Gastropathy

This chapter consists of two sections, the original version in the first edition of “Pancreas Transplantation”, and now an update, almost 20 years later. The original version highlighted the pathophysiologic foundation and diagnosis of diabetic gastropathy as well as the favourable impact of pancreas transplantation on diabetic gastropathy. Very little new data on these topics have been provided in the literature since. This update focuses primarily on therapeutic options that have been proposed over the past 20 years for the treatment of ongoing post-transplant gastroparesis. Diabetic gastroparesis is a chronic disorder resulting in decreased quality of life. The symptoms of gastroparesis usually improve considerably after a successful solitary pancreas or simultaneous pancreas and kidney transplant. This includes improvements in gastric emptying and normalization of electrogastrogram with shifts in gastric cycle frequency from bradygastria to tachygastria post-transplant. Although symptoms diminish following transplant, ongoing or refractory gastroparesis is difficult to treat and pancreas recipients may not report relief of symptoms with medical therapy alone. Several operative approaches have been described including gastric electrical stimulation with or without pyloric surgery and Roux-en-Y gastrojejunostomy with or without gastric resection. Data concerning surgical therapies of severe or refractory gastroparesis after pancreas transplantation are limited and more studies are needed to help guide therapy selection.