A 35-Year-Old Man Comes to the Clinic Due to Progressive

A 35-year-old man comes to the clinic due to progressive nausea and vomiting over the past several months. He has a long time type I diabetes mellitus since childhood. He reports an abdominal discomfort daily especially after eating despite eating small meals. He also notices that his vomiting contains undigested food particles.   His medications include a basal-bolus insulin regimen and lisinopril.  He does not use tobacco, alcohol, or illicit drugs.  Vital signs are within normal limits.  The abdomen is soft and nontender with no organomegaly.  Bowel sounds are normal.  Testing of stool for occult blood is negative.  An upper gastrointestinal endoscopy is unremarkable.  Which of the following mechanisms is most likely responsible for this patient's current symptoms?

A) Decreased activity of vagus motor nucleus
B) Disruption of lower esophageal sphincter
C) Dysfunction of gastric enteric neurons
D) Excessive production of cholecystokinin
E) Hypertrophy of pyloric smooth muscles

Correct Answer:

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