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Education And Debate

A Difficult Case: Severe gastroparesis diabeticorum in a young patient with insulin dependent diabetes

BMJ 1995; 310 doi: (Published 04 February 1995) Cite this as: BMJ 1995;310:308
  1. Clare J Dowling, senior house officera,
  2. Sudhesh Kumar, clinical lecturer in medicinea,
  3. Andrew J M Boulton, reader in medicinea
  1. a Department of Medicine, Manchester Royal Infirmary, Manchester M13 9WL

    “Gastroparesis diabeticorum is more often overlooked than diagnosed.”1 C J Dowling and colleagues present a difficult case of a young woman with this condition who had failed to respond to treatment. Four experts not concerned with the case give their views on how she might be treated.

    Case report

    Abnormalities in autonomic function affecting the gastrointestinal tract can often be shown by quantitative testing but only a few diabetic patients experience symptomatic autonomic neuropathy of the gut. Occasionally patients have severe disabling symptoms that may be difficult to manage. We describe a 28 year old woman found to have insulin dependent diabetes mellitus in 1979 and who has currently been in hospital for almost a year with severe and resistant gastroparesis. In the years before her admission to this hospital she had been investigated elsewhere for nausea and vomiting and had been labelled as suffering from anorexia nervosa. Subclinical nausea had been present for several years, and the vomitus she produced was seen to contain food that she had consumed a few days earlier. …

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