Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Neurogastroenterol Motil. 2021 Jan;33(1):e13885. doi: 10.1111/nmo.13885. Epub 2020 Jun 22.
Although gastrointestinal (GI) symptoms are common in diabetes, they frequently do not correlate with measurable sensorimotor abnormalities. The wireless motility capsule (WMC) measures pressure, temperature, and pH as it traverses the GI tract wherefrom transit times and motility indices are derived. The aim was to investigate whether GI symptoms correlate with changes in (a) segmental transit times, (b) segmental motility index, (c) cardiac vagal tone, or (d) presence/absence of peripheral neuropathy in type 1 diabetes.
Gastrointestinal symptoms in 104 participants with type 1 diabetes were measured using Gastroparesis Cardinal Symptoms Index and Gastrointestinal Symptom Rating Scale. All underwent standardized WMC investigation measuring segmental transit time and motility. Cardiac vagal tone and presence of peripheral neuropathy were measured using electrocardiographic and nerve conduction velocity testing.
Colonic transit time was correlated with postprandial fullness (P = .01) and constipation (P = .03), while decreased colonic motility index was correlated with diarrhea (P = .01) and decreased bloating (P < .05). Symptoms were not correlated with gastric or small bowel transit time or motility index. In participants with low cardiac vagal tone, gastric motility index (P < .01) and colonic transit time (P < .05) were increased, but not in those with peripheral neuropathy. Abdominal pain was decreased with both peripheral neuropathy (P = .04) and decreased cardiac vagal tone (P = .02).
This study supports the rationale for whole gut investigation, using not only transit times but incorporating contractility indices as well. Furthermore, a decreased parasympathetic modulation and an increased hyposensate state appear to be present in type 1 diabetes.
尽管胃肠道（GI）症状在糖尿病中很常见，但它们通常与可测量的感觉运动异常无关。无线动力胶囊（WMC）在穿过胃肠道时测量压力、温度和 pH 值，从中得出传输时间和动力指数。目的是研究胃肠道症状是否与（a）节段性传输时间、（b）节段性动力指数、（c）心脏迷走神经张力或（d）1 型糖尿病中周围神经病变的存在/缺失的变化相关。
使用 Gastroparesis Cardinal 症状指数和胃肠道症状评分量表对 104 名 1 型糖尿病患者的胃肠道症状进行测量。所有患者均接受标准化 WMC 检查，测量节段性传输时间和动力。使用心电图和神经传导速度测试测量心脏迷走神经张力和周围神经病变的存在。
结肠传输时间与餐后饱胀（P=0.01）和便秘（P=0.03）相关，而结肠动力指数降低与腹泻（P=0.01）和腹胀减轻（P<0.05）相关。症状与胃或小肠传输时间或动力指数无关。在心脏迷走神经张力低的患者中，胃动力指数（P<0.01）和结肠传输时间（P<0.05）增加，但在周围神经病变患者中没有增加。腹痛在周围神经病变（P=0.04）和心脏迷走神经张力降低（P=0.02）患者中均减少。
本研究支持使用不仅传输时间，还包括收缩性指数对整个肠道进行研究的原理。此外，在 1 型糖尿病中似乎存在降低的副交感神经调节和增加的低敏状态。
