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Case Reports
. 2024 Mar 11;16(1):111-115.
doi: 10.4274/jcrpe.galenos.2022.2022-5-20. Epub 2022 Sep 1.

Gastroparesis in Adolescent Patient with Type 1 Diabetes: Severe Presentation of a Rare Pediatric Complication

Fortunato Lombardo  1 , Bruno Bombaci  1 , Stefano Costa  2 , Mariella Valenzise  1 , Nino Giannitto  1 , Davide Cardile  3 , Sergio Baldari  3 , Giuseppina Salzano  1 , Stefano Passanisi  1
Affiliations
Case Reports

Gastroparesis in Adolescent Patient with Type 1 Diabetes: Severe Presentation of a Rare Pediatric Complication

Fortunato Lombardo et al. J Clin Res Pediatr Endocrinol. .

Abstract

Gastroparesis is a long-term complication of diabetes related to autonomic neuropathy. It is characterized clinically by delayed gastric emptying and upper gastrointestinal symptoms, including early satiety, postprandial fullness, nausea, vomiting, and abdominal pain. Gastric emptying scintigraphy is the gold standard for diagnosis as it reveals delayed gastric emptying. Therapeutic strategies include dietary modifications, improvement of glycemic control, and prokinetic drugs. Case descriptions of diabetic gastroparesis in pediatric ages are very scarce. We report the case of a 16-year-old adolescent with severe presentation of diabetic gastroparesis. She presented with recurrent episodes of nausea, vomiting and abdominal pain which led progressively to reduced oral intake and weight loss. Her past glycemic control had been quite brittle, as demonstrated by several hospitalizations due to diabetic ketoacidosis and recurrent episodes of severe hypoglycemia. After the exclusion of infectious, mechanical, metabolic, and neurological causes of vomiting, a gastric emptying scintigraphy was performed, leading to the diagnosis of gastroparesis. Treatment with metoclopramide was started with progressive relief of symptoms. To improve glycemic control, insulin therapy with an advanced hybrid, closed loop system was successfully started. Pediatricians should consider diabetic gastroparesis in children and adolescents with long-standing, poorly controlled diabetes and appropriate symptomology.

Keywords: Advanced hybrid closed-loop; gastric emptying; metoclopramide; microvascular complications; scintigraphy.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Upper panel: anterior and posterior planar images of the gastric contents up to 90 minutes after ingestion of the liquid bolus. Lower panel: the activity/time curve of the gastric contents shows no significant deflection
Figure 2
Figure 2
Assessment of glucose control during the first three weeks of advanced hybrid closed loop system use. All glucose metrics met the recommended clinical targets. Data were extracted from CareLink™ system software
See this image and copyright information in PMC

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