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==Diagnosis==
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
'''[[Stomach|Gastric]] [[scintigraphy]]''' or '''stable-isotope 13C breath test''' can detect different gastric emptying abnormalities.
'''[[Stomach|Gastric]] [[scintigraphy]]''' or '''stable-isotope 13C breath test''' can detect different gastric emptying abnormalities.
[[File:GastricEmptying.jpg|thumb|A gastric emptying scan (scintigraphy) that is used as an assessment tool to show the ability of stomach to empty its contents]]


===History and Symptoms===
===History and Symptoms===

Latest revision as of 21:13, 31 May 2021

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamed Riad, M.D.[2]

Synonyms and keywords:

Overview

Diabetic gastroparesis was first discovered by Kassander in 1958 in diabetic patients with delayed gastric emptying and gastric stasis but without mechanical obstruction, and was named gastroparesis diabeticorum. The definition has been changing by adding new symptoms such as severe abdominal pain. Based on the rate of gastric emptying, abnormalities of gastric emptying in diabetes may be classified as: transient slow gastric emptying, transient rapid gastric emptying, persistent slow or delayed gastric emptying (gastroparesis), and persistent rapid gastric emptying. Persistent hyperglycemia results in molecular and metabolic changes in neurons, interstitial cells of Cajal, and smooth muscle cells. Theses changes are caused by oxidative stress and products (cytokines) of the polarized M1 (proinflammatory) and M2 (prohealing, or repair) macrophages. Gastroparesis is not a separate category and is considered a part of functional dyspepsia. The most common symptoms "cardinal symptoms" of gastroparesis include early satiety, postprandial fullness, nausea, vomiting, and bloating. Gastric scintigraphy or stable-isotope 13C breath test can detect different gastric emptying abnormalities. The most effective symptomatic treatment of diabetic gastroparesis is the same as the treatment of functional dyspepsia.

Historical Perspective

Classification

Based on the rate of gastric emptying, abnormalities of gastric emptying in diabetes may be classified as:

  • Transient slow gastric emptying
  • Transient rapid gastric emptying
  • Persistent slow or delayed gastric emptying (gastroparesis)
  • Persistent rapid gastric emptying

Pathophysiology

Metabolic Changes That Affect Gastric Emptying in Diabetes

Transient Slow Gastric Emptying

  • It occurs as a result of a reduction in the proximal stomach muscle tone, inhibition of antral contractions, and inhibition of the powerful contractions of the interdigestive migrating motor complex.
  • Acute hyperglycemia causes a delay in gastric emptying of digestible food in the digestive period and indigestible food during the fasting period.
  • Delayed gastric emptying decreases postprandial hyperglycemia and acts as a negative feedback loop.
  • Hyperglycemia inhibits ATP-sensitive potassium (KATP) channels leading to activation of glucose-sensitive neurons in the vagal afferents. Activation of the gastric inhibitory vagal motor circuit can influence electrical slow waves and smooth muscle.
  • Acute hyperglycemia can cause dysfunction of myenteric interstitial cells of Cajal, resulting in isolated tachygastria (an increase in the cyclic electrical activity in the stomach, with a frequency of >3.6 cycles per minute [cpm]).[7]
  • Elevated blood glucose levels activates the gastric inhibitory vagal motor circuit, suppressing the stomach contractions and can overcome the hyperglycemia-mediated contraction of the smooth muscle.[8]
  • Transient slow gastric emptying as a result of acute hyperglycemia is considered a counter-regulatory phenomenon and does not need any treatment.
  • The transient effect is due to down-regulation of glucokinase.[9]

Transient Rapid Gastric Emptying


Persistent Rapid Gastric Emptying

Persistent Delayed Gastric Emptying (Gastroparesis)

Differentiating Diabetic Gastroparesis from other Diseases

Epidemiology and Demographics

Diagnosis

Diagnostic Study of Choice

Gastric scintigraphy or stable-isotope 13C breath test can detect different gastric emptying abnormalities.

A gastric emptying scan (scintigraphy) that is used as an assessment tool to show the ability of stomach to empty its contents

History and Symptoms

The most common symptoms "cardinal symptoms" of gastroparesis include early satiety, postprandial fullness, nausea, vomiting, and bloating.

