93092843  (REFERENCE 17 OF 19)

Drenth JP  Engels LG  
Diabetic gastroparesis. A critical reappraisal of new treatment
     strategies.
   [ABSTRACT ONLINE]
In: Drugs (1992 Oct) 44(4):537-53


  Delayed gastric emptying, gastroparesis, is one of the sequelae of
diabetes mellitus. Symptoms may include postprandial nausea,
epigastric pain, bloating, vomiting, early satiety and unpredictable
blood sugar fluctuations. Nowadays diagnosis is made by the
measurement of gastric emptying with a radionuclide test meal. Using
this technique some 50% of diabetic patients show signs of disordered
gastric emptying. Relief is best delivered by agents promoting
gastric emptying. In phase II single-dose studies metoclopramide,
domperidone, cisapride, erythromycin and renzapride were all able to
enhance gastric evacuation of solid and liquid meals in patients with
diabetic gastroparesis. A few short term studies support the efficacy
of domperidone and renzapride, but long term trials are lacking.
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Erythromycin, mimicking the potent gastrokinetic effect of motilin,
may hold considerable promise for the future. Experience with
erythromycin in diabetic gastroparesis is nonetheless very limited.
To some extent the therapeutic effectiveness of metoclopramide and
cisapride has been established in placebo-controlled trials. In
trials with a placebo-controlled crossover design, however, only
metoclopramide showed a sustained positive effect. Metoclopramide,
which combines gastrokinetic and antiemetic properties seems, so far,
the best therapeutic option in diabetic gastroparesis. Cisapride may
be considered as a good alternative in cases where limited efficacy
or side effects preclude the use of metoclopramide.
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93005530  (REFERENCE 18 OF 19)

Chaudhuri TK  Fink S  
Prognostic implication of gastroparesis in patients with diabetes
     mellitus.
   [ABSTRACT ONLINE]
In: Clin Auton Res (1992 Aug) 2(4):221-4


  The prognosis and survival in 13 patients with Type II diabetes
mellitus who had delayed gastric emptying as shown by radionuclide
tests performed between August 1985 and August 1987 was determined in
July 1990. The two patients that were over 80 years of age died
within 18 months of the diagnosis of diabetic gastroparesis, but ten
of the remaining eleven patients survived. The clinical data on these
patients suggest that despite the usual presence of significant co-
existent pathology, gastroparesis diabeticorum carries a less ominous
prognosis than currently believed.
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90275927  (REFERENCE 19 OF 19)

Brown CK  Khanderia U  
Use of metoclopramide, domperidone, and cisapride in the management
     of diabetic gastroparesis.
   [ABSTRACT ONLINE]
In: Clin Pharm (1990 May) 9(5):357-65


  The pathophysiology, diagnosis, and treatment of diabetic
gastroparesis are reviewed, and the mechanisms of action,
pharmacokinetics, clinical efficacy, adverse effects, and dosage of
metoclopramide, domperidone, and cisapride are described. Diabetic
gastroparesis is a state of delayed gastric emptying that reportedly
affects 20-30% of diabetic patients. Symptoms include nausea, early
satiety, postprandial bloating and fullness, and vomiting. Diabetic
gastroparesis has been managed most successfully with drugs that
stimulate gastric emptying. Of the three agents studied--
metoclopramide, domperidone, and cisapride--only metoclopramide is
commercially available in the United States. The clinical efficacy of
metoclopramide, domperidone, and cisapride has been well documented
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in several placebo-controlled trials. Metoclopramide effectively
decreases mean gastric emptying time, although tolerance to this
stimulation of gastric emptying may develop with long-term therapy.
However, symptomatic relief persists with long-term therapy because
of metoclopramide's antiemetic properties. Domperidone, which has
also been shown to stimulate gastric motility and to possess
antiemetic properties, improves symptoms in patients suffering from
diabetic gastroparesis. Cisapride appears to have continued
beneficial effects on gastric motility with long-term therapy. All
three agents have favorable adverse-effect profiles. Although
metoclopramide is currently the first-line agent for the management
of gastroparesis, domperidone and cisapride both possess properties
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that may make them useful alternatives in patients who are
unresponsive to or cannot tolerate metoclopramide therapy.



