New Treatment Options in Diabetic Gastroparesis
New Treatment Options in Diabetic Gastroparesis
We have presented a challenging case of medication refractory diabetic gastroparesis which led us to explore alternative novel treatment options. Gastric electrical stimulation by electrodes implanted in the gastric serosa is a new therapeutic option in treating refractory diabetic gastroparesis. Long-term open labelled studies and one small controlled cross over trial have reported relief of symptoms.[3] Gastric electrical stimulation is also reported to enhance nutritional status, reduce the requirements for supplemental feeds and improve glycaemic control in diabetic gastroparesis. The major drawbacks to this treatment are the cost of the pacemaker (approx £7,500) and the potential for infection. Unfortunately, implantation of a gastric pacemaker did not in itself result in more than a short-term improvement in symptoms.
Botulinum toxin injection into the pyloric sphincter has been shown to be a safe alternative in improving symptoms of nausea and vomiting in patients with refractory diabetic gastroparesis in several uncontrolled studies, though a controlled study showed no efficacy.[3] Pylorospasm is thought to be a contributing factor in diabetic gastroparesis. Botulinum toxin inhibits the release of acetylcholine and produces transient paralysis when injected into smooth muscle. Our patient had a good symptomatic improvement with this treatment with no particular adverse effects, though it has to be seen whether this can be sustained in the long term. We speculate that these two therapies may be complementary or even synergistic in promoting gastric motility while at the same time facilitating gastric emptying.
2008
Dr Krishnan Swaminathan, Diabetes Department, Victoria Hospital
Br J Diabetes Vasc Dis.
krishnan.swaminathan@nhs.net