Treatment

Medical Therapy

The most effective symptomatic treatment of diabetic gastroparesis is the same as the treatment of functional dyspepsia.

References

  1. Camilleri M, Chedid V, Ford AC, Haruma K, Horowitz M, Jones KL; et al. (2018). "Gastroparesis". Nat Rev Dis Primers. 4 (1): 41. doi:10.1038/s41572-018-0038-z. PMID 30385743.
  2. Grover M, Farrugia G, Stanghellini V (2019). "Gastroparesis: a turning point in understanding and treatment". Gut. 68 (12): 2238–2250. doi:10.1136/gutjnl-2019-318712. PMC 6874806 Check |pmc= value (help). PMID 31563877.
  3. Varol C, Mildner A, Jung S (2015). "Macrophages: development and tissue specialization". Annu Rev Immunol. 33: 643–75. doi:10.1146/annurev-immunol-032414-112220. PMID 25861979.
  4. Joshi SR, Comer BS, McLendon JM, Gerthoffer WT (2012). "MicroRNA Regulation of Smooth Muscle Phenotype". Mol Cell Pharmacol. 4 (1): 1–16. PMC 4190587. PMID 25309675.
  5. Neshatian L, Gibbons SJ, Farrugia G (2015). "Macrophages in diabetic gastroparesis--the missing link?". Neurogastroenterol Motil. 27 (1): 7–18. doi:10.1111/nmo.12418. PMC 4409126. PMID 25168158.
  6. Cai Y, Yu X, Hu S, Yu J (2009). "A brief review on the mechanisms of miRNA regulation". Genomics Proteomics Bioinformatics. 7 (4): 147–54. doi:10.1016/S1672-0229(08)60044-3. PMC 5054406. PMID 20172487.
  7. Coleski R, Hasler WL (2009). "Coupling and propagation of normal and dysrhythmic gastric slow waves during acute hyperglycaemia in healthy humans". Neurogastroenterol Motil. 21 (5): 492–9, e1–2. doi:10.1111/j.1365-2982.2008.01235.x. PMID 19309443.
  8. Hien TT, Turczyńska KM, Dahan D, Ekman M, Grossi M, Sjögren J; et al. (2016). "Elevated Glucose Levels Promote Contractile and Cytoskeletal Gene Expression in Vascular Smooth Muscle via Rho/Protein Kinase C and Actin Polymerization". J Biol Chem. 291 (7): 3552–68. doi:10.1074/jbc.M115.654384. PMC 4751395. PMID 26683376.
  9. Halmos KC, Gyarmati P, Xu H, Maimaiti S, Jancsó G, Benedek G; et al. (2015). "Molecular and functional changes in glucokinase expression in the brainstem dorsal vagal complex in a murine model of type 1 diabetes". Neuroscience. 306: 115–22. doi:10.1016/j.neuroscience.2015.08.023. PMC 4575893. PMID 26297899.
  10. Lamy CM, Sanno H, Labouèbe G, Picard A, Magnan C, Chatton JY; et al. (2014). "Hypoglycemia-activated GLUT2 neurons of the nucleus tractus solitarius stimulate vagal activity and glucagon secretion". Cell Metab. 19 (3): 527–38. doi:10.1016/j.cmet.2014.02.003. PMID 24606905.
  11. Frank JW, Saslow SB, Camilleri M, Thomforde GM, Dinneen S, Rizza RA (1995). "Mechanism of accelerated gastric emptying of liquids and hyperglycemia in patients with type II diabetes mellitus". Gastroenterology. 109 (3): 755–65. doi:10.1016/0016-5085(95)90382-8. PMID 7657103.
  12. Singh J, Kumar S, Rattan S (2015). "Bimodal effect of oxidative stress in internal anal sphincter smooth muscle". Am J Physiol Gastrointest Liver Physiol. 309 (5): G292–300. doi:10.1152/ajpgi.00125.2015. PMC 4556951. PMID 26138467.
