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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastroparesis is a relatively uncommon but clinically troublesome disorder that develops in some patients with diabetes mellitus or after gastric operations. Its pathogenesis remains obscure. We used a manometric technique to record pressure changes in fasting patients in the gastric fundus, distal stomach, and adjacent small bowel of patients with severe gastroparesis, asymptomatic diabetic patients, asymptomatic postsurgical patients, and healthy controls. Patients with gastroparesis had normal interdigestive motor cycles (phase III) in the intestine but not in the stomach. Sporadic motor activity in the stomach (phase II) also was markedly reduced. Metoclopramide and bethanecol significantly increased gastric motor activity in these patients, often triggering an intense burst of motor activity in the stomach, similar to phase III. These observations suggest that gastroparesis is a potentially reversible disorder and should encourage further attmpts for pharmacologic control of the syndrome.
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PMID:Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and bethanechol. 735 52

The motor function of the antrum was studied in 7 normal subjects, 4 patients with diabetes without GI symptoms, and 7 patients with diabetic gastroparesis. Both the number of antral contractions and the cumulative antral activity (percent of time during which the antrum contracted) in patients with diabetic gastroparesis were significantly lower than in normal subjects and diabetic patients without gastroparesis (P less than 0.01). Interdigestive motor complexes were observed in all normal subjects, but they were not present in any patients with diabetic gastroparesis. Intravenous metoclopramide did not affect the rate of antral contractions (P less than 0.1), but it increased the cumulative antral activity (P less than 0.001) in normal subjects and diabetics without gastroparesis. Metoclopramide, however, did not alter the rate of antral contractions (P less than 0.09) or the total cumulative antral activity (P less than 0.09) in diabetic patients with gastroparesis. Furthermore, in normal subjects, the action of metoclopramide was blocked by atropine sulfate (P less than 0.003). Bethanechol caused a slight increase in the number of antral contractions (P less than 0.05) and cumulative antral activity (P less than 0.01) in normal subjects. This cholinergic drug caused a marked increase in the rate of antral contractions and the cumulative antral activity in diabetic patients with gastroparesis. Antral contractions and cumulative antral activity were restored by bethanechol to normal values. These findings suggest a variable degree of gastric neuropathy in individual patients with diabetic gastroparesis with functionally intact antral muscles as assessed by their pharmacologic response to cholinergic stimulation.
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PMID:Pathogenesis of diabetic gastroparesis: a pharmacologic study. 735 62

It is reported on a 61-year-old patient in whom since 1959 has been existing a diabetes mellitus in need of insulin. 1973 in the endoscopic control of roentgenological findings of a stomach suspect to tumour by means of the Wolf-Schindler gastroscope the suspicion to a gastric carcinoma was expressed. In May 1975 he was again admitted to hospital on account of a hypoglycemic shock. Roentgenologically large filling defects in the stomach were found, gastroscopically macroscopically no clearly explained whitish yellow masses (Histology: remains of food, chronic superficial gastritis, extended settlement of fungi). Only after several days of food carency and daily gastric lavages gastroscopically normal findings could be made. Together with the roentgenological findings of the stomach the diagnosis gastroparesis diabeticorum was made. Therapeutically an optimum stopping of diabetes is recommended and the application of metoclopramide. A surgical intervention is not advisable.
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PMID:[Diabetic gastroparesis]. 744 11

Clinical and laboratory features and risk factors for diabetic gastroparesis (DGP) were investigated in 226 diabetics on chronic dialysis; 106 subjects (43%) had DGP diagnosed by persistent vomiting improved with the use of prokinetic agents and 120 (control group) had no clinical DGP. Type 1 diabetics had DGP more frequently than type 2 diabetics (70 vs. 37%). The DGP group had longer duration of diabetes (21 +/- 8 vs. 13 +/- 6 years), higher frequency of diabetic orthostatic hypotension (95 vs. 33%), enteropathy (49 vs. 5%), blindness (52 vs. 23%), myocardial infarction (86 vs. 42%), extremity gangrene (54 vs. 27%) and cerebrovascular accidents (43 vs. 25%), lower serum albumin 32.3 +/- 3.9 vs. 35.4 +/- 3.8 g/l), urea (24.0 +/- 5.5 vs. 25.5 +/- 5.5 mmol/l) and creatinine (710 +/- 210 vs. 820 +/- 220 mumol/l), and higher serum TCO2 (20.9 +/- 3.1 vs. 19.8 +/- 2.7 mmol/l) than the control group (all differences significant at p +/- 0.004). Glycemic control was adequate in 24% of the DGP group subjects and 83% of the control subjects (p < 0.001). Annual hospitalization rate was 49 +/- 48 days/patient in the DGP group and 16 +/- 27 days/patient in the control group (p < 0.001). Median patient survival was 24 +/- 2 months in the DGP group and 61 +/- 9 months in the control group (p < 0.0001). Logistic regression identified long duration of diabetes and poor glycemic control as risk factors for DGP. In diabetics on dialysis, DGP is associated with high frequency of other diabetic complications, low serum albumin and creatinine, and high morbidity and mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Gastroparesis in diabetics on chronic dialysis: clinical and laboratory associations and predictive features. 747 16

