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Diabetic Gastroparesis Ppt

Gastroparesis: Etiology, Clinical Manifestations, And Diagnosis

Gastroparesis: Etiology, Clinical Manifestations, And Diagnosis

INTRODUCTION Normal gastrointestinal motor function is a complex series of events that requires coordination of the sympathetic and parasympathetic nervous systems, neurons and pacemaker cells (called interstitial cells of Cajal) within the stomach and intestine, and the smooth muscle cells of the gut. Abnormalities of this process can lead to a delay in gastric emptying (gastric stasis) [1]. This topic will review the etiology and diagnosis of gastroparesis. Our recommendations are largely consistent with guidelines by the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) [2,3]. The pathogenesis and treatment of gastroparesis are discussed separately. (See "Pathogenesis of delayed gastric emptying" and "Treatment of gastroparesis".) DEFINITION Gastroparesis is a syndrome of objectively delayed gastric emptying in the absence of a mechanical obstruction and cardinal symptoms of nausea, vomiting, early satiety, bloating, and/or upper abdominal pain [3]. EPIDEMIOLOGY In one of the largest population-based studies that identified 3604 potential cases of gastroparesis of whom 83 fulfilled diagnostic criteria for definite gastroparesis, the age-adjusted incidence of gastroparesis was 2.4 per 100,000 person-years for men and 9.8 per 100,000 person-years for women [4]. The age-adjusted prevalence of definite gastroparesis was 9.6 per 100,000 persons for men and 38 per 100,000 persons for women. Overall survival was significantly lower than for the age- and sex-matched general population. ETIOLOGY Although multiple conditions have been associated with gastroparesis, the majority of cases are idiopathic, diabetic, or postsurgical (figure 1). Continue reading >>

Gastroparesis | France | Pdf | Ppt| Case Reports | Symptoms | Treatment

Gastroparesis | France | Pdf | Ppt| Case Reports | Symptoms | Treatment

Gastroparesis is a condition in which the spontaneous movement of the muscles (motility) in your stomach does not function normally. Gastroparesis affects people with both type 1 and type 2 diabetes in which the stomach takes too long to empty its contents (delayed gastric emptying). The symptoms of gastroparesis can range from mild to severe. They occur more often in some people than others. The symptoms of gastroparesis can include: Heartburn, Nausea, Vomiting of undigested food, Early feeling of fullness when eating, Weight loss, Abdominal bloating, Erratic blood glucose (sugar) levels, Lack of appetite, Gastroesophageal reflux , Spasms of the stomach wall, etc. Gastroparesis has been treated with the help ultrasound, which uses sound waves to create an image of your organs and can be used to rule out pancreatitis and gallbladder disease. And upper endoscopy which uses a long, thin scope that your doctor guides downs your throat to see the lining of your stomach. Gastroparesis results in increased rate of morbidity and mortality rate globally. The degree of occurrence and pervasiveness of this disease is diverse among different societies. It is estimated that, France, Gastroparesis affects 3-9% of the entire community. Age group between 17-55 years are mostly been affected by this disease. Continue reading >>

Get Unlimited Access On Medscape.

Get Unlimited Access On Medscape.

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Gastrointestinal Complications Of Diabetes Mellitus

