diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13427diaendo-13427Research ArticleОБЗОРЫREVIEWSДиабетический гастропарезDiabetic gastroparesishttps://orcid.org/0000-0003-0069-7744ГригорьеваИ. Н.Grigor’evaI. N.

Григорьева Ирина Николаевна, д.м.н., профессор 

WoS Researcher ID: JGE-0324-2023; Scopus Author ID: 7004630757

630089, Новосибирск, улица Бориса Богаткова, д. 175/1

Irina N. Grigor’eva, MD, PhD, Professor

WoS Researcher ID: JGE-0324-2023; Scopus Author ID: 7004630757

175/1, Boris Bogatkov street, 630089 Novosibirsk

grigorieva2024@yandex.ruНаучно-исследовательский институт терапии и профилактической медицины — филиал ФГБНУ Федеральный исследовательский центр «Институт цитологии и генетики Сибирского отделения Российской академии наук»РоссияResearch Institute of Internal and Preventive Medicine — branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of SciencesRussian Federation202601102026294393400Copyright © Григорьева И.Н., 20262026Григорьева И.Н.Grigor’eva I.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/13427

Цель — дать обзор распространенности, клинической картины, механизмов нарушений моторики желудочно-кишечного тракта (ЖКТ) и их диагностики при диабетическом гастропарезе (ДГП), в том числе в сравнении с идиопатическим ГП (ИГП), а также современных подходов к лечению ДГП. Поиск источников проводили в базах данных рецензируемой научной литературы РИНЦ, CyberLeninka, PubMed/MEDLINE и Google Scholar за 1990–2026 гг. по указанным ниже ключевым словам. ГП как клинический синдром включает тошноту, рвоту, чувство переполнения после еды, боль и вздутие живота при задержке опорожнения желудка (ОЖ) в отсутствие механической обструкции. Распространенность «определенного» ГП (задержка ОЖ при сцинтиграфии + симптомы ГП длительностью более 3 месяцев) в США составляет 24,2 на 100 000 человеко-лет, доля ДГП среди случаев ГП различной этиологии достигает 29,0–57,4%. При ДГП тошнота и рвота более выражены по шкале PAGI-SYM, а показатели качества жизни по SF-36 хуже, чем при ИГП. У пациентов с ГП и сахарным диабетом 1 типа по сравнению с пациентами с ГП и сахарным диабетом 2 типа реже отмечалось вздутие живота (p=0,04), было больше госпитализаций (5,1±6,4 и 2,7±5,7; p<0,001), чаще выявлялась задержка ОЖ тяжелой степени (>35% через 4 часа: 53,9% и 32,2%; p<0,001), и симптомы ДГП проявлялись раньше (34±10 и 49±11 лет; p<0,001). Общепризнан вклад автономной нейропатии с потерей энтеральных нейронов в многофакторный патогенез ДГП; также учитывают потерю интерстициальных клеток Кахаля, снижение вагальной функции и экспрессии nNOS, гипергликемию, окислительный стресс и другие факторы. Оптимальными методами диагностики задержки ОЖ при ДГП являются 4-часовая сцинтиграфия или 13С-дыхательный тест. Международные консенсусные рекомендации по лечению ДГП включают нутрициологическую поддержку, контроль гликемии, восстановление гидратации, применение противорвотных и прокинетических средств, а в тяжелых случаях — энтеральное или парентеральное питание и хирургическое вмешательство. Заключение: при ДГП необходим мультидисциплинарный подход, включающий раннее выявление задержки ОЖ и своевременное принятие комплексных мер, что позволит не только успешнее лечить, но и предупреждать развитие ДГП.