Twenty patients (18 males, 2 females) with type II (non-insulin-dependent) diabetes mellitus were enrolled in the study. They were aged 49-72 years (mean age 65 years). Radionuclide-labelled water was used to measure oesophageal motility, expressed as the oesophageal mean transit time (MTT). A radionuclide-labelled solid meal was used to measure gastric motility, expressed as the half-time of gastric emptying (T1/2GET). A baseline study was performed before oral erythromycin therapy. After a 2-week course of treatment, the subjects underwent a second study. Fasting blood sugar (FBS) was also monitored in each study. In the baseline study, MTT was 8.88 +/- 2.00 s and T1/2GET was 198.0 +/- 58.9 min. After treatment with erythromycin, MTT decreased to 7.48 +/- 2.24 s (P < 0.01) and T1/2GET decreased to 137.1 +/- 71.2 min (P < 0.01). In addition, the FBS decreased from 159.0 +/- 40.2 mg dl-1 at baseline to 139.2 +/- 39.8 mg dl-1 after 2 weeks of erythromycin treatment (P < 0.05). We conclude that erythromycin is an effective prokinetic agent for diabetic gastroparesis, and that improved oesophageal transit and gastric emptying may improve glycaemic control.
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PMID:Effects of oral erythromycin on upper gastrointestinal motility in patients with non-insulin-dependent diabetes mellitus. 747 13

About one-half of patients with insulin- or non-insulin-dependent diabetes have delayed gastric emptying (diabetic gastroparesis). Some of them complain of epigastric pain, nausea, vomiting or postprandial fullness (diabetic dyspepsia), although only a minority are severely symptomatic. Diabetic gastroparesis is clinically relevant not only by virtue of the symptoms induced but also because it may contribute to inadequate glycaemic control and impaired absorption of orally administered drugs. Recent data suggest that abnormal blood glucose control, not only autonomic neuropathy, contribute to the pathogenesis of disordered gastric motility. In most cases diabetic gastroparesis is diagnosed clinically in the absence of demonstrable lesions of the upper gastrointestinal tract. To evaluate gastric emptying, scintigraphy is the 'gold standard'. Gastrokinetic drugs are of help in the treatment of gastroparesis: erythromycin is the first choice in acute presentations and cisapride for chronic symptoms. New macrolides with prokinetic action and devoid of antibacterial properties are very promising and should add another pharmacologic approach to control dyspepsia and gastroparesis in diabetic patients in the future.
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PMID:Gastroparesis and dyspepsia in patients with diabetes mellitus. 749 57

Recognition of early phases of diabetic gastroparesis is hampered by the absence of characteristic symptoms and practicable detection systems in clinical practice. Hence, a new procedure estimating phase III activity of the interdigestive migrating motor complex by monitoring gastric emptying of an undigestible marker particle by means of a metal detector was evaluated in 40 diabetic patients (13 type I, 27 type II diabetes) and 14 non-diabetic controls. Simultaneously, orocecal transit of fluids was measured by the hydrogen breath test. Gastric emptying of a solid marker was significantly delayed in diabetics as compared with controls (112.5 +/- 8.6 vs 51.2 +/- 6.8 minutes, M +/- SEM, p < 0.05). Of the diabetics investigated 77.5% had delayed gastric emptying but only 22.5% of those were clinically symptomatic as assessed by a standardized questionnaire. Gastric emptying velocity did not correlate significantly with age, length of diabetes, neuropathy, blood glucose and orocecal transit of fluids. We conclude that determination of gastric emptying time of undigestible marker particles by means of a sensitive metal detector appears to be a clinically promising and easy to perform method to detect early phases of diabetic gastroparesis.
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PMID:[Early diagnosis of diabetic gastroparesis]. 775 16

