Delayed gastric emptying in children with type I diabetes mellitus

ABSTRACT

Diabetes mellitus is considered a cause of gastroparesis in 30-50% of children and it Is presented with various gastrointestinal symptoms. Erythromycin has a variable effect in treating gastroparesis and the increase in blood sugar can affect its effect. The aim of the work is to assess gastroparesis in diabetic children and to evaluate its relation to gastrointestinal symptoms and also to study the role of erythromycin in the treatment of gastroparesis. The study included 67 children suffered type I diabetes mellitus of moro than 5 years duration. Their ages ranged from 7-11 years. Ten children of matchable age and sex were taken as controls. Clinical history and examination were done with the measurement of glycosylated hemoglobin% and gastric emptying time by scintigraphy. Glycosylated hemoglobin% [HbA1c%] was significantly high in the diabetic patients in comparison to that of the controls [8.02 +/- 1.77 and 4.92 +/- 1.64 respectively]. Out of the 67 patients 31[46.26%] showed delayed gastric emptying time and 18 of them were with gastrointestinal symptoms. HbA1c% was significantly high in those patients with delayed gastric emptying time in comparison to those with normal gastric emptying time [8.48 +/- 1.92 and 7.06 +/- 0.81 respectively]. Also it is higher in those with symptoms than those without symptoms [9.64 +/- 1.75 and 6.89 +/- 0.39 respectively]. As regards the other possible complications that are found in diabetes, patients with neurological type showed significant higher HbA1c%and more delayed gastric emptying time than those without neurological complications [8.31 +/- 2.13 and 6.92 +/- 1.39 and 236.21 +/- 79.12 and 102.1 +/- 43.21 respectively]. By giving erythromycin to the symptomatized patients in a dose of 250, mg 3 times daily for 3 months, 8 out of 18 showed improvement. A positive correlation was found between HbA1c% and GET. In conclusion, gastroparesis could be found in diabetic patients even without symptoms. The presence of other complications especially the neurological type and the uncontrolled blood sugar augment gastroparesis. Therefore, the variable response to erythromycin in gastroparesis is multifactorial