96127525  (REFERENCE 8 OF 19)

Farrell FJ  Keeffe EB  
Diabetic gastroparesis.
   [ABSTRACT ONLINE]
In: Dig Dis (1995 Sep-Oct) 13(5):291-300


  Diabetic gastroparesis is a common, underrecognized disorder
affecting both type I and type II diabetics usually in the setting of
other diabetic complications. The pathogenesis of diabetic
gastroparesis is poorly understood, but autonomic neuropathy appears
to play a major role. The symptoms of gastroparesis are nonspecific,
and complications such as hypoglycemia and bezoar formation due to
gastric stasis may occur. Diabetic gastroparesis can be assessed by
measuring the gastric emptying of solid radiopaque markers or by
scintigraphy. Treatment approaches include optimizing glycemic
control and the use of prokinetic agents. Combination therapy or the
alternating use of prokinetic agents may prove to be beneficial in
dealing with drug tachyphylaxis.
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96100057  (REFERENCE 9 OF 19)

Mearin F  Malagelada JR  
Gastroparesis and dyspepsia in patients with diabetes mellitus.
   [ABSTRACT ONLINE]
In: Eur J Gastroenterol Hepatol (1995 Aug) 7(8):717-23

<
  About one-half of patients with insulin- or non-insulin-dependent
diabetes have delayed gastric emptying (diabetic gastroparesis). Some
of them complain of epigastric pain, nausea, vomiting or postprandial
fullness (diabetic dyspepsia), although only a minority are severely
symptomatic. Diabetic gastroparesis is clinically relevant not only
by virtue of the symptoms induced but also because it may contribute
to inadequate glycaemic control and impaired absorption of orally
administered drugs. Recent data suggest that abnormal blood glucose
control, not only autonomic neuropathy, contribute to the
pathogenesis of disordered gastric motility. In most cases diabetic
gastroparesis is diagnosed clinically in the absence of demonstrable
lesions of the upper gastrointestinal tract. To evaluate gastric
emptying, scintigraphy is the 'gold standard'. Gastrokinetic drugs
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are of help in the treatment of gastroparesis: erythromycin is the
first choice in acute presentations and cisapride for chronic
symptoms. New macrolides with prokinetic action and devoid of
antibacterial properties are very promising and should add another
pharmacologic approach to control dyspepsia and gastroparesis in
diabetic patients in the future.
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96101652  (REFERENCE 1 OF 19)

Jones KL  Horowitz M  Wishart MJ  Maddox AF  Harding PE  Chatterton BE  
Relationships between gastric emptying, intragastric meal
     distribution and blood glucose concentrations in diabetes mellitus.
   [ABSTRACT ONLINE]
In: J Nucl Med (1995 Dec) 36(12):2220-8


  The aim of this study was to evaluate the prevalence of disordered
intragastric meal distribution and the relationships between gastric
emptying, intragastric distribution, glycemic control and
gastrointestinal symptoms in diabetes mellitus. METHODS: Eighty-six
patients with diabetes mellitus had measurements of gastric emptying
and intragastric distribution of a radioisotopically labeled
solid/liquid meal (100 g beef and 150 ml 10% dextrose), glycemic
control (plasma glucose concentrations), upper gastrointestinal
symptoms (questionnaire) and autonomic nerve function (cardiovascular
reflexes). Results were compared to those obtained in 20 normal
volunteers. RESULTS: Solid and liquid gastric emptying were delayed
in the diabetic patients and correlated weakly. Intragastric meal
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distribution was also often abnormal, with increased retention of
both solid and liquid in the proximal stomach and increased retention
of solid but not liquid in the distal stomach. In all patients with
increased retention of solid in the proximal stomach, emptying from
the total stomach was delayed. Gastric emptying of liquid was slower
in those subjects who had a mean plasma glucose > 15 mmol/liter
during the gastric emptying measurement, when compared to the
remainder of the group. CONCLUSION: In patients with diabetes
mellitus, there is poor relationship between solid and liquid gastric
emptying and intragastric meal distribution is frequently abnormal.
Interpretation of the results of gastric emptying measurements should
consider meal composition and plasma glucose concentrations.
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95402802  (REFERENCE 2 OF 19)

