Diabetic gastroparesis. A critical reappraisal of new treatment strategies
- PMID: 1281070
- DOI: 10.2165/00003495-199244040-00002
Diabetic gastroparesis. A critical reappraisal of new treatment strategies
Abstract
Delayed gastric emptying, gastroparesis, is one of the sequelae of diabetes mellitus. Symptoms may include postprandial nausea, epigastric pain, bloating, vomiting, early satiety and unpredictable blood sugar fluctuations. Nowadays diagnosis is made by the measurement of gastric emptying with a radionuclide test meal. Using this technique some 50% of diabetic patients show signs of disordered gastric emptying. Relief is best delivered by agents promoting gastric emptying. In phase II single-dose studies metoclopramide, domperidone, cisapride, erythromycin and renzapride were all able to enhance gastric evacuation of solid and liquid meals in patients with diabetic gastroparesis. A few short term studies support the efficacy of domperidone and renzapride, but long term trials are lacking. Erythromycin, mimicking the potent gastrokinetic effect of motilin, may hold considerable promise for the future. Experience with erythromycin in diabetic gastroparesis is nonetheless very limited. To some extent the therapeutic effectiveness of metoclopramide and cisapride has been established in placebo-controlled trials. In trials with a placebo-controlled crossover design, however, only metoclopramide showed a sustained positive effect. Metoclopramide, which combines gastrokinetic and antiemetic properties seems, so far, the best therapeutic option in diabetic gastroparesis. Cisapride may be considered as a good alternative in cases where limited efficacy or side effects preclude the use of metoclopramide.
Similar articles
-
Use of metoclopramide, domperidone, and cisapride in the management of diabetic gastroparesis.Clin Pharm. 1990 May;9(5):357-65. Clin Pharm. 1990. PMID: 2190745 Review.
-
[Disorders of gastric emptying in diabetes. II. Treatment].Wiad Lek. 1997;50(1-3):39-41. Wiad Lek. 1997. PMID: 9297356 Review. Polish.
-
Gastroparesis and the current use of prokinetic drugs.Gastroenterologist. 1993 Jun;1(2):107-14. Gastroenterologist. 1993. PMID: 8049884 Review.
-
Effect of cisapride on gastric emptying of indigestible solids in patients with gastroparesis diabeticorum. A comparison with metoclopramide and placebo.Gastroenterology. 1987 Jan;92(1):171-4. doi: 10.1016/0016-5085(87)90854-7. Gastroenterology. 1987. PMID: 3781184 Clinical Trial.
-
Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis.Diabetes Care. 1993 Nov;16(11):1511-4. doi: 10.2337/diacare.16.11.1511. Diabetes Care. 1993. PMID: 8299441 Clinical Trial.
Cited by
-
Management of gastrointestinal motility disorders. A practical guide to drug selection and appropriate ancillary measures.Drugs. 1996 Oct;52(4):494-506. doi: 10.2165/00003495-199652040-00003. Drugs. 1996. PMID: 8891462 Review.
-
Cephalosporin antibiotics accelerate gastric emptying in mice.Dig Dis Sci. 1998 Aug;43(8):1690-4. doi: 10.1023/a:1018811114815. Dig Dis Sci. 1998. PMID: 9724153
-
Influence of blood glucose levels on rat liquid gastric emptying.Dig Dis Sci. 1996 Mar;41(3):528-32. doi: 10.1007/BF02282333. Dig Dis Sci. 1996. PMID: 8617129
-
Disordered gastric motor function in diabetes mellitus.Diabetologia. 1994 Jun;37(6):543-51. doi: 10.1007/BF00403371. Diabetologia. 1994. PMID: 7926337 Review.
-
Feed the ICU patient 'gastric' first, and go post-pyloric only in case of failure.Crit Care. 2010;14(1):123. doi: 10.1186/cc8862. Epub 2010 Feb 19. Crit Care. 2010. PMID: 20236501 Free PMC article.
References
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical