Abstract
Background. A 31-year-old woman with an 11-year history of poorly controlled type 1 diabetes mellitus was admitted with severe vomiting and ketoacidosis. The patient had been admitted to hospital on 14 occasions in the past 3 years for diabetic ketoacidosis precipitated by intractable vomiting, and she had been diagnosed with gastroparesis 2 years previously.
Investigations. Assessment of the patient's response to standard treatments for diabetic gastroparesis. These approaches involved tight glycemic control that included subcutaneous insulin infusion via a pump, correction of electrolyte disturbances, use of standard antiemetic and promotility agents, somatostatin-analog treatment, intrapyloric injection of botulinum toxin, and insertion of a percutaneous jejunal feeding tube.
Diagnosis. Severe diabetic gastroparesis refractory to standard treatments.
Management. The neurokinin-receptor antagonist aprepitant was started and her vomiting stopped within 24 h. This treatment was successfully continued for 4 months until a gastric electrical stimulation device was inserted, which enabled aprepitant treatment to be withdrawn and the percutaneous jejunostomy feeding tube to be removed. This successful treatment led to a substantial improvement in the patient's quality of life and overall glycemic control.
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References
Camilleri, M. Clinical practice. Diabetic gastroparesis. N. Engl. J. Med. 356, 820–829 (2007).
Soykan, I., Sivri, B., Sarosiek, I., Kiernan, B. & McCallum, R. W. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig. Dis. Sci. 43, 2398–2404 (1998).
Kockar, M. C., Kayahan, I. K. & Baybek, N. Diabetic gastroparesis in association with autonomic neuropathy and microvasculopathy. Acta Med. Okayama 56, 237–243 (2002).
Jones, K. L. et al. Predictors of delayed gastric emptying in diabetes. Diabetes Care 24, 1264–1269 (2001).
Lacy, B. E., Crowell, M. D., Schettler-Duncan, A., Mathis, C. & Pasricha, P. J. The treatment of diabetic gastroparesis with botulinum toxin injection of the pylorus. Diabetes Care 27, 2341–2347 (2004).
Edmunds, M. C., Chen, J. D., Soykan, I., Lin, Z. & McCallum, R. W. Effect of octreotide on gastric and small bowel motility in patients with gastroparesis. Aliment. Pharmacol. Ther. 12, 167–174 (1998).
American Society of Clinical Oncology et al. American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J. Clin. Oncol. 24, 2932–2947 (2006).
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology, v.2. 2009: antiemesis http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf (2009).
Madsen, J. L. & Fuglsang, S. A randomized, placebo-controlled, crossover, double-blind trial of the NK1 receptor antagonist aprepitant on gastrointestinal motor function in healthy humans. Aliment. Pharmacol. Ther. 27, 609–615 (2008).
McCallum, R. W., Cynshi, O. & Investigative Team. Clinical trial: effect of mitemcinal (a motilin agonist) on gastric emptying in patients with gastroparesis—a randomized, multicentre, placebo-controlled study. Aliment. Pharmacol. Ther. 26, 1121–1130 (2007).
Chawla, S. P. et al. Establishing the dose of the oral NK1 antagonist aprepitant for the prevention of chemotherapy-induced nausea and vomiting. Cancer 97, 2290–2300 (2008).
Navari, R. M. et al. Reduction of cisplatin-induced emesis by a selective neurokinin-1-receptor antagonist. L-754, 030 Antiemetic Trials Group. N. Engl. J. Med. 340, 190–195 (1999).
Keller, M. et al. Lack of efficacy of the substance P (neurokinin 1 receptor) antagonist aprepitant in the treatment of major depressive disorder. Biol. Psychiatry 59, 216–223 (2006).
Abell, T. et al. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 125, 421–428 (2003).
Lin, Z., McElhinney, C., Sarosiek, I., Forster, J. & McCallum, R. Chronic gastric electrical stimulation for gastroparesis reduces the use of prokinetic and/or antiemetic medications and the need for hospitalizations. Dig. Dis. Sci. 50, 1328–1334 (2005).
Lin, Z., Sarosiek, I., Forster, J. & McCallum, R. W. Symptom responses, long-term outcomes and adverse events beyond 3 years of high-frequency gastric electrical stimulation for gastroparesis. Neurogastroenterol. Motil. 18, 18–27 (2007).
Parkman, H. P. et al. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 127, 1592–1622 (2004).
Acknowledgements
Written consent for publication was obtained from the patient. The authors thank Dr David Hopkins, Dr Guy Chung-Faye, and Mr Sri Kadirkamanathan for their invaluable help in the patient's management.
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Chong, K., Dhatariya, K. A case of severe, refractory diabetic gastroparesis managed by prolonged use of aprepitant. Nat Rev Endocrinol 5, 285–288 (2009). https://doi.org/10.1038/nrendo.2009.50
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DOI: https://doi.org/10.1038/nrendo.2009.50
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