Section on Gastroenterology, Wake Forest University, Winston-Salem, North Carolina.
Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan.
Neurogastroenterol Motil. 2020 Jan;32(1):e13720. doi: 10.1111/nmo.13720. Epub 2019 Oct 1.
Symptoms induced by caloric or non-caloric satiety test meals and gastric myoelectrical activity (GMA) have not been studied in patients with diabetic gastroparesis (DGP) before and after intense glucose management.
We determined the effects of continuous subcutaneous insulin infusion (CSII) with continuous glucose monitoring (CGM) on GI symptoms, volume consumed, and GMA induced by the caloric meal satiety test (CMST) and water load satiety test (WLST) in DGP.
Forty-five patients with DGP underwent CMST and WLST at baseline and 24 weeks after CSII with CGM. Subjects ingested the test meals until they were completely full. Visual analog scales were used to quantify pre- and postmeal symptoms, and GMA was recorded with cutaneous electrodes and analyzed visually and by computer. KEY RESULTS: At baseline and 24-week visits, nausea, bloating, abdominal discomfort, and fullness were immediately increased after CMST and WLST (Ps < 0.01). The meal volumes ingested were significantly less than normal controls at both visits in almost one-third of the subjects. After the CMST, the percentage 3 cycle per minute GMA increased and bradygastria decreased compared with WLST (Ps < 0.05). After treatment for 24 weeks meal volumes ingested, postmeal symptoms and GMA were no different than baseline. CONCLUSIONS AND INFERENCES: (a) Satiety test meals elicited symptoms of nausea, bloating, and abdominal discomfort; (b) CMST stimulated more symptoms and changes in GMA than WLST; and (c) CSII with CGM for 24 weeks did not improve symptoms, volumes ingested, or GMA elicited by the two satiety test meals in these patients with diabetic GP. Satiety tests in diabetic gastropresis are useful to study acute postprandial symptoms and GMA, but these measures were not improved by intensive insulin therapy.
在接受强化血糖管理前后，尚未研究过糖尿病胃轻瘫（DGP）患者的热量或非热量饱腹感测试餐和胃电活动（GMA）引起的症状。
我们旨在确定持续皮下胰岛素输注（CSII）联合连续血糖监测（CGM）对 DGP 患者的热量餐饱腹感测试（CMST）和水负荷饱腹感测试（WLST）引起的胃肠道症状、摄入的容量和 GMA 的影响。
45 例 DGP 患者在 CSII 联合 CGM 前和 24 周后进行 CMST 和 WLST。患者摄入测试餐，直到完全饱胀。使用视觉模拟量表量化餐前和餐后症状，并使用皮肤电极记录 GMA，然后进行视觉和计算机分析。
在基线和 24 周就诊时，CMST 和 WLST 后立即出现恶心、腹胀、腹部不适和饱胀感增加（均 P<0.01）。在两次就诊中，几乎有三分之一的患者摄入的餐量明显少于正常对照。与 WLST 相比，CMST 后 3 分钟/周期 GMA 的百分比增加，而缓波减少（均 P<0.05）。经过 24 周的治疗，摄入的餐量、餐后症状和 GMA 与基线时无差异。
（a）饱腹感测试餐引起恶心、腹胀和腹部不适症状；（b）CMST 比 WLST 引起更多的症状和 GMA 变化；（c）CSII 联合 CGM 治疗 24 周并未改善这些糖尿病 GP 患者两种饱腹感测试餐引起的症状、摄入的容量或 GMA。糖尿病胃轻瘫的饱腹感测试有助于研究急性餐后症状和 GMA，但这些措施并未通过强化胰岛素治疗得到改善。
