Gastric electrical stimulation for the treatment of diabetic gastroparesis

• Published in: Diabetes & metabolism 2012-11, Vol.38 (5), p.393-402
• Main Authors: Guerci, B, Bourgeois, C, Bresler, L, Scherrer, M.-L, Böhme, P
• Format: Article
• Language: English
• Subjects: Autonomic neuropathy; Biological and medical sciences; Diabetes mellitus; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - physiopathology; Diabetic Neuropathies - therapy; Diabète; Electric Stimulation Therapy - methods; Endocrine pancreas. Apud cells (diseases); Endocrinology & Metabolism; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Gastric electrical stimulation; Gastric emptying; Gastric neuromodulation; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents - therapeutic use; Gastrointestinal scintigraphy; Gastroparesis; Gastroparesis - physiopathology; Gastroparesis - therapy; Gastroparésie; Humans; Internal Medicine; Male; Medical sciences; Nausea; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Neuromodulation gastrique; Neuropathie végétative; Nutritional Support; Other diseases. Semiology; Review; Revue générale; Scintigraphie digestive; Stimulation électrique gastrique; Stomach - physiopathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Vidange gastrique; Vomiting
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2012.05.001

Abstract Diabetic gastroparesis is a component of autonomic neuropathy, and is the most common manifestation of gastrointestinal neuropathy. Diabetes is responsible for about one quarter of gastroparesis. The upper gastrointestinal symptoms are often non-specific and dominated by nausea, vomiting, early satiety, fullness, bloating. We also have to look for diabetic gastroparesis in case of metabolic instability, such as postprandial hypoglycaemia. The pathophysiology of diabetic gastroparesis is complex, partly due to a vagus nerve damage, but also to changes in secretion of hormones such as motilin and ghrelin. A decrease in the stem cell factor (SCF), growth factor for cells of Cajal (gastric pacemaker), was found in subjects with diabetic gastroparesis. These abnormalities lead to an excessive relaxation in the corpus, a hypomotility of antrum, a desynchronization antrum-duodenum-pylorus, and finally an abnormal duodenal motility. The treatment of diabetic gastroparesis is based on diabetes control, and split meals by reducing the fiber content and fat from the diet. The antiemetic and prokinetic agents should be tested primarily in people with nausea and vomiting. Finally, after failure of conventional measures, the use of gastric neuromodulation is an effective alternative, with well-defined indications. Introduced in the 1970s, this technology works by applying electrical stimulation continues at the gastric antrum, particularly in patients whose gastric symptoms are refractory to other therapies. Its efficacy has been recently reported in different causes of gastroparesis, especially in diabetes. Gastric emptying based on gastric scintigraphy, gastrointestinal symptoms, biological markers of glycaemic control and quality of life are partly improved, but not normalized. Finally, a heavy nutritional care is sometimes necessary in the most severe forms. The enteral route should be preferred (nasojejunal and jejunostomy if possible efficiency). However, in case of failure especially in patients with small bowel neuropathy, the long-term parenteral nutrition is sometimes required.