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World J Gastroenterol. Sep 14, 2018; 24(34): 3821-3833
Published online Sep 14, 2018. doi: 10.3748/wjg.v24.i34.3821
Implication of neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function in diabetic gastroparesis
Bashair M Mussa, Sanjay Sood, Anthony JM Verberne
Bashair M Mussa, Sanjay Sood, Department of Basic Medical Science, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
Anthony JM Verberne, Department of Medicine, Austin Health, University of Melbourne, Melbourne 3084, Australia
Author contributions: Mussa BM developed, designed and wrote the review; Sood S designed the figures and revised the manuscript; Verberne AJ edited and revised the manuscript; all authors approved the final version.
Conflict-of-interest statement: The authors have no personal, financial or non-financial conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Bashair M Mussa, PhD, Assistant Professor, Department of Basic Medical Science, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates. bmussa@sharjah.ac.ae
Telephone: +971-6-5057220 Fax: +971-6-558579
Received: May 21, 2018
Peer-review started: May 21, 2018
First decision: June 13, 2018
Revised: June 22, 2018
Accepted: June 27, 2018
Article in press: June 27, 2018
Published online: September 14, 2018
Processing time: 116 Days and 4 Hours
Abstract

Recently, diabetic gastroparesis (DGP) has received much attention as its prevalence is increasing in a dramatic fashion and management of patients with DGP represents a challenge in the clinical practice due to the limited therapeutic options. DGP highlights an interrelationship between the gastric emptying and pancreatic secretory function that regulate a wide range of digestive and metabolic functions, respectively. It well documented that both gastric emptying and pancreatic secretion are under delicate control by multiple neurohormonal mechanisms including extrinsic parasympathetic pathways and gastrointestinal (GI) hormones. Interestingly, the latter released in response to various determinants that related to the rate and quality of gastric emptying. Others and we have provided strong evidence that the central autonomic nuclei send a dual output (excitatory and inhibitory) to the stomach and the pancreas in response to a variety of hormonal signals from the abdominal viscera. Most of these hormones released upon gastric emptying to provide feedback, and control this process and simultaneously regulate pancreatic secretion and postprandial glycemia. These findings emphasize an important link between gastric emptying and pancreatic secretion and its role in maintaining homeostatic processes within the GI tract. The present review deals with the neurohormonal-coupled mechanisms of gastric emptying and pancreatic secretory function that implicated in DGP and this provides new insights in our understanding of the pathophysiology of DGP. This also enhances the process of identifying potential therapeutic targets to treat DGP and limit the complications of current management practices.

Keywords: Gastroparesis; Gastric emptying; Pancreatic secretion; Postprandial glycemia; Neurohormonal control

Core tip: Prevalence of diabetic gastroparesis (DGP) is increasing in a dramatic fashion, however there are still gaps in our understanding of the pathophysiology of DGP. It well documented that gastric emptying and subsequent pancreatic secretion are interrelated and regulated by several neurohormonal mechanisms. Dysfunction of these mechanisms affects gastric emptying, pancreatic secretion and postprandial glycemia. Therefore, the present article reviews the neurohormonal-coupled mechanisms that control gastric emptying and pancreatic secretion and their plausible involvement in DGP. This will help in identification of novel therapeutic targets to treat DGP with minimal adverse effects on postprandial glycemia.