Diabetic control, prokinetic drugs and gastroparesis diabeticorum

ABSTRACT

Gastric emptying time was investigated in 30 non insulin dependent diabetic patients [NIDD] using a non invasive technique; abdominal ultrasonography. They were subdivided into two groups, controlled diabetics [15 patients] and uncontrolled diabetic patients [15 patients]. Moreover, 10 apparently healthy subjects were included in the research as a control group. All patients had symptom[s] of gastroparesis [nausea, early satiety, vomiting etc]. The patients showed a significant delayed gastric emptying time when compared with healthy subjects, the mean of the latter is [3.3 +/- 0.3 hours]. The delay in gastric emptying is obvious in those with longer duration of diabetes mellitus, and is marked in the uncontrolled group [mean 5.4 +/- 0.7 hours] than the controlled diabetics [mean 4.1 +/- 0.3 hours]. Following domperidone administration for one month [one tablet 3-4 times a day]; gastric emptying time was shortened. That improvement was more significant in patients with uncontrolled diabetes [with much more delayed gastric emptying time] than those with controlled diabetes [with less delayed gastric emptying time] when either of them is compared to the normal healthy group. Inspite of significant improvement in symptom score after treatment, the total symptom score did not show significant correlation with improvement in gastric emptying time in the uncontrolled group denoting that symptoms of gastroparesis diabeticorum are not solely related to delayed emptying of the stomach and suggest that gastric dysrhythmia is to be considered in patients with long standing diabetes mellitus. Moreover, domperidone may restore the three cycles per minute gastric myoelectric activity rather than a prokinetic effect on gastric emptying rates