Gastroparese bei diabetischer Polyneuropathie

Zusammenfassung

Die Gastroparese kann mit Symptomen wie postprandialem Völlegefühl, Brechreiz, Übelkeit, vorzeitigem Sättigungsgefühl, Aufstoßen oder epigastrischen Schmerzen einhergehen, häufig ist aber auch der asymptomatische Verlauf. Bei häufig entgleisendem Blutzuckerspiegel sollte grundsätzlich eine diagnostische Abklärung der Magenentleerung erfolgen. Dies ist mit dem ¹³C-Atemtest für flüssige oder feste Speisen nicht-invasiv möglich. Diese Methode zeigte gute Korrelationen mit der Funktionszintigrafie. Grundlegende therapeutische Maßnahmen sind die normnahe Blutglukoseeinstellung und eine fett- und ballaststoffarme, leicht verdauliche Diät, die aus 4-6 kleinen Mahlzeiten bestehen sollte. In der Regel lässt sich die Gastroparese medikamentös behandeln. Hierfür werden die Dopaminantagonisten Metoclopramid und Domperidon sowie das Motilid Erythromicin eingesetzt. Bei pharmakotherapie-refraktären Gastroparesen, die mit starker Übelkeit und rezidivierendem Erbrechen einhergehen, wird oft eine parenterale Ernährung oder die Ernährung über eine Jejunalsonde notwendig. Für diese Patienten finden auch elektrische Magenschrittmacher Anwendung. Deren Langzeitwirkung auf die Symptome und die Magenentleerung ist z.Zt. noch Gegenstand experimenteller Studien.

Summary

Symptoms of gastroparesis include nausea and vomiting, early satiety, post-prandial fullness, early satiety, bloating and abdominal pain but may frequently be asymptomatic as well. Patients with difficult metabolic control should be considered to have a disordered gastric emptying. Nuclear scintigraphy is the gold standard for quantifying delayed gastric emptying, but noninvasiv methods like the ¹³C-octanoic acid breath test have found to exhibit highly significant positive correlation to scintigraphy. The main goal of treatment is to minimize symptoms and accelerate gastric emptying, and basic measures to achieve this are improved glucose control and low fat/low fibre diets that are easy to digest. The prokinetic agents metoclopramide, domperidone, and erythromycin are successful in controlling symptoms in the majority of patients with gastroparesis due to diabetes. Patients with persistent symptoms or intermittent but severe symptoms may require surgical techniques such as the gastrostomy and jejunostomy. The significance of gastric pacing devices on gastric emptying and specific symptom control has to be elucidated in further studies.

Key Words

diabetic gastroparesis - pathophysiology - diagnostic - therapeutic approach

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