastric emptying in diabetic gastroparesis and postoperative gastroparesis. Tachyphylaxis will occur, so it cannot be used uninterruptedly for long periods. 

Unlabeled Uses Systemic Treatment of acne vulgaris, chancroid, Campylobacter enteritis, gastroparesis, Lyme disease, diabetic gastroparesis Topical Treatment of minor bacterial skin infections... 

Other Uses in Geriatric Patient Diabetic gastroparesis. Chemotherapy-induced nausea and vomiting. Postoperative nausea and vomiting... 

Unlabeled Uses Treatment of diabetic gastroparesis, sexual dysfunction associated with the use of selective serotonin reuptake inhibitors... 

These agents are widely used in the treatment of patients with delayed gastric emptying due to postsurgical disorders (vagotomy, antrectomy) and diabetic gastroparesis. Metoclopramide is sometimes administered in hospitalized patients to promote advancement of nasoenteric feeding tubes from the stomach into the duodenum. 

Macrolides Erythromycin useful in diabetic gastroparesis but tolerance develops... 

The mechanism of action and chnical use of domperidone and its specific use in diabetic gastroparesis have been reviewed (5,6). Domperidone is generally well tolerated and has a low incidence of adverse effects. Adverse effects after oral administration include headache, dry mouth, diarrhea, itching, muscle cramps, and anxiety. Galactorrhea, breast tenderness, and pseudopregnancy can occur in women because of a dopamine-induced increase in serum prolactin concentration. 

Oral metoclopramide is indicated in the treatment of diabetic gastroparesis (10 mg 30 minutes before each meal and at bedtime for 2 to 8 weeks) and symptomatic gastroesophageal reflux (10 to 15 mg orally up to 4 times daily 30 minutes before each meal and at bedtime for 4 to 12 weeks). Furthermore, parenteral metoclopramide is indicated in prevention of nausea and vomiting associated with emetogenic cancer chemotherapy, for prophylaxis of postoperative nausea and vomiting when nasogastric suction is undesirable, and as a single dose to facilitate small-bowel intubation when the tube does not pass the pylorus with conventional maneuvers. 

After the discovery of motilin, its unique ability to stimulate gastric motility led to clinical studies on the effect of motilin on gastric emptying. Although earlier data on the effects of motilin had been inconclusive [45, 46], Peeters et al. [47] clearly showed that motilin accelerated delayed gastric emptying in patients with diabetic gastroparesis. 

A 55-year-old woman with insulin-dependent diabetes of 40 years duration complains of severe bloating and abdominal distress, especially after meals. Evaluation is consistent with diabetic gastroparesis. The drug you would be most likely to recommend is... 

Systematic reviews The efficacy of domperidone in diabetic gastroparesis has been evaluated in a systematic review of 28 clinical trials in a total of 1016 patients [7 ]. Domperidone improved symptoms, enhanced gastric emptying, and reduced hospital admissions in 60-70% of trials. None of the studies assessed the risk of adverse reactions to domperidone versus comparators. The most common adverse reaction was hyperprolactinemia, but in no case was it serious. 

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