Nowak TV  Johnson CP  Kalbfleisch JH  Roza AM  Wood CM  Weisbruch JP  
   Soergel KH  
Highly variable gastric emptying in patients with insulin dependent
     diabetes mellitus.
   [ABSTRACT ONLINE]
In: Gut (1995 Jul) 37(1):23-9


  Some diabetic patients--particularly those with nausea and vomiting--
frequently have evidence of delayed gastric emptying while other
diabetic patients may in fact exhibit accelerated gastric emptying.
Whether the presence or absence of symptoms of upper gastrointestinal
dysfunction correlated with objective measures of gastric emptying in
insulin dependent diabetic subjects was investigated. Twenty one
insulin dependent diabetic patients underwent a solid phase gastric
emptying scintiscan using in vivo labelled chicken liver. Thirteen
patients had symptoms suggestive of gastrointestinal dysfunction
(nausea, vomiting, early satiety, or constipation), while eight
patients had no gastrointestinal symptoms. Eleven patients had
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orthostatic hypotension. All patients had been diabetic since
childhood or adolescence. As a group, the diabetic patients showed a
half time (T50) of gastric emptying (mean (SD) 150.0 min (163.7) that
was not significantly different from that of 12 healthy control
subjects (148.1 min (62.4)). Those diabetic patients without
gastrointestinal symptoms and without orthostatic hypotension,
however, showed a gastric emptying half time (70.1 min (41.6)) that
was significantly faster than that of the control subjects.
Conversely, those diabetic patients with nausea, vomiting, and early
satiety (or early satiety alone) showed T50 values that were
significantly greater than those of the diabetic patients without
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these symptoms. No correlation was found between the T50 value and
the duration of diabetes, the fasting blood glucose at the time of
study, or the respiratory variation in heart rate (E:I ratio). These
observations indicate that highly variable rates of gastric emptying
occur in insulin dependent diabetic patients, and that accelerated
gastric emptying may occur in diabetic patients who have no symptoms
of gastrointestinal dysfunction.
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94298435  (REFERENCE 3 OF 19)

Caballero-Plasencia AM  Muros-Navarro MC  Martin-Ruiz JL  
   Valenzuela-Barranco M  de los Reyes-Garcia MC  Vilchez-Joya R  
   Casado-Caballero FJ  Gil-Extremera B  
Gastroparesis of digestible and indigestible solids in patients with
     insulin-dependent diabetes mellitus or functional dyspepsia.
   [ABSTRACT ONLINE]
In: Dig Dis Sci (1994 Jul) 39(7):1409-15


  Gastric emptying of a solid meal and of 10 indigestible radiopaque
solids was measured with scintigraphic and radiological techniques in
50 healthy volunteers (controls), 41 patients with insulin-dependent
diabetes mellitus, and 50 patients with functional dyspepsia.
Gastroparesis was found in 51% of our diabetic patients and 74% of
our patients with dyspepsia. The values of Tlag, T1/2 and the
percentage of isotope remaining in the stomach at 105 min were 14.9
min, 59.4 min and 25.3% in control subjects; 21.4 min, 88.1 min, and
46.9% in diabetic patients (P < 0.05 vs the control group); and 23.2
min, 114.6 min, and 58.7% in dyspeptic patients (P < 0.05 vs the
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control group). Whereas all healthy volunteers emptied all 10
indigestible solids in less than 4 hr, only 51% and 32% of diabetics
and dyspeptics, respectively, achieved this emptying time (P < 0.01).
Their respective values of T1/2 were 81 min, 212 min, and 203 min (P
< 0.01 for diabetics and dyspeptics vs controls). We found no
correlation between the findings for gastric emptying of digestible
and indigestible solids. We conclude that gastroparesis affecting
digestive and interdigestive motility is present in a high percentage
of diabetics and functional dyspeptics and that conscientious
evaluation of gastroparesis in both groups requires studies designed
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specifically to characterize each type of motility.
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93142738  (REFERENCE 4 OF 19)

