Physiologic studies of autonomic-nervous-system dysfunction accompanying diabetes mellitus

Gastroparesis after a presumed viral illness: clinical and laboratory features and natural history

Gastroparesis after a viral infection has rarely been reported. In this article, we describe the clinical features and long-term outcome of 7 patients who had gastroparesis after a presumed viral illness and who were identified in a retrospective review of 103 consecutive cases of gastroparesis seen at our institution from 1977 through 1988. The three male and four female patients with gastroparesis after a suspected viral illness were young (mean age, 26.9 years) and healthy before the onset of the illness, which manifested as low-grade fever, fatigue, and myalgia with or without diarrhea. A mean of 4.5 days after spontaneous resolution of the viral illness, persistent nausea, vomiting, and epigastric pain developed in these patients. In all seven patients, delayed emptying of the gastric contents was substantiated. Autonomic neuropathy was found in all three patients who underwent autonomic function tests. During a mean follow-up of 32.3 months, five of the seven patients had complete resolution of gastroparetic symptoms, and the other two had considerable improvement of their condition. We conclude that postviral gastroparesis is uncommon, is frequently associated with autonomic dysfunction, and is associated with an apparently excellent prognosis.

Plasma motilin concentration and interdigestive migrating motor complex in diabetic gastroparesis: effect of metoclopramide

The objective of this study is to determine whether abnormal rhythm and amplitude of the oscillation in plasma motilin concentration are responsible for the abnormal motility observed in patients with diabetic gastroparesis. We also investigated the effect of metoclopramide on plasma motilin concentration and gastrointestinal motility in these patients. In healthy controls, basal plasma motilin concentration fluctuated in phase with the interdigestive migrating motor complex. All patients with diabetic gastroparesis did not have antral phase III activities and had significantly higher basal motilin concentrations, which maintained a normal oscillatory pattern. Administration of metoclopramide initiated antral phase III activities in healthy controls and in patients with diabetic gastroparesis. These were accompanied by a concurrent rise in plasma motilin concentration in healthy controls, contrasting with a fall in plasma motilin concentrations in patients with diabetic gastroparesis. We conclude that diabetic gastroparesis is associated with absence of antral interdigestive migrating motor complex and with elevated plasma motilin concentration with normal cyclic fluctuations. Our studies also show that metoclopramide initiates antral phase III activities in diabetic gastroparesis independent of plasma motilin concentration.