Gastrointestinal Complications Of Diabetes Mellitus

Go to: Abstract Diabetes mellitus affects virtually every organ system in the body and the degree of organ involvement depends on the duration and severity of the disease, and other co-morbidities. Gastrointestinal (GI) involvement can present with esophageal dysmotility, gastro-esophageal reflux disease (GERD), gastroparesis, enteropathy, non alcoholic fatty liver disease (NAFLD) and glycogenic hepatopathy. Severity of GERD is inversely related to glycemic control and management is with prokinetics and proton pump inhibitors. Diabetic gastroparesis manifests as early satiety, bloating, vomiting, abdominal pain and erratic glycemic control. Gastric emptying scintigraphy is considered the gold standard test for diagnosis. Management includes dietary modifications, maintaining euglycemia, prokinetics, endoscopic and surgical treatments. Diabetic enteropathy is also common and management involves glycemic control and symptomatic measures. NAFLD is considered a hepatic manifestation of metabolic syndrome and treatment is mainly lifestyle measures, with diabetes and dyslipidemia management when coexistent. Glycogenic hepatopathy is a manifestation of poorly controlled type 1 diabetes and is managed by prompt insulin treatment. Though GI complications of diabetes are relatively common, awareness about its manifestations and treatment options are low among physicians. Optimal management of GI complications is important for appropriate metabolic control of diabetes and improvement in quality of life of the patient. This review is an update on the GI complications of diabetes, their pathophysiology, diagnostic evaluation and management. Keywords: Gastrointestinal complications, Diabetes mellitus, Esophageal complications, Nonalcoholic fatty liver disease, Diabetic gastroparesis, Continue reading >>

Diagnostic Assessment Of Diabetic Gastroparesis

Diagnostic Assessment Of Diabetic Gastroparesis

Gastroparesis is characterized by a constellation of upper gastrointestinal (GI) symptoms in association with delayed gastric emptying (GE) in the absence of mechanical outlet obstruction from the stomach. Cardinal symptoms are nausea, vomiting, early satiety or postprandial fullness, bloating, and abdominal or epigastric pain (1). Gastric retention may be asymptomatic in some, possibly due to afferent dysfunction in the setting of vagal denervation (2,3), and delayed GE may be associated with recurrent hypoglycemia in patients without upper GI symptoms (4,5). In these individuals, the term “delayed GE” is preferred to gastroparesis (1), although others have used terms such as “gastric hypoglycemia” (6). Thus, clinical manifestations of impaired GE may include anorexia, weight loss, malnutrition, phytobezoar formation, poorer quality-of-life, or impaired glycemic control due to erratic delivery of nutrients to the small bowel for absorption, and these may occur independent of factors such as age, gender, alcohol consumption, tobacco use, and diabetes type (7–9). Upper GI symptoms in diabetic patients may result from accelerated GE, often in association with vagal neuropathy and impaired proximal gastric accommodation (10). In addition, upper GI symptoms in diabetic patients were not significantly different in those with delayed compared with rapid GE, except possibly for postprandial distress (P = 0.076 on univariate analysis) (11). Hence, it is essential to measure GE in patients with upper GI symptoms if the right treatment is to be selected, such as choice of a prokinetic agent in those with delayed GE. Similarly, one cannot assume that patients with known vagal neuropathy and upper GI symptoms have gastroparesis, because the measured GE may be normal, fast Continue reading >>

Delayed Radionucleotide Gastric Emptying Studies Predict Morbidity In Diabetics With Symptoms Of Gastroparesis

Delayed Radionucleotide Gastric Emptying Studies Predict Morbidity In Diabetics With Symptoms Of Gastroparesis

Background & Aims The aim of this study was to evaluate the prognostic value of gastric emptying studies on the morbidity associated with diabetic gastroparesis. Methods This was a parallel cohort study of 3 groups. Group A (n = 94) contained diabetic patients (type 1 and type 2) with classic symptoms of gastroparesis (including early satiety, postprandial fullness, bloating, abdominal swelling, nausea, vomiting, and retching) and delay in radionucleotide gastric emptying study. Group B (n = 94) contained diabetic subjects with classic symptoms of gastroparesis but negative scintigraphy. Group C (n = 94) contained diabetic subjects without symptoms of gastroparesis. Data were gathered on the number of days hospitalized and hospitalizations, office visits, emergency department visits, death rate, glycosylated hemoglobin levels, medications, and past medical history. Results Group A had significantly more hospital days per 1000 patient days (25.5) than both group B (5.1; P < .01) and group C (2.3; P < .01). Group A also had significantly more hospitalizations, office visits, and emergency department visits than both group B and group C. Deaths and mean glycosylated hemoglobin levels did not differ between the groups. Patients in group A were more likely to have cardiovascular disease (19.2% vs 6.4%, A vs C; P < .05), hypertension (63% vs 43%, A vs C; P = .005), and retinopathy (33% vs 11.7%, A vs C; P < .001). Conclusions A delayed radionucleotide gastric emptying study predicts negative health outcomes in diabetic patients with symptoms of gastroparesis. We identified a correlation between diabetic gastroparesis and cardiovascular disease, hypertension, and retinopathy that may indicate an underlying vascular etiology. Gastroparesis is due to abnormal gastric motility in Continue reading >>

