GASTROKINETIC EFFECTS OF LEVOSULPIRIDE IN DYSPEPTIC PATIENTS WITH DIABETIC GASTROPARESIS

Objective: Antidopaminergic drugs may be useful in diabetic gastropare sis because the inhibitory activity of hyperglycemia on gastric motili ty seems to be related to dopamine receptor stimulation. For this reas on, we evaluated the effect of levosulpiride on gastric emptying, dysp eptic symptoms, and metabolic parameters of insulin-treated diabetic p atients. Methods: Under double-blind conditions, 40 longstanding, insu lin-treated dyspeptic patients with autonomic neuropathy and delayed g astric emptying were randomly submitted, with an interval of 15 days, to 4 wk of administration of both levosulpiride 25 mg t.i.d. and place bo according to a cross-over design. At the beginning of the study and after levosulpiride or placebo treatment, the gastric emptying time o f a standard meal was measured ultrasonically; gastrointestinal sympto m scores and glycaemic control were also evaluated. Results: Levosulpi ride reduced significantly (p < 0.001) the gastric emptying time from 416 +/- 58 to 322 +/- 63 min, whereas placebo did not change it consis tently (396 +/- 58 vs 372 +/- 72 min). Symptoms improved significantly (p < 0.001) with levosulpiride compared with placebo. However, there was no significant correlation between the acceleration of gastric emp tying and the symptomatological improvement. The reduction of mean pla sma glycosylated hemoglobin concentrations after levosulpiride (7.3 +/ - 1.9 vs 5.8 +/- 1.3) was nob significantly different (p = not signifi cant) compared with placebo (6.8 +/- .7 vs 6.1 +/- 1.4). Conclusions: Our study first demonstrates that levosulpiride has an accelerating ef fect on the emptying of solids from the stomach of patients with diabe tic gastroparesis. The drug is also effective in relieving upper gastr ointestinal symptoms in patients whose gastric emptying times remain v ery slow. Our findings suggest, but do not prove, that better blood gl ucose control could be achieved with reduction of gastric emptying tim e; further trials are needed in this field.