Gastrointestinal hormonal dysfunction in gastroparesis and functional dyspepsia
Article first published online: 5 OCT 2010
© 2010 Blackwell Publishing Ltd
Neurogastroenterology & Motility
Volume 22, Issue 12, pages 1270–1278, December 2010
How to Cite
Khoo, J., Rayner, C. K., Feinle-Bisset, C., Jones, K. L. and Horowitz, M. (2010), Gastrointestinal hormonal dysfunction in gastroparesis and functional dyspepsia. Neurogastroenterology & Motility, 22: 1270–1278. doi: 10.1111/j.1365-2982.2010.01609.x
- Issue published online: 4 NOV 2010
- Article first published online: 5 OCT 2010
- Received: 20 July 2010 Accepted for publication: 7 September 2010
- glucagon-like peptide-1;
- peptide YY;
Background Numerous hormones secreted by the gut, during both the fasted state and in response to a meal, influence gastrointestinal motor and/or sensory function, and appear to contribute to the pathogenesis of delayed gastric emptying associated with gastroparesis, functional dyspepsia (FD) and feed intolerance in critical illness. Gut hormones are, accordingly, potential targets for the management of these patients.
Purpose This article will discuss the hypersensitivity to enteral fat and endogenous (nutrient-stimulated) and exogenous cholecystokinin (CCK) in patients with FD, and the elevation in both fasting and postprandial CCK levels evident in this group. It will review the use of pharmacological agonists of motilin and ghrelin, which accelerate gastric emptying, in the management of gastroparesis and FD. The frequent finding of markedly delayed gastric emptying in the critically ill will be examined; this is associated with elevated plasma CCK and peptide YY in both the fasted and postprandial states, which may account for the increase in small intestinal nutrient inhibitory feedback on gastric motility in this group. The concepts that the rate of gastric emptying is a major determinant of postprandial glycemic excursions in diabetes, and that modulation of gastric emptying may improve glycemic control, will be addressed; in type 1 and insulin-treated type 2 diabetic patients, co-ordination of insulin administration with nutrient delivery and absorption should be optimized, while type 2 patients who are not on insulin are likely to respond to dietary and/or pharmacological interventions which slow gastric emptying.