Blunting Of Colon Contractions In Diabetics With Gastroparesis Quantified By Wireless Motility Capsule Methods

Blunting Of Colon Contractions In Diabetics With Gastroparesis Quantified By Wireless Motility Capsule Methods

Blunting of Colon Contractions in Diabetics with Gastroparesis Quantified by Wireless Motility Capsule Methods Radoslav Coleski , Gregory E. Wilding , John R. Semler , William L. Hasler Affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, United States of America Affiliation: Department of Biostatistics, State University of New York at Buffalo, Buffalo, New York, United States of America Affiliation: Medtronic, Sunnyvale, California, United States of America Affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, United States of America Generalized gut transit abnormalities are observed in some diabetics with gastroparesis. Relations of gastric emptying abnormalities to colon contractile dysfunction are poorly characterized. We measured colon transit and contractility using wireless motility capsules (WMC) in 41 healthy subjects, 12 diabetics with gastroparesis (defined by gastric retention >5 hours), and 8 diabetics with normal gastric emptying (5 hours). Overall numbers of colon contractions >25 mmHg were calculated in all subjects and were correlated with gastric emptying times for diabetics with gastroparesis. Colon transit periods were divided into quartiles by time and contraction numbers were calculated for each quartile to estimate regional colon contractility. Colon transit in diabetics with gastroparesis was prolonged vs. healthy subjects (P<0.0001). Overall numbers of colon contractions in gastroparetics were lower than controls (P = 0.02). Diabetics with normal emptying showed transit and contraction numbers similar to controls. Gastric emptying inversely correlated with overall contraction numbers Continue reading >>

Gi Complications Of Diabetes: What Are The Treatment Options?

Gi Complications Of Diabetes: What Are The Treatment Options?

GI Complications of Diabetes: What Are the Treatment Options? Diabetic GI manifestations include gastroparesis and diabetic enteropathy Research indicates that the prevalence of gastrointestinal (GI) complications caused by diabetes mellitus (DM) has been increasing, with up to 75% of diabetic patients experiencing GI symptoms.1 GI manifestations seen in diabetic patients include gastroparesis, or delayed gastric emptying, and enteropathy, or large bowel dysfunction. These complications present as GI motility dysfunction and are the result of diabetic autonomic neuropathy. Gastroparesis and enteropathy are not only associated with increased health care costs, but significant morbidity and decreased patient quality of life. Gastroparesis is a well-recognized GI complication of diabetes.1 It has been found to affect 27-65% of patients with type 1 DM and up to 30% of patients with type 2 DM. A higher prevalence has also been seen in female patients. Symptoms of gastroparesis include nausea, vomiting, early satiety, bloating, and upper abdominal pain. These symptoms can present acutely or chronically with periodic exacerbations. Diagnosis of gastroparesis occurs only after all other potential causes of symptoms have been excluded and postprandial gastric stasis has been confirmed. Treatment of gastroparesis includes medication, diet, and symptom management and is detailed in the treatment algorithm shown in Figure 1 . On the other hand, enteropathy is a less well-recognized GI complication associated with DM.1 This GI manifestation occurs more commonly in patients with type 1 DM and symptoms include diarrhea, constipation, fecal incontinence, and steatorrhea. It has been found that constipation affects nearly 60% of diabetic patients while diarrhea occurs in up to 20%. The Continue reading >>

