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

Nat Rev Endocrinol. 2009 May;5(5):285-8. doi: 10.1038/nrendo.2009.50.


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for 4 months until a gastric electrical stimulation device was inserted, which enabled aprepitant treatment to be withdrawn and the percutaneous jejunostomy feeding tube to be removed.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.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antiemetics / therapeutic use*
  • Aprepitant
  • Diabetes Mellitus, Type 1 / drug therapy
  • Female
  • Gastroparesis / diagnosis
  • Gastroparesis / drug therapy*
  • Gastroparesis / etiology
  • Humans
  • Morpholines / therapeutic use*
  • Treatment Outcome


  • Antiemetics
  • Morpholines
  • Aprepitant