Objective

Objective: to provide an overview of the prevalence, clinical features, mechanisms and diagnosis of gastrointestinal motility disorders in diabetic gastroparesis (DGP), including a comparison with idiopathic gastroparesis (IGP), and current approaches to DGP treatment. The search was conducted in the RSCI, CyberLeninka, PubMed/MEDLINE, and Google Scholar databases for the period 1990–2026 using the keywords listed below. GP as a clinical syndrome is characterized by nausea, vomiting, postprandial fullness, pain, and bloating accompanied by delayed gastric emptying (GE) in the absence of mechanical obstruction. The prevalence of “definite” GP (delayed GE on scintigraphy + GP symptoms lasting >3 months) in the United States is 24.2 per 100,000 person-years, and the proportion of DGP among cases of GP of various etiologies reaches 29.0–57.4%. In DGP, nausea and vomiting are more pronounced on the PAGI-SYM scale, and SF-36 quality-of-life scores are worse than in IGP. In patients with GP and T1DM, compared with those with GP and T2DM, bloating was less frequent (p=0.04), the number of hospitalizations was higher (5.1±6.4 vs 2.7±5.7; p<0.001), severe delayed GE (>35% after 4 hours) was more frequent (53.9% vs 32.2%; p<0.001), and DGP symptoms appeared earlier (34±10 vs 49±11 years; p<0.001). Autonomic neuropathy with loss of enteric neurons is generally recognized as contributing to the multifactorial pathogenesis of DGP; other factors include loss of interstitial cells of Cajal, reduced vagal function and nNOS expression, hyperglycemia, oxidative stress, and others. Four-hour gastric-emptying scintigraphy or a 13C breath test is optimal for diagnosing delayed GE in DGP. International consensus recommendations for DGP treatment include nutritional support, glycemic control, rehydration, antiemetics, and prokinetics; in severe cases, enteral or parenteral nutrition and surgery may be required.

Conclusion

Conclusion: DGP requires a multidisciplinary approach, including earlier recognition of delayed GE and prompt comprehensive measures. This will enable more successful treatment and may help prevent the development of DGP.