Diabetic Neuropathy Treatment & Management

Diabetic Neuropathy Treatment & Management

LYRICA is contraindicated in patients with known hypersensitivity to pregabalin or any of its other components. Angioedema and hypersensitivity reactions have occurred in patients receiving pregabalin therapy. There have been postmarketing reports of hypersensitivity in patients shortly after initiation of treatment with LYRICA. Adverse reactions included skin redness, blisters, hives, rash, dyspnea, and wheezing. Discontinue LYRICA immediately in patients with these symptoms. There have been postmarketing reports of angioedema in patients during initial and chronic treatment with LYRICA. Specific symptoms included swelling of the face, mouth (tongue, lips, and gums), and neck (throat and larynx). There were reports of life-threatening angioedema with respiratory compromise requiring emergency treatment. Discontinue LYRICA immediately in patients with these symptoms. Antiepileptic drugs (AEDs) including LYRICA increase the risk of suicidal thoughts or behavior in patients taking AEDs for any indication. Monitor patients treated with any AED for any indication for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. Pooled analyses showed clinical trial patients taking an AED had approximately twice the risk of suicidal thoughts or behavior than placebo-treated patients. The estimated incidence rate of suicidal behavior or ideation among 27,863 AED-treated patients was 0.43%, compared to 0.24% among 16,029 placebo-treated patients, representing an increase of approximately one patient for every 530 patients treated with an AED. The most common adverse reactions across all LYRICA clinical trials are dizziness, somnolence, dry mouth, edema, blurred vision, weight gain, constipation, euphoric mood, balance Continue reading >>

Domperidone - Wikipedia

Domperidone - Wikipedia

Prescription medicine (Rx only): India, Australia, Canada, Israel, Belgium, France; over-the-counter : Egypt, Ireland, Italy, Japan, Netherlands, South Africa, Switzerland, China, Russia, Slovakia, Ukraine [2] Mexico, Thailand, Malta, South Korea, and Romania [3] Domperidone, sold under the brand name Motilium among others, is a peripherally selective dopamine D2 receptor antagonist that was developed by Janssen Pharmaceutica and is used as an antiemetic , gastroprokinetic agent , and galactagogue . [1] [6] [7] It may be administered orally or rectally , and is available in the form of tablets , orally disintegrating tablets (based on Zydis technology), [8] suspension , and suppositories . [9] The drug is used to relieve nausea and vomiting ; to increase the transit of food through the stomach (by increasing gastrointestinal peristalsis ); and to promote lactation ( breast milk production) by release of prolactin . [1] [7] It was reported in 2007 that domperidone is available in 58 countries, including Canada , [10] but the uses or indications of domperidone vary between nations. In Italy it is used in the treatment of gastroesophageal reflux disease and in Canada, the drug is indicated in upper gastrointestinal motility disorders and to prevent gastrointestinal symptoms associated with the use of dopamine agonist antiparkinsonian agents. [11] In the United Kingdom, domperidone is only indicated for the treatment of nausea and vomiting and the treatment duration is usually limited to 1 week. In the United States, domperidone is not currently a legally marketed human drug and it is not approved for sale in the U.S. On 7 June 2004, FDA issued a public warning that distributing any domperidone-containing products is illegal. [12] There is some evidence that domperidone ha Continue reading >>