Richards RD  Davenport K  McCallum RW  
The treatment of idiopathic and diabetic gastroparesis with acute
     intravenous and chronic oral erythromycin [see comments]
   [ABSTRACT ONLINE]
In: Am J Gastroenterol (1993 Feb) 88(2):203-7


  The objective of this study was to investigate the effects of
intravenous erythromycin and chronic oral dosing of erythromycin on
gastric emptying in patients with idiopathic or diabetic
gastroparesis. Symptoms were assessed on oral dosing and during long-
term follow-up in an ambulatory setting at a University referral
center. Fourteen patients (10 idiopathic and four diabetic
gastroparesis) were studied. Four patients left during the 4-wk
study; two due to rash, one with cramps and vomiting on erythromycin,
and one due to other medical problems. Ten patients completed the 4-
wk study and commenced long-term therapy. Five of these patients
experienced enough symptomatic relief to continue oral erythromycin
long-term, being followed for an average period of 8.4 months. After
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initial documentation of delayed gastric emptying, patients received
6 mg/kg intravenous erythromycin lactobionate before a second gastric
emptying study. Erythromycin base was then given orally at a dose of
500 mg tid-ac and qhs, with a final gastric emptying study performed
after 4 wk. During long-term follow-up, erythromycin dosage was
adjusted to minimize symptoms. Radionuclide-labeled gastric emptying
of a solid meal was studied at baseline, following intravenous
erythromycin, and after 4 wk of oral treatment with erythromycin.
Symptom scores were assessed at baseline, at 4 wk, and then at 8-wk
intervals. The percentage of the solid meal retained in the stomach
at 2 h decreased from 85% +/- 11% (SD) at baseline to 20% +/- 29%
following intravenous erythromycin (p < 0.001), and to 48% +/- 21%
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after 4 wk of oral therapy (p < 0.01 vs. baseline). There was a
reduction in total symptom scores and a significant reduction in
global assessment scores (p = 0.03). We conclude that erythromycin
has a strong gastric prokinetic effect in both idiopathic and
diabetic gastroparesis, and may represent a useful new therapeutic
approach to this problem.
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93092808  (REFERENCE 5 OF 19)

Burgstaller M  Barthel S  Kasper H  
[Diabetic gastroparesis and gallbladder disease. Ultrasound diagnosis
     after multiple-component meals]
Diabetische Gastroparese und Cholezystopathie. Sonographische
     Diagnostik nach Multikomponentenmahlzeiten.
   [ABSTRACT ONLINE]
In: Dtsch Med Wochenschr (1992 Dec 4) 117(49):1868-73


  Thirty insulin-dependent diabetics (16 women, 14 men, mean age 37.7
[17-74] years) and 12 controls (eight women and four men; aged 20-58
years) were studied by real-time ultrasound before and after each of
three meals to assess gastric and gallbladder motility. The diabetics
were grouped according to the results into those without (n = 17) and
those with diabetic autonomic neuropathy (n = 13). Antral cross-
section provided the criterion for gastric emptying. It decreased
significantly more slowly in diabetics with autonomic neuropathy than
in the other two groups. The difference during the postprandial
observation period of 240 min became the greater the longer the
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interval after the test meal (multivariance analysis: P < 0.001).
Gallbladder emptying, too, was slowest in diabetics with autonomic
neuropathy (P < 0.05). These results indicate that abnormalities of
gastric and gallbladder emptying in diabetics can be recognized by
measuring antral cross-section and longitudinal gallbladder area on
fasting and 180 min after a test meal.
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92307337  (REFERENCE 6 OF 19)