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Aliment Pharmacol Ther. 2021;53(9):1010–1020. doi: https://doi.org/10.1111/apt.16304Hernández Mondragón OV, Contreras LFG, Velasco GB, et al. Gastric peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis. Gastrointest Endosc. 2022;96(3):487-499. doi: 10.1016/j.gie.2022.03.025Patel P, Zaher EA, Khataniar H, et al. Safety and Efficacy of Highly Selective 5-Hydroxytryptamine Receptor 4 Agonists for Diabetic and Idiopathic Gastroparesis: A Systematic Review and MetaAnalysis of Randomized Controlled Trials. Cureus. 2024;16(1):e51851. doi: https://doi.org/10.7759/cureus.51851Friedenberg FK, Palit A, Parkman HP, et al. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103(2):416-423. doi: 10.1111/j.1572-0241.2007.01676.xCarbone F, Van den Houte K, Clevers E, et al. Prucalopride in Gastroparesis: A Randomized Placebo-Controlled Crossover Study. Am J Gastroenterol. 2019;114(8):1265–1274. doi: https://doi.org/10.14309/ajg.0000000000000304Aswath GS, Foris LA, Ashwath AK, Patel K. Diabetic Gastroparesis. 2023 Mar 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.Carlin JL, Lieberman VR, Dahal A, et al. Efficacy and Safety of Tradipitant in Patients With Diabetic and Idiopathic Gastroparesis in a Randomized, Placebo-Controlled Trial. Gastroenterology. 2021;160(1):76–87.e4. doi: https://doi.org/10.1053/j.gastro.2020.07.029Carlin JL, Lieberman VR, Dahal A, et al. Efficacy and Safety of Tradipitant in Patients With Diabetic and Idiopathic Gastroparesis in a Randomized, Placebo-Controlled Trial. Gastroenterology. 2021;160(1):76–87.e4. doi: https://doi.org/10.1053/j.gastro.2020.07.029Midani D, Parkman HP. Granisetron Transdermal System for Treatment of Symptoms of Gastroparesis: A Prescription Registry Study. J Neurogastroenterol Motil. 2016;22(4):650–655. doi: https://doi.org/10.5056/jnm15203Midani D, Parkman HP. Granisetron Transdermal System for Treatment of Symptoms of Gastroparesis: A Prescription Registry Study. J Neurogastroenterol Motil. 2016;22(4):650–655. doi: https://doi.org/10.5056/jnm15203Camilleri M, Lembo A, McCallum R, et al. Overall safety of relamorelin in adults with diabetic gastroparesis: Analysis of phase 2a and 2b trial data. Aliment Pharmacol Ther. 2020;51(11):1139–1148. doi: https://doi.org/10.1111/apt.15711Camilleri M, Lembo A, McCallum R, et al. Overall safety of relamorelin in adults with diabetic gastroparesis: Analysis of phase 2a and 2b trial data. Aliment Pharmacol Ther. 2020;51(11):1139–1148. doi: https://doi.org/10.1111/apt.15711Broglio F, Arvat E, Benso A, et al. Ghrelin, a natural GH secretagogue produced by the stomach, induces hyperglycemia and reduces insulin secretion in humans. J Clin Endocrinol Metab. 2001;86(10):5083–5086. doi: https://doi.org/10.1210/jcem.86.10.8098Broglio F, Arvat E, Benso A, et al. Ghrelin, a natural GH secretagogue produced by the stomach, induces hyperglycemia and reduces insulin secretion in humans. J Clin Endocrinol Metab. 2001;86(10):5083–5086. doi: https://doi.org/10.1210/jcem.86.10.8098Zhang YX, Zhang YJ, Miao RY, et al. Effectiveness and safety of traditional Chinese medicine decoction for diabetic gastroparesis: A network meta-analysis. World J Diabetes. 2023;14(3):313–342. doi: https://doi.org/10.4239/wjd.v14.i3.313Zhang YX, Zhang YJ, Miao RY, et al. Effectiveness and safety of traditional Chinese medicine decoction for diabetic gastroparesis: A network meta-analysis. World J Diabetes. 2023;14(3):313–342. doi: https://doi.org/10.4239/wjd.v14.i3.313Li X, Yan Z, Xia J, et al. Traditional Chinese acupoint massage, acupuncture, and moxibustion for people with diabetic gastroparesis: A systematic review and metaanalysis. Medicine (Baltimore). 2022;101(48):e32058. doi: https://doi.org/10.1097/MD.0000000000032058Li X, Yan Z, Xia J, et al. Traditional Chinese acupoint massage, acupuncture, and moxibustion for people with diabetic gastroparesis: A systematic review and metaanalysis. Medicine (Baltimore). 2022;101(48):e32058. doi: https://doi.org/10.1097/MD.0000000000032058Hernández Mondragón OV, Contreras LFG, Velasco GB, et al. Gastric peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis (with video). Gastrointest Endosc. 2022;96(3):487–499. doi: https://doi.org/10.1016/j.gie.2022.03.025Hernández Mondragón OV, Contreras LFG, Velasco GB, et al. Gastric peroral endoscopic myotomy outcomes after 4 years of follow-up in a large cohort of patients with refractory gastroparesis (with video). Gastrointest Endosc. 2022;96(3):487–499. doi: https://doi.org/10.1016/j.gie.2022.03.025Friedenberg FK, Palit A, Parkman HP, et al. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103(2):416–423. doi: https://doi.org/10.1111/j.1572-0241.2007.01676.xFriedenberg FK, Palit A, Parkman HP, et al. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103(2):416–423. doi: https://doi.org/10.1111/j.1572-0241.2007.01676.xAswath GS, Foris LA, Ashwath AK, Patel K. Diabetic Gastroparesis (Archived). [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. https://www.ncbi.nlm.nih.gov/books/NBK430794/Aswath GS, Foris LA, Ashwath AK, Patel K. Diabetic Gastroparesis (Archived). [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. https://www.ncbi.nlm.nih.gov/books/NBK430794/

The authors declare that there are no conflicts of interest present.