Diabetic gastropathy and prokinetics

Talley, Nicholas J.

doi:10.1111/j.1572-0241.2003.07268.x

Cited by 81Gastrointestinal motility and disordersGastroesophageal reflux and treatmentsDiabetes Treatment and Management

Diabetic gastropathy and prokinetics

Talley, Nicholas J.·2003·The American Journal of Gastroenterology

DOI 10.1111/j.1572-0241.2003.07268.x

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Abstract

The treatment of diabetic gastropathy, which here refers to a clinical syndrome of upper GI tract symptoms suggestive of an upper motility disturbance in diabetes whether or not there is delayed gastric emptying, remains suboptimal. New prokinetics and other motility-modifying agents may prove useful, but adequate clinical trials will be required to establish a role for them. However, diabetic gastropathy seems to represent a heterogenous syndrome in terms of pathophysiology, which potentially complicates the design of new randomized, controlled trials. This review aims to provide guidelines for future trials in this field. The evidence that delayed gastric emptying is a cause of symptoms in diabetic gastropathy is critically evaluated. The trial evidence supporting the short and long term efficacy of prokinetics is reviewed. Based on the available literature, it is concluded that improvement in gastric emptying does not equate with symptom relief in diabetic gastropathy. It is suggested that although gastric emptying should still be measured in clinical trials, it should not represent the primary outcome. The withdrawal treatment design applied in studies of diabetic gastropathy might be suboptimal. Double blind, parallel group studies remain the trial design of choice, but incorporation of validated outcome assessments and measurement of potential confounders of treatment response need attention in future trials.

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Prokinetic agents increase antral contractility, reduce gastric dysrhythmias, and improve coordination between the antrum and duodenum, with modest effect.
“This group of drugs increases antral contractility, reduces gastric dysrhythmias, and improves coordination between the antrum and duodenum. The effect is modest, and responses are assessed clinically [63].”
From Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review (2018) · cites this paper as [63]

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HVIDBERG, A. D., Christensen, N. J., & Hilsted, J. (1998) · Diabetic Medicine · doi:10.1002/(sici)1096-9136(199803)15:3 · Cited by 5 · see citing works

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Treatment of gastroparesis: a multidisciplinary clinical review: The American Motility Society Task Force on Gastroparesis (members in alphabetical order)
Abell, T. L., Bernstein, V. K., Cutts, T., Farrugia, G., Forster, J., Hasler, W. L., Mccallum, R. W., Olden, K. W., Parkman, H. P., Parrish, C. R., et al. (2006) · Neurogastroenterology & Motility · doi:10.1111/j.1365-2982.2006.00760.x · Cited by 361 · see citing works
Diabetic gastrointestinal motility disorders and the role of enteric nervous system: Current status and future directions
Yarandi, S. S., & Srinivasan, S. (2014) · Neurogastroenterology & Motility · doi:10.1111/nmo.12330 · Cited by 236 · see citing works
Diabetic Gastroparesis: Diagnosis and Management
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Therapy Insight: gastrointestinal complications of diabetes-pathophysiology and management
Sellin, J. H., & Chang, E. B. (2008) · Nature Clinical Practice Gastroenterology & Hepatology · doi:10.1038/ncpgasthep1054 · Cited by 59 · see citing works
Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review
Mehr, S. E., Barbul, A., & Shibao, C. A. (2018) · Clinical Autonomic Research · doi:10.1007/s10286-018-0519-x · Cited by 55 · see citing works

Double blind controlled trial of effect of cisapride on gastric emptying in diabetics.
Dutta, U., Ak, P., Ahuja, & Mp, S. (1999) · PubMed · Cited by 23 · see citing works
A clinical assessment of cisapride for the treatment of symptoms associated with gastroparesis in primary care patients
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Authors: Talley, N. J.
Affiliations: The University of Sydney (AU)
Corresponding author: Talley, Nicholas J.
ORCID: Talley, Nicholas J.
Venue: The American Journal of Gastroenterology
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2003-02
Volume: 98
Issue: 2
Pages: 264-271
ISSN: 0002-9270 (ISSN-L)
1572-0241
DOI: 10.1111/j.1572-0241.2003.07268.x
OpenAlex: W1999274639
Cited by: 81
References: 83
Citations by year: 2024: 2 · 2023: 1 · 2021: 3 · 2020: 1 · 2019: 1 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 5
FWCI: 7.63
Type: journal article
Language: en
Open access: closed
Locations: The American Journal of Gastroenterology (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords: diabetic gastropathy, prokinetic agents, delayed gastric emptying, upper gastrointestinal motility, trial design, outcome measures, symptom relief
MeSH terms: Clinical Trials as Topic, Diabetes Mellitus, Gastric Emptying, Gastrointestinal Agents, Humans, Research Design, Gastroparesis, Diabetes Complications

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Diabetic gastropathy and prokinetics

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