Current Concepts in Gastric Motility in Diabetes Mellitus

摘要

This review addresses the current concepts in our understanding of the epidemiology, mechanisms, symptoms,nclinical consequences, diagnosis and treatment of delayed gastric emptying in patients with diabetes.nUpper gastrointestinal symptoms, particularly postprandial fullness, nausea, vomiting and abdominal bloating, occur inn30-50% of patients with diabetes. The use of scintigraphic techniques, and more recently breath test, has shown that asnmany as 50% of diabetic patients have gastroparesis. Diabetic gastroparesis comprises a decrease in fundic and antralnmotor activity, a reduction or a lack of the interdigestive migrating motor complex, gastric dysrhythmias, andnpylorospasms. The mechanisms involved include: autonomic neuropathy, acute hyperglycaemia, and abnormalities inngastrointestinal hormones and neuropeptides. Other possible contributing factors such as hypothyroidism and H. pylorininfection are discussed as well. Because treatment is possible by means of dietary advise, prokinetics or surgicalnprocedures, it is important to identify risk factors for and to diagnose gastroparesis to prevent morbidity by controllingngastrointestinal symptoms, and to enhance glucoregulation. Understanding the current advances is key to the developmentnof novel therapeutic strategies and for making rational choices in the management of diabetic gastroparesis.