Diabetesrelaterade Magtarmstörningar - Gastro Diabetes Update

MOTILITY UPDATE

Mesurement of Gastric Emptying using Radio-opaque Markers by Christoph Beglinger in summary Motility March 1997;37:4-6

30-35% of patients refereed to medical centers for symtoms of nausea, early satiety, and vague upper abdominal discomfortm i.e. dyspepsia, with normal upper endoscopy and ultrasound of gallbladder and pancreas, have delayed gastric emptying or gastroparesis.
Gastric dysrhythmias are frequently seen in patients with gastroparesis. In patients with delayed gastric emptying and high-amplitude normal 3 cycles per min EGG rhytm, mechanical obstruction should be considered.
To appreciate the neuromuscular abnormalities, the simularities between continuum ogf gastric neuromuscular dysfunction and cardiac dysfunction may be considered;

CARDIAC GASTRIC

cardiac dysrhytmias gastric dysrhytmias dilated ventricle dilated antrum ventricular hypomotility antral hypomotility delayed ventricular emptying delayed gastric emptying poor cardiac output poor gastric output

Neuromuscular function of the stomach may be affetcted by estrogen/progesterone or other hormones related to menstrual cycles. Estrogen and progesterone provoke evoke nausea and gastric dysrhytmias in healthy women. Subtle alterations in gut hormone syntehsis and release may also affect the neuromuscular function of the stomach and result in dyspepsia symtoms. Finally, the effects of chronic physical and/or psychologic stress or abuse are also factors that may affect autonomic nervous system function and alter the neuromuscular and neurohormonal activity of the stomach. Personality traits such as anxiety and somatization are present in patient with chronic dyspepsia of unknown origin. Depending on life stresses, coping ability and psychosocial support systems, these patients may or may not seek medical attention.
Pharmacological treatment: a meta-analysis of drug trials show data indicating that in adiition to increase gastric emptying the prokinetic drugs may improve symtoms by their gastric antiarrhytmic action. Erytromycin, which stimulates motilin receptors in the gastric antrum, may be helpful in some symtomatic patients with gastroparesis and dyspepsia symtoms. In diabetic gastroparesis eythromycin improves the rate of gastric emptying, howveer, in a recent trial only 30% of patients could tolerate the drug because of side-effects.