Diabetic gastroparesis in its severe form is one of the most distressing diabetes complications in terms of quality of life. Delayed gastric emptying is an under-recognised complication occurring in around a third of those with type 1 or type 2 diabetes. Clinically, it can present as abdominal bloating, discomfort or pain. In its severe forms it presents as nausea, vomiting and early satiety.
Diagnosis is based on a typical history, exclusion of other causes and confirmation of delayed emptying, most usually by endoscopy and scintigraphy assessing solid phase emptying.
Treatment consists of dietary advice, maintenance/improvement of glycaemic control and pharmacological treatment with prokinetics and anti-emetics. Further investigation of gastric and small bowel function may be appropriate in more severe cases.
Gastric pacing and gastric surgery have been used in refractory cases. Copyright © 2008 John Wiley & Sons.