Diabetic Gastropathy.pptx

Ppt

1. Diabetic Gastropathy

2. Introdu ction Delayed gastr ic emptying in the absence of mechanical obstruction Present in 5% Type 1 DM after 10 years and 1% in Type 2 DM Form of autonomic neuropathy Usually associated with other microvascular complications

3. Pathogenesis Decreased intersti tial cells of cajal due to decreased nNOS expression by AGE binding Loss of heme oxygenase expression in gastric macrophage which is protective for gastric mucosa Hyperglycemia leads to decreased motility by increasing apoptosis of enteric neurons

4. Clinical features Early satiety, nausea, abdominal pain, bloating sensation Delayed gastric emptying leads to delayed post prandial rise of glucose leading to mismatch between insulin timing and meals Worsening symptoms with GLP1 agonists Vomiting of undigested food hours after food intake Weight loss and malnutrition in long standing disease

5. Diagnosis Gastric emptyi ng scintrigraphy - gold standard standard low-fat, egg-white sandwich is used as a test meal, with images taken at 0, 1, 2, and 4 hours after food ingestion At the end of the fourth hour, gastric retention .10% is considered delayed gastric emptying mild gastric emptying is characterized by 10–15% gastric retention after 4 hours of food ingestion, moderate has 16–35% retention, and severe has .35% retention Gastroparesis can also be diagnosed when 35% ofa standard low-fat meal remains in the stomach 4 hours after ingestion

6. Dietary advices Small frequent feeds (5-6 time s per day) Low fat, low fiber diet To avoid whole grains, beans, legumes Low fat - dairy products, lean meat, fruits, vegetables Low fiber - white bread, white rice, meat, eggs, fish Insulin injection take after food ingestion

7. Drugs Metoclopromide D2 and 5HT3 receptor antagonist Prokinetic agent Only FDA approved dru g Maximum dose of 40 mg/day (10 mg 30 min before each meal) Maximum duration : 4 weeks Complication : dystonia, tardive dyskinesia

8. Domperidone Dopamine 2 receptor antagonist Risk of QT prolongation ECG done 1 week after initiation Not used if QTc more th an 470 in females and 450 in males Erythromycin Tried if above two are not effective 250 mg 4 times daily ADR: diarrhea Risk of tachyphylaxis, not used beyond 4 weeks Other drugs : Amitryptiline, Gabapentin, Tramadol

9. Surgical approaches Gastric electrical stimulation (high frequency, low energy signal) Pyloroplasty and gastrojejunostomy Feeding jejunostomy Complete gastrectomy