Tack J  Janssens J  Vantrappen G  Peeters T  Annese V  Depoortere I  
   Muls E  Bouillon R  
Effect of erythromycin on gastric motility in controls and in
     diabetic gastroparesis.
   [ABSTRACT ONLINE]
In: Gastroenterology (1992 Jul) 103(1):72-9

<

  The effect of three doses of erythromycin on interdigestive
gastrointestinal motility and on plasma motilin levels was studied in
healthy volunteers and patients with diabetic gastroparesis.
Abnormalities of interdigestive motility were observed in 40% of the
patients. In healthy volunteers, 40 mg erythromycin elicited a
premature phase 3 that started in the stomach. In contrast to the
spontaneous gastric phase 3, this erythromycin-induced phase 3 was
not accompanied by a motilin peak. In patients with diabetic
gastroparesis, 40 mg erythromycin induced a premature phase 3 in
three patients, no response in one patient, and a burst of antral
contractions in another patient. Doses of 200 and 350 mg erythromycin
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elicited a burst of antral phase-3-like contractions in both
volunteers and patients, which was not accompanied by a motilin peak.
This phase-3-like activity did not migrate to the small intestine and
was not followed by a phase 1, but by a prolonged period of antral
contractile activity. The number and amplitude of antral contractions
after 200 or 350 mg erythromycin were significantly higher than after
40 mg. The motor patterns induced by different doses of erythromycin
offer potential therapeutic applications.
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90369344  (REFERENCE 7 OF 19)

Urbain JL  Vantrappen G  Janssens J  Van Cutsem E  Peeters T  De Roo M  
Intravenous erythromycin dramatically accelerates gastric emptying in
     gastroparesis diabeticorum and normals and abolishes the emptying
     discrimination between solids and liquids [see comments]
   [ABSTRACT ONLINE]
In: J Nucl Med (1990 Sep) 31(9):1490-3

  Erythromycin, a macrolide antibiotic, has recently been shown to have
a motilin like effect on gastrointestinal muscle strips. In this
study, we have evaluated the effect of erythromycin on patients with
delayed gastric emptying and healthy subjects using the dual
radionuclide technique. Twelve patients with gastroparesis
diabeticorum and ten healthy age- and sex-matched controls were
studied. Gastric emptying of solids and liquids was determined using
99mTc-SC scrambled egg and 111In-DTPA in water. Following a baseline
study and on a separate day, each patient and control received a 15-
min i.v. perfusion of erythromycin starting at meal ingestion. Eleven
out of the 12 patients were restudied after a 3-wk oral
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administration. In patients and controls, i.v. erythromycin
dramatically accelerated gastric emptying of both solids and liquids
which were emptied at the same rate. After chronic oral
administration, solid and liquid emptying remained significantly
accelerated. Erythromycin appears to be a very powerful gastrokinetic
drug. Derived compounds with the gastrokinetic effect and without the
antibiotic activity could be useful in dyspeptic patients with
delayed gastric emptying.
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96056933  (REFERENCE 10 OF 19)

Ishii K  Tanabe S  Mitsuhashi T  Saigenji K  
[Influence on glycemic control of improved diabetic gastroparesis by
     long-term cisapride therapy]
   [ABSTRACT ONLINE]
In: Nippon Shokakibyo Gakkai Zasshi (1995 Oct) 92(10):1724-33



