A 58-year-old man with 15 years of type 2 diabetes reports early satiety, postprandial bloating, and erratic glycaemic control with postprandial hypoglycaemia. Gastric emptying scintigraphy shows marked retention of solids at four hours. Autonomic testing confirms cardiovascular autonomic neuropathy. Which agent acts most rapidly to improve gastric emptying in acute symptomatic episodes?
- A Metoclopramide taken before meals
- B Erythromycin as a motilin receptor agonist ✓
- C Domperidone long term
- D Octreotide subcutaneously daily
Correct answer: B. Erythromycin as a motilin receptor agonist
Explanation
Erythromycin agonises motilin receptors and produces the fastest prokinetic effect, making it useful for acute decompensation of gastroparesis, though tachyphylaxis limits chronic use. Metoclopramide is the standard outpatient agent but carries extrapyramidal and tardive dyskinesia risk with prolonged use; domperidone has cardiac QT concerns and limited availability. Octreotide inhibits gastric emptying at some doses and is used mainly for associated hypoglycaemia, not as a first-line prokinetic.
Reference: Williams Textbook of Endocrinology, 14th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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