Sangnes Dag A, Søfteland Eirik, Teigland Tonje, Dimcevski Georg
Department of Medicine, Haukeland University Hospital, Bergen, Norway.
The National Centre for Functional Gastrointestinal Disorders, Haukeland University Hospital, Bergen, Norway.
Clin Exp Gastroenterol. 2019 May 7;12:193-201. doi: 10.2147/CEG.S200875. eCollection 2019.
Determining gastric emptying is mandatory in the diagnosis of diabetic gastroparesis. Several methods of investigation exist, but none has proven reliable, inexpensive and accessible. In this study, we aimed to compare gastric emptying of radiopaque markers (ROM) and carbon-labelled gastric emptying breath tests for solids (GEBT). We also aimed to determine any association between gastric emptying and patient-reported symptoms, glycemic control and the patients' age, diabetes duration and occurrence of other late complications. Forty-five patients (30 women, 15 men) with diabetes mellitus types 1 or 2 (40, 5) and symptoms of gastroparesis were examined with ROM and GEBT. All were interviewed, filled out symptom questionnaires and had HbA1c levels measured. Forty percent of patients had delayed gastric emptying of ROM, while 55% had delayed gastric emptying of GEBT. Correlation between ROM and GEBT was not significant. Compared to GEBT, sensitivity for a positive ROM test was 0.52, while specificity was 0.74. In women, we found a higher specificity of 0.92, sensitivity 0.47. Difference in HbA1c between patients with positive and negative results was of borderline significance for both tests. GEBT (=0.41, =0.008) correlated with HbA1c. Patients with any late complications of diabetes had higher gastric retention of ROM (=0.028), while patients with polyneuropathy (=0.014) and diabetic wounds (=0.004) had slower emptying with GEBT. None of the methods identified significant associations between gastric emptying and symptom scores, age or diabetes duration. As a measure of gastric emptying, the ROM test has benefits of being affordable and available. Compared to GEBT, the method has low diagnostic reliability. Before continued use, we recommend additional studies validating the test in diabetes patients.
确定胃排空情况对于糖尿病胃轻瘫的诊断至关重要。现有多种检查方法，但尚无一种被证明是可靠、廉价且易于实施的。在本研究中，我们旨在比较不透X线标志物（ROM）的胃排空情况与碳标记固体胃排空呼气试验（GEBT）。我们还旨在确定胃排空与患者报告的症状、血糖控制以及患者年龄、糖尿病病程和其他晚期并发症的发生之间的任何关联。对45例患有1型或2型糖尿病（40例2型，5例1型）且有胃轻瘫症状的患者进行了ROM和GEBT检查。所有患者均接受了访谈，填写了症状问卷并检测了糖化血红蛋白（HbA1c）水平。40%的患者ROM胃排空延迟，而55%的患者GEBT胃排空延迟。ROM和GEBT之间的相关性不显著。与GEBT相比，ROM试验阳性的敏感性为0.52，特异性为0.74。在女性中，我们发现特异性较高，为0.92，敏感性为0.47。两种试验中，结果阳性和阴性的患者之间HbA1c的差异均具有临界显著性。GEBT（=0.41，=0.008）与HbA1c相关。患有糖尿病任何晚期并发症的患者ROM胃潴留较高（=0.028），而患有多发性神经病变（=0.014）和糖尿病伤口（=0.004）的患者GEBT排空较慢。两种方法均未发现胃排空与症状评分、年龄或糖尿病病程之间存在显著关联。作为胃排空的一种测量方法，ROM试验具有价格低廉且可获得的优点。与GEBT相比，该方法的诊断可靠性较低。在继续使用之前，我们建议进行更多研究以验证该试验在糖尿病患者中的有效性。
