J Clin Res Pediatr Endocrinol. Ahead of Print: JCRPE-40427 | DOI: 10.4274/jcrpe.galenos.2022.2022-5-20

Gastroparesis in Adolescent Patient with Type 1 Diabetes: Severe Presentation of a Rare Pediatric Complication

Fortunato Lombardo¹, Bruno Bombaci¹, Stefano Costa², Mariella Valenzise¹, Nino Giannitto¹, Davide Cardile³, Sergio Baldari³, Giuseppina Salzano¹, Stefano Passanisi^1
1Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
²Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
³Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy

Gastroparesis is a long-term complication of diabetes related to autonomic neuropathy. It is clinically characterized by delayed gastric emptying and upper gastrointestinal symptoms including early satiety, postprandial fullness, nausea, vomiting, and abdominal pain. Gastric emptying scintigraphy is the gold standard for the diagnosis as it reveals delayed gastric emptying. Therapeutic strategies include dietary modifications, improvement of glycemic control, and prokinetic drugs. Case descriptions of diabetic gastroparesis in pediatric age are very scarce. We hereby report the case of a 16-year-old adolescent with severe presentation of diabetic gastroparesis. She presented with recurrent episodes of nausea, vomiting and abdominal pain which led progressively to reduced oral intake and weight loss. Her past glycemic control had been quite brittle as demonstrated by several hospitalizations due to diabetic ketoacidosis and recurrent episodes of severe hypoglycemia. After the exclusion of infectious, mechanical, metabolic, and neurological causes of vomiting, a gastric emptying scintigraphy was performed, leading to the diagnosis of gastroparesis. Treatment with metoclopramide was started with progressive relief of symptoms. To improve glycemic control, insulin therapy with advanced hybrid closed loop system was successfully practiced. Pediatricians should seriously consider diabetic gastroparesis in children and adolescents with long-standing, poorly controlled diabetes.

Keywords: Advanced hybrid closed-loop, gastric emptying, metoclopramide, microvascular complications; scintigraphy

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