  13. Hayashi Y, Toyomasu Y, Saravanaperumal SA, Bardsley MR, Smestad JA, Lorincz A; et al. (2017). "Hyperglycemia Increases Interstitial Cells of Cajal via MAPK1 and MAPK3 Signaling to ETV1 and KIT, Leading to Rapid Gastric Emptying". Gastroenterology. 153 (2): 521–535.e20. doi:10.1053/j.gastro.2017.04.020. PMC 5526732. PMID 28438610.
  14. Frank JW, Saslow SB, Camilleri M, Thomforde GM, Dinneen S, Rizza RA (1995). "Mechanism of accelerated gastric emptying of liquids and hyperglycemia in patients with type II diabetes mellitus". Gastroenterology. 109 (3): 755–65. doi:10.1016/0016-5085(95)90382-8. PMID 7657103.
  15. Meier JJ, Rosenstock J, Hincelin-Méry A, Roy-Duval C, Delfolie A, Coester HV; et al. (2015). "Contrasting Effects of Lixisenatide and Liraglutide on Postprandial Glycemic Control, Gastric Emptying, and Safety Parameters in Patients With Type 2 Diabetes on Optimized Insulin Glargine With or Without Metformin: A Randomized, Open-Label Trial". Diabetes Care. 38 (7): 1263–73. doi:10.2337/dc14-1984. PMID 25887358.
  16. Goyal RK (2021). "Gastric Emptying Abnormalities in Diabetes Mellitus". N Engl J Med. 384 (18): 1742–1751. doi:10.1056/NEJMra2020927. PMID 33951363 Check |pmid= value (help).
  17. Singh J, Boopathi E, Addya S, Phillips B, Rigoutsos I, Penn RB; et al. (2016). "Aging-associated changes in microRNA expression profile of internal anal sphincter smooth muscle: Role of microRNA-133a". Am J Physiol Gastrointest Liver Physiol. 311 (5): G964–G973. doi:10.1152/ajpgi.00290.2016. PMC 5130548. PMID 27634012.
  18. Bhetwal BP, An C, Baker SA, Lyon KL, Perrino BA (2013). "Impaired contractile responses and altered expression and phosphorylation of Ca(2+) sensitization proteins in gastric antrum smooth muscles from ob/ob mice". J Muscle Res Cell Motil. 34 (2): 137–49. doi:10.1007/s10974-013-9341-1. PMC 3651903. PMID 23576331.
  19. Eisenman ST, Gibbons SJ, Verhulst PJ, Cipriani G, Saur D, Farrugia G (2017). "Tumor necrosis factor alpha derived from classically activated "M1" macrophages reduces interstitial cell of Cajal numbers". Neurogastroenterol Motil. 29 (4). doi:10.1111/nmo.12984. PMC 5367986. PMID 27781339.
  20. Feldman M, Smith HJ, Simon TR (1984). "Gastric emptying of solid radiopaque markers: studies in healthy subjects and diabetic patients". Gastroenterology. 87 (4): 895–902. PMID 6468877.
  21. Camilleri M, McCallum RW, Tack J, Spence SC, Gottesdiener K, Fiedorek FT (2017). "Efficacy and Safety of Relamorelin in Diabetics With Symptoms of Gastroparesis: A Randomized, Placebo-Controlled Study". Gastroenterology. 153 (5): 1240–1250.e2. doi:10.1053/j.gastro.2017.07.035. PMC 5670003. PMID 28760384.
  22. Goyal RK (2021). "Gastric Emptying Abnormalities in Diabetes Mellitus". N Engl J Med. 384 (18): 1742–1751. doi:10.1056/NEJMra2020927. PMID 33951363 Check |pmid= value (help).
  23. Bharucha AE, Camilleri M, Forstrom LA, Zinsmeister AR (2009). "Relationship between clinical features and gastric emptying disturbances in diabetes mellitus". Clin Endocrinol (Oxf). 70 (3): 415–20. doi:10.1111/j.1365-2265.2008.03351.x. PMC 3899345. PMID 18727706.
  24. Goyal RK (2021). "Gastric Emptying Abnormalities in Diabetes Mellitus". N Engl J Med. 384 (18): 1742–1751. doi:10.1056/NEJMra2020927. PMID 33951363 Check |pmid= value (help).


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