  To investigate the effect on glycemic control of improving diabetic
gastroparesis, we evaluated symptoms (scored), gastric motor
functions (solid and liquid gastric emptying studies and
electrogastrography), and glycemic control in 11 patients with
diabetic gastroparesis (5 men, 6 women, 50.4 +/- 4.5 years old)
before and after treatment with cisapride (15 mg/day p.o., 12 weeks).
None of the patients had organic abnormalities on gastrointestinal
endoscopy. The dysmotility symptom score (maximum: 18) on cisapride
significantly improved from 13.1 to 4.0 (p < 0.01). Retention rates
at 15 and 80 minutes after ingestion improved in a solid-food gastric
emptying study using a test meal of instant noodles labeled with 37
MBq (1 mCi) technetium-99m (both p < 0.05). Liquid gastric emptying,
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evaluated using a sulfamethizole technique, also improved but not
significantly. Electrogastrography revealed no significant changes
after treatment, but the postprandial rate of normal frequency waves
tended to increase. Glycemic control was assessed based on HbA1C,
fructosamine and M value. There were no significant changes in
glycemic control after treatment with cisapride. We conclude that
long-term administration of cisapride reduced dysmotility symptoms
and improved solid and liquid gastric emptying without adversely
affecting glycemic control.
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96050765  (REFERENCE 11 OF 19)

Marangos MN  Skoutelis AT  Nightingale CH  Zhu Z  Psyrogiannis AG  
   Nicolau DP  Bassaris HP  Quintiliani R  
Absorption of ciprofloxacin in patients with diabetic gastroparesis.
   [ABSTRACT ONLINE]
In: Antimicrob Agents Chemother (1995 Sep) 39(9):2161-3



  The purpose of this study was to assess the pharmacokinetic profile
of ciprofloxacin in 12 patients with diabetic gastroparesis. Patients
received both a single 500-mg oral (p.o.) dose and a single 400-mg
intravenous (i.v.) dose of ciprofloxacin separated by a 1-week
washout period. Pharmacokinetic parameters (means +/- standard
deviations) for the p.o. and i.v. doses were as follows: areas under
the concentration-time curve from 0 h to infinity, 9.74 +/- 2.59 and
11.78 +/- 3.18 micrograms.h/ml, respectively; maximum concentrations
of drug in serum, 2.13 +/- 0.67 and 4.21 +/- 1.07 micrograms/ml,
respectively; and half-lives, 4.03 +/- 0.58 and 4.20 +/- 0.58 h,
respectively. The ratio of the areas under the concentration-time
curves from 0 h to infinity for the p.o. and i.v. doses was 0.84,
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with a 90% confidence interval of 0.68 to 0.98; the mean absolute
bioavailability was calculated to be 67% (range, 43 to 82%). From
these data it appears that ciprofloxacin is adequately absorbed in
patients with diabetic gastroparesis.
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95397130  (REFERENCE 12 OF 19)

Wedmann B  Adamek RJ  Wegener M  
[Ultrasound detection of gastric antrum motility--evaluating a simple
     semiquantitative method]
Sonographische Erfassung der Magenantrummotilitat--Evaluierung einer
     einfachen semiquantitativen Methode.
   [ABSTRACT ONLINE]
In: Ultraschall Med (1995 Jun) 16(3):124-6


  AIM: This study was carried out to evaluate a simplified sonographic
technique for the sonographic analysis of antral motility. METHOD:
For this purpose the percentage of visually complete contractions
(estimated reduction of the antral area > 50%)/2 minutes was compared
to the mean amplitude (%) and the mean velocity (%/s) of the
contractions. RESULTS: The percentage of complete contractions was
closely correlated to both the mean amplitude (r = 0.97, p < 0.0001)
and the velocity (r = 0.92, p < 0.0001) of the antral contractions.
CONCLUSION: Since the simplified technique is regardless to a
postprocessing unit, which is not available in many sonolayers, it
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could be recommended as a valid routine screening method for the
detection of antral motility disorders.
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95360830  (REFERENCE 13 OF 19)

Pan DY  Chen GH  Chang CS  Ho KS  Poon SK  Huang CK  Kao CH  Wang SJ  
Effect of oral erythromycin on patients with diabetic gastroparesis.
   [ABSTRACT ONLINE]
In: Chung Hua I Hsueh Tsa Chih (Taipei) (1995 Jun) 55(6):447-51