A 19-year-old woman with insulin-dependent diabetes mellitus (IDDM) of 3.5 years duration had been suffering from recurrent episodes of diabetic ketoacidosis (DKA), dizziness, and weight loss (16 kg, 29%) for 6 months. History and physical examination gave evidence of severe peripheral and autonomic neuropathy. Radionuclide retention on gastric emptying test at 60 min was greater than 90% (normal < 60%). On autonomic cardiovascular testing there was evidence of both parasympathetic and sympathetic damage. There was no evidence of nephropathy or retinopathy. Optimal diabetic control using 4 insulin injections (2 u/kg/day) and high-dose cisapride terminated the vomiting, and she regained the weight lost within 5 months. This case is unique in that severe diabetic neuropathy followed relatively soon after onset of disease, without other microvascular complications. The correct diagnosis of gastroparesis as the cause of the recurrent DKA and weight loss, and the specific prokinetic therapy and nearly normoglycemic control of the diabetes led to dramatic clinical and functional improvement. Specific prokinetic therapy and the nearly normoglycemic control of the diabetes led to dramatic clinical and functional improvement. Gastroparesis can cause recurrent DKA even in young patients with IDDM of short duration.
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PMID:[Severe neuropathy in a young diabetic]. 784 56

The application of novel investigative techniques has demonstrated that disordered gastric motility occurs frequently in diabetes mellitus. Gastric emptying is abnormal in about 50% of diabetic patients and delay in gastric emptying of nutrient-containing meals is more common than rapid emptying. The blood glucose concentration influences gastric motility in diabetes. In IDDM patients, gastric emptying is retarded during hyperglycaemia and may be accelerated by hypoglycaemia. Gastroparesis therefore does not necessarily reflect irreversible autonomic neuropathy and blood glucose concentrations must be monitored when gastric motility is evaluated in diabetic patients. There is a poor relationship between gastric emptying and gastrointestinal symptoms and the mechanisms by which abnormal motility causes symptoms are unclear. The introduction of new gastrokinetic drugs has improved therapeutic options for the management of symptomatic patients with gastroparesis considerably. The contribution of disordered gastric emptying to poor glycaemic control is unclear, but the demonstration that the rate of gastric emptying is a major factor in normal blood glucose homeostasis suggests that this is likely to be significant.
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PMID:Disordered gastric motor function in diabetes mellitus. 748 51

In patients with diabetes mellitus and gastroparesis, dysrhythmias of gastric myoelectrical activity, especially tachygastrias, are thought to be involved in the pathogenesis of dyspeptic symptoms. Using surface electrogastrography we studied the prevalence of these abnormalities, and their relationships to dyspeptic symptoms and the extent of cardiac autonomic neuropathy in 30 euglycemic patients with type I diabetes mellitus and 12 controls. Neither in the fasting nor in the postprandial state were differences in mean frequency of gastric electrical control activity and its variability found between patients and controls. In the fasting state, the power content of the 3 cpm component in the power spectrum of the electrogastrogram was even higher in patients than in controls (P = 0.049). In the fasting state, second harmonics of the 3 cpm fundamental gastric signal were seen more often in patients than in controls (P = 0.03). In patients with symptoms during the study, no second harmonics were found after the meal. The postprandial/fasting power ratio was decreased in patients with symptoms during the study as compared to patients without symptoms and controls (P < 0.05). The incidence of dysrhythmias, such as tachygastrias and bradygastrias, was not higher in patients than in controls (17% and 8%, respectively). No correlation was found between electrogastrographic parameters and the severity of autonomic neuropathy or dyspeptic symptoms scored before the study. In conclusion, this study has shown that patients with type I diabetes mellitus and autonomic neuropathy studied under euglycemic conditions do not have grossly disturbed myoelectrical activity, except when symptomatic during the study.
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PMID:Gastric myoelectrical activity in patients with type I diabetes mellitus and autonomic neuropathy. 795 6


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