TY - JOUR
T1 - The Investigation and Treatment of Diabetic Gastroparesis
AU - Kumar, Mohit
AU - Chapman, Adam
AU - Javed, Saad
AU - Alam, Uazman
AU - Malik, Rayaz A.
AU - Azmi, Shazli
PY - 2018/6
Y1 - 2018/6
N2 - Purpose: This review provides an update on the investigations and treatment options for gastroparesis. Methods: A comprehensive literature search of Medline, PubMed, Embase and OVID was conducted which included all systematic reviews and research articles that focused on the diagnosis, investigations and management diabetic gastroparesis. Findings: Dietary modifications and pharmacologic treatment with prokinetics to increase gastric motility form the mainstay of treatment. However, the use of prokinetics is limited by adverse effects and serious adverse effects, leaving metoclopramide as the only drug approved by the US Food and Drug Administration for the treatment of gastroparesis. Newer therapies, including motilin receptor agonists, ghrelin receptor agonists, and neurokinin receptor antagonists, are currently being investigated. Transpyloric stenting, gastric electrical stimulation, and gastric per-oral endoscopic myotomy provide mechanical options for intervention, and surgical interventions in severe intractable gastroparesis include laparoscopic pyloroplasty or gastrectomy. Implications: Advances to better understand the pathophysiology and management of diabetic gastroparesis have been limited, especially with discordance between symptoms and severity of delay in gastric emptying. Established treatment options are limited; however, recent pharmacologic and surgical interventions show promise.
AB - Purpose: This review provides an update on the investigations and treatment options for gastroparesis. Methods: A comprehensive literature search of Medline, PubMed, Embase and OVID was conducted which included all systematic reviews and research articles that focused on the diagnosis, investigations and management diabetic gastroparesis. Findings: Dietary modifications and pharmacologic treatment with prokinetics to increase gastric motility form the mainstay of treatment. However, the use of prokinetics is limited by adverse effects and serious adverse effects, leaving metoclopramide as the only drug approved by the US Food and Drug Administration for the treatment of gastroparesis. Newer therapies, including motilin receptor agonists, ghrelin receptor agonists, and neurokinin receptor antagonists, are currently being investigated. Transpyloric stenting, gastric electrical stimulation, and gastric per-oral endoscopic myotomy provide mechanical options for intervention, and surgical interventions in severe intractable gastroparesis include laparoscopic pyloroplasty or gastrectomy. Implications: Advances to better understand the pathophysiology and management of diabetic gastroparesis have been limited, especially with discordance between symptoms and severity of delay in gastric emptying. Established treatment options are limited; however, recent pharmacologic and surgical interventions show promise.
KW - Gastroparesis
KW - Microvascular
KW - Type 1 Diabetes Mellitus
KW - Type 2 Diabetes Mellitus
UR - http://www.scopus.com/inward/record.url?scp=85046632375&partnerID=8YFLogxK
U2 - 10.1016/j.clinthera.2018.04.012
DO - 10.1016/j.clinthera.2018.04.012
M3 - Review article
AN - SCOPUS:85046632375
SN - 0149-2918
VL - 40
SP - 850
EP - 861
JO - Clinical Therapeutics
JF - Clinical Therapeutics
IS - 6
ER -