  BACKGROUND. Abnormal gastrointestinal motility is a well recognized
complication of diabetes mellitus, and disordered gastric emptying
may hamper glycemic control. The objects of this study were to
investigate the effect of oral erythromycin on gastric emptying and
to evaluate the effect of corrected gastric emptying on glycemic
control in patients with diabetic gastroparesis. METHODS. Twenty
patients of Type II (non-insulin-dependent) diabetes mellitus with
typical symptoms of gastroparesis and delayed solid phase gastric
emptying were studied. There were 18 males and 2 females, aged 49 to
72 years. Erythromycin (erythromycin estolate) was given orally at a
dose of 250 mg, 3 times daily, 30 minutes before each meal.
Radionuclide-labelled solid phase gastric emptying and fasting blood
sugar (FBS) were studied after one day of erythromycin therapy, and
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again after 2 weeks of the therapy. The half time of gastric emptying
(GETt1/2) represented the time needed for 50 percent of the initial
radioactivity to leave the stomach, and was used to express the
gastric emptying status. RESULTS. The GETt1/2 decreased from 198.0 +/-
58.9 minutes at baseline to 139.1 +/- 67.6 minutes following one day
of erythromycin therapy (p < 0.01), and to 137.1 +/- 71.2 minutes
after two weeks of treatment (vs. baseline p < 0.01). The FBS
decreased from 159.0 +/- 40.2 mg/dl at baseline to 149.0 +/- 38.5
mg/dl following one day of therapy (p = 0.12, NS), and to 139.2 +/-
39.8 mg/dl after two weeks of treatment (vs. baseline p < 0.02).
CONCLUSIONS. It was concluded that erythromycin is an effective
prokinetic agent for diabetic gastroparesis, and that corrected
gastric emptying may improve glycemic control.
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95329554  (REFERENCE 14 OF 19)

Rosa-e-Silva L  Troncon LE  Oliveira RB  Iazigi N  Gallo L Jr  Foss MC  
Treatment of diabetic gastroparesis with oral clonidine.
   [ABSTRACT ONLINE]
In: Aliment Pharmacol Ther (1995 Apr) 9(2):179-83


  BACKGROUND/AIMS: Clonidine, a specific alpha-2-adrenergic receptor
agonist, has been suggested to improve symptoms of gastroparesis in
diabetics with diarrhoea. The aim of this study was to investigate
the effects of clonidine on gastric emptying and symptoms suggestive
of gastroparesis in patients with longstanding diabetes mellitus and
evidence of autonomic neuropathy. METHODS: Six diabetics with
chronic, refractory symptoms of bloating, nausea and vomiting were
studied. Gastric emptying of a liquid nutrient meal (250 mL; 430
kcal) was evaluated by scintigraphy and symptoms were scored.
Patients were treated with clonidine (median dose: 0.3 mg/day) for 2-
12 weeks (median: 4 weeks), after which symptoms and gastric emptying
were re-evaluated. Treatment was then sustained for a median follow-
up period of 7 weeks (range: 2-56 weeks). RESULTS: Gastric emptying
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half-time values in diabetic patients ranged from 16 to 180 min
(median: 100 min) and four patients had abnormally delayed emptying
before treatment. In all patients, half-time values decreased during
treatment (median: 35 min; range: 14-106 min, P < 0.025 vs. pre-
treatment values) and in three of the four patients with abnormal
gastric retention, half-time values returned to the normal range.
During clonidine treatment, a substantial decrease in the score for
symptoms was observed (median and range: 7.5; 2-9 vs. 0; 0-9). In
four patients, symptoms virtually disappeared, an effect that was
maintained throughout follow-up (6-56 weeks). CONCLUSIONS: These
findings suggest that impairment of adrenergic influences on
gastrointestinal motility control may play a role in the
pathophysiology of diabetic gastroparesis and that clonidine may be a
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useful alternative for treating patients with this condition.
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95274256  (REFERENCE 15 OF 19)