Diabetic Gastroparesis

Diabetic Gastroparesis

To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Published by Mildred Sibyl French Modified about 1 year ago 2 Introduction Pathophysiology Pathogenesis Clinical Features Differential Diagnosis Diagnostic Test Treatment Summary 3 Introduction Delay of gastric emptying without any gastric outlet obstruction. Longstanding, poorly controlled DM, autonomic failure First describtion : Rundles, 1945 part of a generalized autonomic neuropathy Gastroparesis diabeticorum : Kassander,1954 prospective study of asymtomatic diabetic patients where 22% had radiologic evidence of gastric retention - Rundles,Medicine,1945 :24 - Kassander P, Ann Intern Med, 1954 :48 4 Pathophysiology - Interdigestive motor activiey Alterd gastric electrical activity tachygastria Decreased fundic motor activity Delayed emptying of solids from the proximal Late filling of the antrum Reduced antral motor activity Impaired antroduodenal coordination Dysfunction of interdigestive motor activity phase three (the MMC) overnight retention of large indigestible food Pyloric motility: prolonged intense contraction - Nilsson PH. J Diab Comp,1996:10 - Atlas of Clinical Endocrinology - Interdigestive motor activiey : Third phase Migrating Motor Complex (MMC) - Gastric Neuromuscular Function - 5 and duodenum from a patient with diabetic gastroparesis > < Simultaneous recording of motor activity from the antrum, pylorus, and duodenum from a patient with diabetic gastroparesis > pylorospasm - Mearin F et al.Gastroenterology, 1986: 90 Gastric vagal denervation Altered secretion of various hormones Motilin : Cholinegic dificiency lack of motilin action on gastric smooth muscle Pancreatic polypeptide, Somatostatin : decreased Gastrin : vagal denervation increa Continue reading >>

A Systematic Review On Intrapyloric Botulinum Toxin Injection For Gastroparesis

A Systematic Review On Intrapyloric Botulinum Toxin Injection For Gastroparesis

A Systematic Review on Intrapyloric Botulinum Toxin Injection for Gastroparesis Bai Y.ac Xu M.-J.d Yang X.a Xu C.a, b Gao J.a, c Zou D.-W.a, b Li Z.-S.ac I have read the Karger Terms and Conditions and agree. I have read the Karger Terms and Conditions and agree. Buy a Karger Article Bundle (KAB) and profit from a discount! If you would like to redeem your KAB credit, please log in . Save over 20% compared to the individual article price. Buy Cloud Access for unlimited viewing via different devices Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use * The final prices may differ from the prices shown due to specifics of VAT rules. For additional information: Background: Though trials evaluating the effect of intrapyloric botulinum toxin injection on gastroparesis have been reported, there is no agreement whether botulinum toxin can effectively relieve the symptoms and improve the results of gastric emptying study in patients with gastroparesis. We performed a systematic literature review to address this issue. Methods: Databases including PubMed, EMBASE, and the Cochrane Library and Science Citation Index were searched. Two reviewers independently identified relevant trials. Outcome measures were the improvement of subjective symptoms and objective measurement. Results: 15 reports were included; only 2 randomized controlled trials were available. Almost all the non-randomized trials reported significant improvement in subjective symptoms and objective gastric emptying study after botulinum toxin injection. While the 2 randomized controlled trials did not confirm the efficacy of botulinum toxin injection, none of the individual trials s Continue reading >>

Prokinetics In The Management Of Functional Gastrointestinal Disorders

Prokinetics In The Management Of Functional Gastrointestinal Disorders

J Neurogastroenterol Motil 2015; 21(3): 330-336 Prokinetics in the Management of Functional Gastrointestinal Disorders Division of Gastroenterology and Hepatology, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA Correspondence to: Eamonn M M Quigley, MD, FRCP, FACP, FACG, FRCPI, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, 6550 Fannin St, SM 1001, Houston, Texas 77030, USA, Tel: +1-713-441-0853, Fax: +1-713-797-9595, E-mail: [email protected] Received: June 1, 2015; Accepted: June 23, 2015; Published online: July 3, 2015. The Korean Society of Neurogastroenterology and Motility. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. A variety of common and some not common gastrointestinal syndromes are thought to be based on impaired gut motility. For some, the role of motility is well defined, for others and the functional gastrointestinal disorders, in particular, the role of hypo- or dysmotility remains unclear. Over the years pharmacological and physiological laboratories have developed drugs which stimulate gut motility; many have been evaluated in motility and functional disorders with what can best be described as mixed results. Lack of receptor specificity and resultant expected and unexpected adverse events have led to the demise of some of these agents. Newer, more selective agents offer promise but the heterogeneity of the clinical disorders they target continues to pose a formidable challenge to drug development in this area. Keywords: Constipation, Dyspepsia, Gastroparesis, Intestin Continue reading >>

