1998 Abstract: FUNCTIONAL AND SYMPTOMATIC IMPROVEMENT IN PATIENTS WITH DIABETIC GASTROPARESIS FOLLOWING PYLOROPLASTY. Ziad E. Abouezzi, W. Scott Melvin, E. Christopher Ellison, William J. Schirmer. Department of Surgery, The Ohio State University, Columbus, Ohio. 66
Abstracts 1998 Digestive Disease Week
#970
FUNCTIONAL AND SYMPTOMATIC IMPROVEMENT IN PATIENTS WITH DIABETIC GASTROPARESIS FOLLOWING PYLOROPLASTY. Ziad E. Abouezzi, W. Scott Melvin, E. Christopher Ellison, William J. Schirmer. Department of Surgery, The Ohio State University, Columbus, Ohio.
Diabetic Gastroparesis (DGP) is a cause of significant morbidity, expense and suffering in diabetic patients. No suitable therapy has been described in severe DGP refractory to medical therapy. We hypothesized that vagal nerve dysfunction may be part of the general autonomic dysfunction affecting diabetics. We present this data summarizing our observation in the initial 6 patients treated with pyloroplasty. We retrospectively reviewed the medical records of patients with severe DGP who underwent pyloroplasty for relief of symptoms. Data on the duration of symptoms, associated conditions, previous admissions and treatments, preoperative and postoperative gastric emptying studies (GES) as well as clinical follow-up (nausea-vomiting, NV) were analyzed. Six patients (4 women and 2 men) with a mean age of 39 years were treated over a period of 3 years. follow-up averaged 11.3 months (ms) (range 3 to 33). All patients had more than 13 years history of complicated type I diabetes mellitus, required hospitalizations for dehydration at least 4 times over the previous year, and all were on prokinetic drugs or combinations for at least one year with minimal improvement. The results of gastric emptying studies (GES) are summarized in the following table:
Patients
1
2
3
4
5
6
GES preop
t ½ in min
130
> 120
285
> 120
90
very
delayed
GES postop
t ½ in min
37
(16 ms)
59
(2 ms)
35
(8 ms)
54
(8 ms)
N/A
N/A
clinical
improvement
80-90%
60-70%
60-70%
70-80%
0%
80-90%
Pyloroplasty induced a significant shortening of gastric emptying times in 4 of 4 patients studied. Marked clinical improvement was seen in 5 of 6 patients.
CONCLUSIONS: Pyloroplasty is effective in relieving symptoms of diabetic gastroparesis and should be considered in the management of this condition.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
