Temple University, School of Medicine, Philadelphia, Pennsylvania 19140, USA.
Clin Gastroenterol Hepatol. 2011 Dec;9(12):1056-64; quiz e133-4. doi: 10.1016/j.cgh.2011.08.013. Epub 2011 Aug 24.
BACKGROUND & AIMS: Gastroparesis can be diabetic or idiopathic, yet little is known about differences in their presentation. We compared clinical characteristics, symptoms, and gastric emptying in patients with type 1 or type 2 diabetic (DG) or idiopathic (IG) gastroparesis.
We analyzed data from 416 patients with gastroparesis who were enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Registry; 254 had IG (most were female and white), and 137 had DG (78 had type 1 and 59 had type 2). Registry data included detailed histories, physical examinations, results from gastric emptying scintigraphy, and responses to validated symptom questionnaires.
Patients with type 2 diabetes mellitus (DM) were an average of 13 years older at the onset of symptoms of gastroparesis and heavier than patients with IG. Patients with type 1 DM had more hospitalizations in the past year than patients with IG. Symptoms that prompted evaluation more often included vomiting for DG and abdominal pain for IG. Patients with DG had more severe retching and vomiting than those with IG, whereas patients with IG had more severe early satiety and postprandial fullness subscores. Compared with IG, gastric retention was greater in patients with type 1 DM. More than 50% of patients with type 1 DM had severe retention (>35% at 4 hours); they took prokinetic agents more frequently and were more likely to receive gastric electric stimulation.
There are similarities and differences in clinical characteristics of DG and IG. Gastroparesis is a heterogeneous disorder; its etiology affects symptoms and severity. Long-term studies are needed to determine whether the differences in symptoms and gastric emptying affect progression and treatment responses.
胃轻瘫可由糖尿病或特发性因素引起，但对于两者在临床表现上的差异，我们知之甚少。本研究旨在比较 1 型或 2 型糖尿病（DG）或特发性（IG）胃轻瘫患者的临床特征、症状和胃排空情况。
我们分析了美国国立糖尿病、消化和肾脏疾病研究所胃轻瘫注册研究中 416 例胃轻瘫患者的数据；其中 254 例为 IG（多数为女性和白人），137 例为 DG（78 例为 1 型，59 例为 2 型）。注册研究数据包括详细的病史、体格检查、胃排空闪烁扫描结果以及对经过验证的症状问卷的应答。
2 型糖尿病患者在出现胃轻瘫症状时的平均年龄比 IG 患者大 13 岁，且更重。1 型糖尿病患者在过去 1 年中的住院次数多于 IG 患者。促使患者进行评估的症状在 DG 中更常为呕吐，而在 IG 中更常为腹痛。DG 患者的恶心和呕吐比 IG 患者更严重，而 IG 患者的早饱和餐后饱胀症状评分更严重。与 IG 相比，1 型 DM 患者的胃潴留更严重。超过 50%的 1 型 DM 患者存在严重的胃潴留（4 小时时>35%）；他们更常使用促动力药物，且更有可能接受胃电刺激。
DG 和 IG 的临床特征既有相似之处，也有不同之处。胃轻瘫是一种异质性疾病；其病因会影响症状和严重程度。需要进行长期研究，以确定症状和胃排空的差异是否会影响疾病进展和治疗反应。
