Department of Internal Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, 4800 Alberta Ave, El Paso, TX 79905, USA.
Dig Dis Sci. 2011 Apr;56(4):1147-53. doi: 10.1007/s10620-010-1485-x. Epub 2010 Nov 28.
The objectives of this study were as follows: (1) Whether gastric emptying is different between gastroparesis (GP) patients responding or not responding to standard medical therapy; (2) Identifying if mild, moderate, and severe degrees of gastroparesis based on the scintigraphic gastric emptying test (GET) can predict treatment responses for GP of diabetic (DM) and idiopathic (ID) origin.
A total of 165 patients (119 F) diagnosed with GP [126 (76%) DM, 39 (24%) ID etiology] failed medical treatment and required the gastric electrical stimulation (GES) device (GES group). In addition, 112 patients (89 F) [37 (33%) DM, 75 (67%) ID] with GP who symptomatically responded to medical therapies are the comparison group (MED GP). All patients underwent a standardized scintigraphic GET consisting of low-fat (2%) isotope labeled egg beaters meal of 250 kcal. We also analyzed the GET data to find cut-off points for different degrees of GP and identified mild (11-20% retention), moderate (21-35%), and severe gastroparesis (>35%) based on percent retention of isotope at 4 h.
Overall gastric retention at 4 h was significantly greater in the GES group (45±1.9%) than MED GP (30±2%) (p<0.001). The distribution severity of the GET was different in GES-treated patients than MED treated (p<0.001). In the diabetics, 57% of GES patients retained >35% after 4 h (severe) similar to 43% in the DM MED group. However, 50% of the ID GES patients had retention>35% at 4 h significantly more than only 17% of ID MED GP. Significantly more ID patients who responded to medical therapy had mild gastroparesis and significantly more requiring GES had severe GET (p<0.05).
(1) GET in patients whose GP symptoms were refractory to standard medical therapy and required GES was significantly slower than in GP patients whose symptoms responded to medical therapy. (2) Stratifying GET into mild, moderate, and severe degrees of gastric retention does not predict whether a medical or surgical approach will be better to control the symptoms of diabetic GP but does correlate with treatment for the idiopathic GP subgroup.
本研究的目的如下：（1）胃排空在对标准医学治疗有反应和无反应的胃轻瘫（GP）患者之间是否存在差异；（2）基于闪烁胃排空试验（GET）确定轻度、中度和重度 GP 是否可以预测糖尿病（DM）和特发性（ID）起源的 GP 的治疗反应。
共有 165 名患有 GP 的患者（119 名女性）[126 名（76%）DM，39 名（24%）ID 病因]接受了标准医学治疗但未成功，需要胃电刺激（GES）装置（GES 组）。此外，112 名患有 GP 的患者（89 名女性）[37 名（33%）DM，75 名（67%）ID]对医学治疗有症状反应，是对照组（MED GP）。所有患者均接受低脂肪（2%）同位素标记蛋羹餐 250 卡路里的标准化闪烁 GET。我们还分析了 GET 数据，以找到不同程度 GP 的截止点，并根据 4 小时时同位素的保留百分比确定轻度（11-20%保留）、中度（21-35%）和重度胃轻瘫（>35%）。
总体而言，GES 组（45±1.9%）的 4 小时胃潴留明显大于 MED GP（30±2%）（p<0.001）。GES 治疗患者的 GET 严重程度分布与 MED 治疗不同（p<0.001）。在糖尿病患者中，57%的 GES 患者在 4 小时后保留>35%（重度），与 DM MED 组的 43%相似。然而，50%的 ID GES 患者在 4 小时时保留>35%，明显高于 ID MED GP 组的 17%。需要 GES 的 ID 患者中，对医学治疗有反应的患者明显更多患有轻度胃轻瘫，而需要 GES 的患者则明显更多患有重度 GET（p<0.05）。
（1）对标准医学治疗有反应且需要 GES 的 GP 患者的 GET 明显慢于对医学治疗有反应的 GP 患者。（2）将 GET 分为轻度、中度和重度胃潴留程度并不能预测医学或手术方法是否更能控制糖尿病 GP 的症状，但与特发性 GP 亚组的治疗相关。
