A case of severe, refractory diabetic gastroparesis managed by prolonged use of aprepitant

Background. a 31-year-old woman with an 11-year history of poorly controlled type 1 diabetes mellitus was admitted with severe vomiting and ketoacidosis. the patient had been admitted to hospital on 14 occasions in the past 3 years for diabetic ketoacidosis precipitated by intractable vomiting, and she had been diagnosed with gastroparesis 2 years previously. Investigations. assessment of the patient's response to standard treatments for diabetic gastroparesis. these approaches involved tight glycemic control that included subcutaneous insulin infusion via a pump, correction of electrolyte disturbances, use of standard antiemetic and promotility agents, somatostatin-analog treatment, intrapyloric injection of botulinum toxin, and insertion of a percutaneous jejunal feeding tube. Diagnosis. severe diabetic gastroparesis refractory to standard treatments. Management. the neurokinin-receptor antagonist aprepitant was started and her vomiting stopped within 24 h. this treatment was successfully continued for 4 months until a gastric electrical stimulation device was inserted, which enabled aprepitant treatment to be withdrawn and the percutaneous jejunostomy feeding tube to be removed. this successful treatment led to a substantial improvement in the patient's quality of life and overall glycemic control.