Diabetic gastroparesis: what treatment options are available?

This review examined the various treatments available to treat diabetic gastroparesis.

Gastroparesis is a condition in which stomach motility is reduced. This results in delayed gastric (stomach) emptying. Symptoms of gastroparesis include nausea, vomiting, bloating and early satiety (feeling full). Gastroparesis is common in patients with diabetes. Diabetic gastroparesis (DGP) can result in weight loss, poor control of blood glucose (sugar) levels and poor nutritional status.

There are various treatments available for treating DGP. Most treatments aim to reduce nausea and vomiting, improve gastric emptying and improve nutritional status. Western therapies include drugs, nutritional support, gastric electrical stimulation (GES), botox injections in the stomach and surgery. However, not all patients will benefit from these treatments and some may be expensive and invasive. Therefore, traditional Chinese medicine (TCM) may be preferred.

This review aimed to summarize the latest treatment options available for DGP.

Drugs used to reduce nausea and vomiting include erythromycin (Erythrocin), metoclopramide (Reglan) and domperidone (Motilium). Metoclopramide and domperidone are equally effective in reducing symptoms. A recent study has shown that a drug known as TZP-101 (Ulimorelin) can improve nausea and vomiting in patients who have moderate to severe DGP.

Patients with DGP are encouraged to reduce fat intake and reduce fiber intake. Patients who don’t respond well to drugs may receive nutritional and hydration supplements through a tube placed in the nose or the small intestine. A jejunostomy tube (J-tube) is a tube which is connected to the small intestine and bypasses the stomach. This treatment can improve overall health status. One study showed that 83% of patients reported an improvement after an average of 47 months. However, patients may experience skin infections.

GES involves a stimulating device being placed into the stomach to enhance stomach motility. One study involved 188 DGP patients. This study showed that patients were hospitalized less often, required less DGP medication and had improved nutritional status. GES also improved HbA1c (average blood glucose levels over 3 months). 11% of patients had the device removed, due to infection, bowel blockage, or the device not being effective.

Botox injections can relax the stomach muscles. Results on the effectiveness of this treatment in DGP have been mixed. While some studies report an improvement in symptoms and gastric emptying, other studies have not found an effect. Further studies are needed to determine the effectiveness of this treatment. Surgery, such as to remove part of the stomach, has also led to mixed results, with further studies needed.

TCM is used for the treatment of DGP in China. One study involved 47 patients. This study showed that patients experienced an improvement in symptoms and had a lower HbA1c three months after treatment with TCM.

This review concluded that both Western therapy and TCM can be effective in improving symptoms of DGP and may be used in combination.

Consult your physician regarding the most suitable treatment option available for DGP.