Diabetic gastroparesis from autonomic neuropathy: surgical considerations and changes in vagus nerve morphology.
Open accessAbstract
Two cases with intractable vomiting due to gastroparesis, a rare feature of diabetic autonomic neuropathy, are described. Both required surgical treatment. In the first a gastroenterostomy was complicated by reflux gastritis requiring a revision operation; in the second a gastrojejunostomy was successful. Electron microscopic studies of the vagus nerve in one of the cases showed a severe reduction in the density of unmyelinated axons, the surviving axons tending to be of small calibre. The severity of the abnormalities supports the view that diabetic gastroparesis is related to vagal denervation.
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Damage to extrinsic vagal efferent pathways and intrinsic enteric nerves results in alteration of impulse transmission with loss of gastric tone, reduced contractility and impaired coordination of peristaltic waves, slowing gastric emptying.
“Damage to these pathways results in alteration of impulse tramission [28] with loss of gastric tone, reduced contractility and impaired coordination of peristaltic waves, slowing gastric emptying [25, 29, 30].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [29]
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Experimental — accuracy not yet measuredSustained hyperglycemia represents the principal driver of DGP pathogenesis; however, disease duration, chronic glycemic variability, and acute hyperglycemia episodes also contribute independently to neural and motor dysfunction, resulting in impaired motility and delayed gastric emptying.
“Sustained hyperglycemia represents the principal driver; however, disease duration, chronic glycemic variability, and acute hyperglycemia episodes also contribute independently to neural and motor disfunction, resulting in impaired motility and delayed gastric emptying [27–31].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [29]
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“Histological examinations have identified alterations in both myelinated and unmyelinated vagal nerve fibers among DGP patients [16].”
BackgroundPathogenesis and management of diabetic gastroparesis: An updated clinically oriented review
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Diabetic gastroparesis: pathophysiology and impact on insulin timing choices
Galeano, F., Tumminia, A., Oteri, V., Le Moli, R., Piticchio, T., Scilletta, S., Di Marco, M., Di Pino, A., & Frasca, F. (2026) · Endocrine · doi:10.1007/s12020-026-04693-6
- Authors
- Guy, R. J., Dawson, J. L., Garrett, J. R., Laws, J. W., Thomas, P. K., Sharma, A. K., & Watkins, P. J.
- Affiliations
- University of Aberdeen (GB)
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 1984-07-01
- Volume
- 47
- Issue
- 7
- Pages
- 686-691
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC1027895
- OpenAlex
- W1989289801
- Cited by
- 109
- References
- 18
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 1 · 2017: 5 · 2016: 5 · 2015: 2 · 2014: 3 · 2013: 1 · 2012: 1
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Health Sciences › Medicine › Neurology › Peripheral Neuropathies and Disorders
- Keywords
- diabetic gastroparesis, diabetic autonomic neuropathy, intractable vomiting, gastroenterostomy, gastrojejunostomy, reflux gastritis, vagus nerve, unmyelinated axons, vagal denervation
- MeSH terms
- Adult, Autonomic Nervous System Diseases, Diabetic Neuropathies, Female, Gastric Emptying, Humans, Jejunum, Male, Microscopy, Electron, Stomach, Vagotomy, Vagus Nerve, Vomiting
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