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November 21, 2024, 16:10

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The author suggests to use in all diabetic patients an interesting technique, the” body surface gastric mapping” (BSGM), to detect the onset of gastric dysmotility precursor of gastroparesis, instead of invasive procedures, as gastroscopy, manometry, emptying of radiopaque markers or radioactive bolus and breath tests . The idea is interesting , but there are some observations to make. First of all the author forgot a simple, not invasive, physiologic and reliable method to measure gastric emptying, that is real-time ultrasonography, which allows the use of a normal solid–liquid meal and gives an immediate result (1). Furthermore the author did not take into account the fact that, as indicated in figure 1 of ref. 4, the cause of delayed gastric emptying in gastroparesis may be also due, not only to antral dysmotility detectable with BSGM, but also to impaired pyloric relaxation upon arrival of antral peristalsis (pylorospasm) and, sometimes, to dysmotility of duodenum, which does not accept the bolus coming from the stomach. The pylorospasm, which was observed in 14 of 24 diabetics, by Mearin et al (2) forms part of the widespread disruption of gut motility that affects some patients with diabetes. Unfortunately these pyloric and duodenal motor abnormalities are not detected by the technique of BSGM, which could find a normal antral motility, giving the impression that everything is OK, while the gastric emptying is already delayed. Therefore I would suggest to monitor the diabetic patients with the real-time ultrasonography, which is able to detect also a minimal delay in gastric emptying harbinger of gastroparesis, and, if the gastric emptying is delayed, then perform the BSGM, to see if the cause of the slowing is due to antral dysmotility. If the latter examination is negative, then the cause of delayed gastric emptying shoul be pylorospasm or duodenal dysmotility. REFERENCES 1) Bolondi L, Bortolotti M, Santi V, Calletti T, Gaiani S, Labò G. Measurement of gastric emptying time by real-time ultrasonography. Gastroenterology. 1985 Oct; 89(4):752-9.PMID:3896910. 2) Mearin F, Camilleri M, Malagelada JR. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology. 1986 Jun;90(6):1919-25. doi: 10.1016/0016-5085(86)90262-3. PMID: 3699409

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