Introduction
Mechanism of Gastric Emptying and the Pathogenesis of DG
Drug
|
Effect on gastric emptying and mechanism
|
---|---|
Metformin | Possibly delayed: due to DPP-4 inhibition (gastric emptying studies required for definitive assessment) |
Sulfonylureas | None |
Glitazones | None |
α-Glucosidase inhibitors (particularly arcabose) | Delayed: probably due to release of gut hormones including GLP-1 and CCK |
Amylinomimetics | Delayed: inhibition of vagal cholinergic function |
GLP-1 analogs | Delayed: inhibition of vagal cholinergic function and changes in neuroendocrine axis leading to reduced antroduodenal contractility |
DPP-4 inhibitors | None: presumably because of lower GLP-1 concentrations than in GLP-1 analogs |
Diagnosis
Management
Prokinetic Agents
Metoclopramide
Domperidone
Class of agent
|
Name(s)
|
Route (s)
|
Dosing
|
Side effects
|
---|---|---|---|---|
Dopamine (D2)-receptor antagonists | Metoclopramide | PO, IV, SC, IM | 10 mg TDS/QDS before meals | Anxiety, depression, extrapyramidal movement disorders, galactorrhoea, tardive dyskinesia |
Domperidone | PO | 10–20 mg TDS before meals | Side effects listed above plus: abdominal cramps, irregular menstrual periods, loss of libido | |
Motilin-receptor agonists | Erythromycin | PO, IV | 40–250 mg TDS before meals | Abdominal cramping, early satiety, urticaria, rashes |
Clarithromycin | PO | 125–250 mg OD | ||
Azithromycin | PO | 250 mg OD | ||
Acetylcholinesterase inhibitors | Pyridostigmine | PO | 30 mg QDS | Sweating, bladder dysfunction, increased production of saliva, diaphoresis, muscle weakness |