Pfaffenbach B  Wegener M  Adamek RJ  Wissuwa H  Schaffstein J  Aygen S  
   Hennemann O  
[Non-invasive 13C octanoic acid breath test for measuring stomach
     emptying of a solid test meal--correlation with scintigraphy in
     diabetic patients and reproducibility in healthy probands]
Nicht-invasiver 13C-Oktansaureatemtest zur Messung der
     Magenentleerung einer festen Testmahlzeit--Korrelation mit der
     Szintigraphie bei Diabetikern und Reproduzierbarkeit bei gesunden
     Probanden.
   [ABSTRACT ONLINE]


  The recently developed 13C-octanoic acid breath test allows the
measurement of gastric emptying of solids. In this prospective study
we wanted to investigate, whether the 13C-octanoic acid breath test
using breath samples every half an hour is suitable in assessing
gastric emptying in comparison to scintigraphy in diabetics.
Furthermore, we examined the intraindividual reproducibility in
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healthy volunteers. 20 consecutive diabetics with clinical symptoms
of gastroparesis received a solid double-labeled standard test meal.
The meal consisted of 1 scrambled egg, labeled with 75 mg 13C-
octanoic acid and 0.5 mCi 99mTc colloid, 50 g rye bread, 20 g butter,
200 ml orange juice; 280 kcal. Breath samples were taken at half hour
intervals for 4 hours and analyzed for 13CO2 by isotope ratio mass
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spectrometry. Using a regression method gastric emptying half times
(t 1/2) were determined and correlations to simultaneous 99mTc-
scintigraphy were calculated. There was a moderate significant
correlation of 13C-octanoic acid breath test t 1/2 and scintigraphic
t 1/2 (R = 0.6; p = 0.008). The 13C-octanoic acid breath test t 1/2
obtained in 20 healthy volunteers measured at two separate days
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showed a coefficient of variation (VC), that was greater between
subjects (VK = 42%) than between two measurements in the same subject
(VK = 24%), which reflects a moderate intraindividual
reproducibility. Taking breath samples every half an hour the 13C-
octanoic acid breath test only reveals a moderate intraindividual
reproducibility and a moderate correlation to scintigraphy in
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diabetics. For detailed assessment of solid gastric emptying in
diabetics a 13C-octanoic acid breath test using shorter breath
sampling intervals is recommended.
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95063873  (REFERENCE 16 OF 19)

Pfaffenbach B  Schaffstein J  Wegener M  Adamek RJ  Wedmann B  
   Uffmann M  Wissuwa H  
[Ultrasound measurement of gastric emptying of a solid test meal.
     Correlation with scintigraphy in diabetic patients and
     reproducibility in healthy probands]
Sonographische Magenentleerungsmessung einer festen Testmahlzeit.
     Korrelation mit der Szintigraphie bei Diabetikern und
     Reproduzierbarkeit bei gesunden Probanden.
   [ABSTRACT ONLINE]
In: Ultraschall Med (1994 Aug) 15(4):207-12



  Measurement of gastric emptying of liquids by sagittal antral
planimetry is established. Ultrasonic measurement of gastric emptying
of solids has not been assessed although gastroparesis often reveals
a delayed gastric emptying of solids first. Therefore in this
prospective study we used a solid meal (50 g rye bread, 1 egg, 40 g
butter, 200 ml orange juice; 280 kcal) to examine intraindividual
reproducibility of ultrasound in 20 healthy volunteers. Moreover, in
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20 diabetics antral planimetry assessed by ultrasound was compared to
scintigraphy. Antral planimetry showed a coefficient of variation,
that was nearly three times greater between subjects than between two
measurements performed on the same subject. This results reflect a
good intraindividual reproducibility. Gastric emptying half-times
assessed by ultrasound and scintigraphy did not correlate in
diabetics (R = 0.2). However, correlation between sonographic
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measurement of antral area and scintigraphy at defined times (60,
120, 180, 240 min) was significant (R = 0.7; p < 0.001). These
results imply that ultrasonic antral planimetry is a suitable
orientating method for measuring gastric emptying of solids.
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