Management of diabetic gastroparesis

Diabetic patients with nausea and vomiting need evaluation to determine symptom etiology; diabetic gastroparesis should never be the default diagnosis. If no other etiology for nausea and vomiting is found after an appropriate evaluation, treatment focuses on effectively relieving symptoms while maintaining adequate nutritional status. Therapy for patients with nausea and vomiting consists of restoring volume, glycemic, and electrolyte status and providing antiemetics generously in both a remittive and prophylactic fashion. Prokinetics are best used to treat gastric stasis or clinically significant delayed gastric emptying. A gastrostomy is rarely indicated, but a jejunostomy may be helpful in maintaining nutrition. Parenteral nutrition should generally be avoided because of high complication rates in this setting. Surgical intervention is essentially unstudied in this population and cannot be recommended. Gastric electrical stimulation is an interesting and novel therapy, but its efficacy beyond placebo remains to be conclusively shown.