Gastric neuropathy in diabetes mellitus: Clinical and radiologic observations

Abstract

Thirty-five cases of diabetic gastric neuropathy are reviewed. This complication appears mainly in long-duration diabetics and does not appear to be sex-related. Typically, gastric neuropathy occurs in patients with a long history of inadequately controlled, moderately severe diabetes. It occurs most frequently in the presence of other diabetic complications; half of the patients presented had peripheral neuropathy, retinopathy and nephropathy at the time of diagnosis. Gastric neuropathy symptoms are generally mild and non-specific. Vomiting of undigested food material from the previous day is not uncommon. Radiologic examination of the gastrointestinal tract usually reveals gastric residue, diminished peristalsis and abnormal retention of barium in the stomach. Striking dilatation of the duodenal bulb may be present. A possible mechanism for the development of these findings is presented. Five patients were re-studied following the oral administration of a ambenenium chloride, a cholinesterase inhibitor. Follow-up radiologic studies revealed a striking improvement in amount of residue, peristalsis and retention in 4 patients. Further investigation in this area appears warranted.