The aims of our study were to: determine the effect of
metoclopramide parenterally and orally on delayed gastric emptying of a
radionuclide test meal in symptomatic patients with diabetic
gastroparesis not explained by ulceration or other mechanical problems; and evaluate in a double-blind crossover fashion the efficacy of
metoclopramide in relieving the symptoms of diabetic
gastroparesis. Thirteen patients with subjective evidence of
gastric stasis had delayed gastric emptying of an
isotope-labeled semisolid meal which was significantly accelerated (p less than 0.05) after 10 mg of
metoclopramide parenterally. Patients then received
metoclopramide 10 mg and placebo before meals and prior to retiring for 3 weeks in a randomized double-blind crossover design. During
metoclopramide therapy nausea,
vomiting,
anorexia, fullness, and bloating were significantly (p less than 0.05) ameliorated compared to placebo with an overall mean symptom reduction of 52.6%. Gastric emptying studies after completion of the trial is seven patients, subjectively improved and receiving open-labeled
metoclopramide, showed significantly less gastric retention. Individual improvements in gastric emptying after parenteral or oral
metoclopramide, however, could not be correlated with symptom change during the treatment trial. We conclude that
metoclopramide is an important therapeutic adjunct in the management of diabetic
gastroparesis and its
therapeutic effects are mediated through its prokinetic properties as well as centrally mediated
antiemetic actions.