Gastroparesis

Superior mesenteric artery syndrome Enteric infections Inflammatory bowel diseases Pancreatitis Appendicitis Cholecystitis Biliary colic Gastroparesis Postvagotomy syndrome Intestinal pseudo-obstruction Functional dyspepsia Gastroesophageal reflux Peptic ulcer disease Hepatitis Peritonitis Gastric malignancy Liver failure... 

Autonomic neuropathy is also a common complication as DM progresses. Clinical presentation of autonomic neuropathy may include gastroparesis, resting tachycardia, orthostatic hypotension, impotence, constipation, and hypoglycemic autonomic failure. Therapy for each individual autonomic complication is addressed separately. 

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

Gastroparesis/atony causing regurgitation Feeding tube malpositioned Compromised lower esophageal sphincter Diminished gag reflex... 

Malagelada JR, Rees WD, Mazzotta LJ, Go VL Gastric motor abnormalities in diabetic and postvagotomy gastroparesis Effect of metoclopramide and bethanechol. Gastroenterology 1980 78 286-293. 

Gastroparesis can be severe and debilitating. Improved glycemic control, discontinuation of medications that slow gastric motility, and use of meto-dopramide (preferably for only a few days at a time) or erythromycin may be helpful. 

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. 

Known hypersensitivity to pramlintide acetate or any of its components, including metacresol diagnosis of gastroparesis hypoglycemia. 

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

Hypoglycemia Gastroparesis (gastric stasis) may be responsible for poor diabetic control. Exogenously administered insulins may act before food has left the stomach, leading to hypoglycemia. 

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... 

In addition to these receptors, enkephalins may be involved in some parts of this process, while agents which act on gastric serotonin (5-HT4), dopamine, and motilin receptors accelerate gastric emptying and relieve symptoms in gastroparesis. 

While the 5-HT3 receptor is the most important in control of nausea and vomiting, others are also involved. 5-HT4 agonists have prokinetic properties in nauseated patients with gastroparesis and functional dyspepsia. The 5-HTlD-receptor agonists, such as sumatripan, are used in treatment of migraine and reduce emesis both in this condition and also in the cyclic vomiting syndrome, most likely via action on CNS sites. 

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. 

Macrolide antibiotics such as erythromycin directly stimulate motilin receptors on gastrointestinal smooth muscle and promote the onset of a migrating motor complex. Intravenous erythromycin (3 mg/kg) is beneficial in some patients with gastroparesis however, tolerance rapidly develops. It may be used in patients with acute upper gastrointestinal hemorrhage to promote gastric emptying of blood before endoscopy. 

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

Patrick A et al Review article Gastroparesis. Aliment Pharmacol Ther 2008 27 724. [PMID 18248660]... 

Pramlintide slows gastric emptying and it should not be used in those with gastroparesis. The manufacturer also recommends that analgesics should not be taken less than 1 hour before or 2 hours after pramlintide. 

---