Diabetic Gastroparesis

Diabetic Gastroparesis

Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea Correspondence to Joong Goo Kwon, M.D. Department of Internal Medicine, Daegu Catholic University Hospital, 3056-6 Daemyeong 4-dong, Nam-gu, Daegu 705-718, Korea Tel: +82-53-650-4215, Fax: +82-53-628-4005, E-mail: [email protected] Copyright 2011 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( ) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Diabetic gastroparesis is a complication that often occurs in long-standing diabetic patients and it is characterized by delayed gastric emptying and upper gastrointestinal symptoms. The pathophysiology of gastroparesis is complex and poorly understood but substantial advances in knowledge about it have been gained from experimental studies of gastric tissue in animal models and humans with diabetes. Several abnormalities in diabetes might result in gastroparesis, including autonomic neuropathy, enteric neuropathy, abnormalities of interstitial cells of Cajal and smooth muscle cells, acute hyperglycemia and psychological dysfunction. Scintigraphic measurement of solid emptying is regarded as gold standard diagnostic technique for comparison of newer diagnostic modalities such as ultrasound, breath test and MRI. The available therapeutic options include dietary modification, optimization of glycemia, pharmacological interventions, endoscopic treatment, and gastric electrical stimulation. The efficacy of current treatment remains suboptimal and the search for more specific and effective treatments will likely be needed. (Korean J Med 2011; Continue reading >>

Effect Of Metoclopramide On Gastric Fluid Volumes In Diabetic Patients Who Have Fasted Before Elective Surgery | Anesthesiology | Asa Publications

Effect Of Metoclopramide On Gastric Fluid Volumes In Diabetic Patients Who Have Fasted Before Elective Surgery | Anesthesiology | Asa Publications

Effect of Metoclopramide on Gastric Fluid Volumes in Diabetic Patients Who Have Fasted before Elective Surgery * Professor, Research Nurse, Professor, Department of Anesthesiology, Loyola University Medical Center, Maywood, Illinois. Assistant Professor, Department of Anesthesiology, Ohio State University Childrens Hospital, Columbus, Ohio. Clinical Science / Endocrine and Metabolic Systems / Gastrointestinal and Hepatic Systems / Respiratory System Effect of Metoclopramide on Gastric Fluid Volumes in Diabetic Patients Who Have Fasted before Elective Surgery Anesthesiology 5 2005, Vol.102, 904-909. doi: Anesthesiology 5 2005, Vol.102, 904-909. doi: WScott Jellish, Vyas Kartha, Elaine Fluder, Stephen Slogoff; Effect of Metoclopramide on Gastric Fluid Volumes in Diabetic Patients Who Have Fasted before Elective Surgery. Anesthesiology 2005;102(5):904-909. 2018 American Society of Anesthesiologists Effect of Metoclopramide on Gastric Fluid Volumes in Diabetic Patients Who Have Fasted before Elective Surgery You will receive an email whenever this article is corrected, updated, or cited in the literature. You can manage this and all other alerts in My Account NEUROPATHIC gastroparesis is among the many complications associated with both insulin-dependent (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM). Reported incidence of gastroparesis ranges from 9.9% to 76%. 13 The relation between the duration of diabetes mellitus, glycemic control, and the prevalence of gastroparesis is poorly defined. 4 There is little correlation between gastrointestinal symptoms and objective data for gastric emptying in patients with IDDM or NIDDM. 2,57 Although no determinable duration of chronicity of diabetes can clearly predict the presence of gastroparesis in these patients, physic Continue reading >>

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