Bortolotti M. Gastroparesis, a diabetic complication causing further, even serious, complications: How to prevent its worsening? World J Gastroenterol 2025; 31(23): 104932 [DOI: 10.3748/wjg.v31.i23.104932]
Corresponding Author of This Article
Mauro Bortolotti, MD, Department of Internal Medicine and Gastroenterology, S Orsola-Malpighi Polyclinic, University of Bologna, Via Massarenti 48, Bologna 40138, Italy. bormau@tin.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
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/
World J Gastroenterol. Jun 21, 2025; 31(23): 104932 Published online Jun 21, 2025. doi: 10.3748/wjg.v31.i23.104932
Gastroparesis, a diabetic complication causing further, even serious, complications: How to prevent its worsening?
Mauro Bortolotti
Mauro Bortolotti, Department of Internal Medicine and Gastroenterology, S Orsola-Malpighi Polyclinic, University of Bologna (retired), Bologna 40138, Italy
Author contributions: Bortolotti M solely contributed to the manuscript.
Conflict-of-interest statement: No relevant conflict of interest exists for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mauro Bortolotti, MD, Department of Internal Medicine and Gastroenterology, S Orsola-Malpighi Polyclinic, University of Bologna, Via Massarenti 48, Bologna 40138, Italy. bormau@tin.it
Received: January 7, 2025 Revised: April 8, 2025 Accepted: April 29, 2025 Published online: June 21, 2025 Processing time: 165 Days and 1 Hours
Abstract
Gastroparesis is a severe diabetic complication, caused by a progressive multifactorial enteric neuropathy. To make an early diagnosis in patients at risk of diabetic gastroparesis is crucial for slow down its progression towards full-blown disease source of further complications and requesting effective, but unsafe, drugs as well as invasive surgical treatments. This aim can be achieved by detecting its first signal represented by the gastric emptying (GE) delay, by using, among the tests to measure GE, the simple, safe, reliable, and easily available one, that is real-time ultrasonography, possibly done annually. Once the GE delay has been identified, it is necessary to evaluate with endoluminal functional lumen imaging probe or manometry whether it depends on pylorospasm, which should be treated by means of non-surgical endoscopic therapies. If, instead, it depends on initial gastropathy, detected by electrogastrograhic body surface gastric mapping, it should be treated with the safest prokinetic drugs and with the newly emerging treatments, thus distancing heavy medical and surgical treatments, while waiting for future solutions.
Core Tip: Gastroparesis, a diabetic complication with a worsening delay in gastric emptying (GE), responsible of further serious complications, is due to the progressive multifactorial damage of the enteric neurons. It could be discovered early by performing the antral real-time ultrasonography annually, which measures the GE of a semi-solid meal. Furthermore if “the body surface gastric mapping”, evaluating the gastric bioelectric activity, is normal, the cause of GE may be pylorospasm, to be confirmed manometrically. Subsequently, a strict control of glycemia, even with “artificial pancreas” devices, together with prokinetics intake, which counteracts the symptoms and gastric dilatation, must be done, after the correction of a possible pylorospasm.
