A clinical review of gastroparesis in a diabetic patient, starting with a case presentation. Gastroparesis is a syndrome characterised by delayed gastric emptying in the absence of mechanical obstruction of the stomach; about a third of cases are in patients with diabetes, with other causes including previous gastric surgery and neurological disease. Many cases are idiopathic, possibly related to viral infections.

This review presents the case of a man with type-1 diabetes of 20 years duration, with a history of nausea and vomiting over several months; he also has retinopathy, peripheral neuropathy, and nephropathy. It briefly describes normal stomach emptying, followed by gastroparesis as it appears in diabetic patients. Limited studies on the natural history of diabetic gastroparesis suggest that it generally remains stable for prolonged periods and does not itself cause increased mortality. It may, however, cause considerable impairment in quality of life and impair nutrition.

The review covers the clinical diagnosis and techniques for confirming this: these include endoscopy or contrast radiography to exclude obstruction, and scintigraphy or breath-testing as diagnostic tests. Management includes attention to precipitating factors, optimisation of nutritional support, and pharmacological treatment.

The main drug treatments used are prokinetic agents to improve gastric emptying, and antiemetics to reduce vomiting. Prokinetic drugs that have been shown to be of benefit include metoclopramide and domperidone; cisapride was used, but is now no longer readily available due to rare reports of severe cardiac toxicity. Erythromycin may also be effective, and may be used IV in severe hospitalised cases. A number of non-pharmacological therapies have been investigated, however the data supporting these is generally weak.

The author finally notes published guidelines, and summarises the likely management options for the patient presented.