Gastroparesis Less Common Than Thought in Diabetics

Original Medscape Article

By Anne Harding
NEW YORK (Reuters Health) Dec 23 - Gastroparesis may not be as common among people with diabetes as had previously been thought, new findings show.
Over a 10-year follow-up period, just 5% of people with type 1 diabetes developed gastroparesis, while 1% of type 2 diabetics did, Dr. G. Richard Locke III of the Mayo Clinic in Rochester, Minnesota and his colleagues found.
"Our sense is there's a perception out there that as soon as someone with diabetes has a stomach problem, it gets called gastroparesis," Dr. Locke told Reuters Health. "While it's true that people with bad, long-standing diabetes get gastroparesis, most people don't."
Studies have shown that many people with gastroparesis have diabetes mellitus (DM), and cross-sectional studies have also found a high prevalence of abnormally slow stomach emptying among people with long-standing type 1 or type 2 DM.
Still, it hasn't been clear how common gastroparesis is among the general population of diabetic patients, Dr. Locke and his team explain in their report, published online November 15 in the American Journal of Gastroenterology.
To investigate, the researchers gathered data on 227 patients with type 1 DM and 360 with type 2 DM as of January 1995, and 639 non-diabetic controls.
Over the following 10 years, 10 of the patients with type 1 DM and four of those with type 2 DM developed gastroparesis, compared to just one of the controls. Cumulative risk of gastroparesis was 5.2% for patients with type 1 DM, 1% for patients with type 2 DM, and 0.2% for the controls. The adjusted hazard ratio for gastroparesis was 33 for type 1 DM and 7.5 for type 2, although the latter finding was not statistically significant.
Heartburn was the only gastrointestinal symptom independently associated with gastroparesis risk at baseline among type 1 diabetics; these patients were 6.6 times more likely to develop gastroparesis during follow-up.
The finding of a greater risk of gastroparesis in type 1 diabetes patients is "consistent with poorer diabetic control and high rates of autonomic neuropathy that occur in patients with type 1 DM," Dr. Locke and colleagues write. "A remarkable finding of the current study is that the incidence of clinically evident gastroparesis among those with diabetes is still rare."
The prevalence of the condition among diabetics may have been overestimated, the researchers suggest, because many studies have used surveys asking patients about symptoms rather than relying on medical tests and diagnosis.
"One needs to be aware that there are other causes of nausea, vomiting and stomach discomfort in people with diabetes," Dr. Locke said. When gastroparesis is suspected, he added, patients will typically undergo endoscopy and possibly abdominal imaging with CT scanning or ultrasound. Patients may also complete a gastric emptying study. According to Dr. Locke, while many centers still do two-hour gastric emptying studies, a full four-hour study is preferred.
While doctors and patients may prefer the clearer diagnosis of gastroparesis, he added, most patients are likely to have normal gastric emptying, which points to a diagnosis of functional dyspepsia.
"We think it's more accurate to think of these people as having functional dyspepsia, with a few having gastroparesis," Dr. Locke said. "We think it's important to find out, to do the testing and see."
SOURCE: http://bit.ly/tBaIcG
Am J Gastroenterol 2011.