A 36-year-old man with 15 years of type 1 diabetes reports early satiety, postprandial nausea and bloating, with erratic glucose excursions unrelated to meal carbohydrate counting. Endoscopy shows retained food after an overnight fast. The most appropriate prokinetic agent for long-term symptomatic control is:
- A Metoclopramide ✓
- B Erythromycin
- C Octreotide
- D Loperamide
Correct answer: A. Metoclopramide
Explanation
Diabetic gastroparesis reflects autonomic neuropathy of the vagus. Metoclopramide, a dopamine antagonist with prokinetic action, is the standard long-term pharmacological agent, though its use should be time-limited where possible because of tardive dyskinesia risk. Erythromycin acts as a motilin agonist but tachyphylaxis limits it to short courses, so option B is unsuitable for chronic therapy. Octreotide inhibits gastric emptying and is used for dumping syndrome. Loperamide treats diarrhoea, not gastroparesis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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