Mearin F, Malagelada J R
Digestive System Research Unit, Hospital General Vall d'Hebron, Autonomous University of Barcelona, Spain.
Eur J Gastroenterol Hepatol. 1995 Aug;7(8):717-23.
About one-half of patients with insulin- or non-insulin-dependent diabetes have delayed gastric emptying (diabetic gastroparesis). Some of them complain of epigastric pain, nausea, vomiting or postprandial fullness (diabetic dyspepsia), although only a minority are severely symptomatic. Diabetic gastroparesis is clinically relevant not only by virtue of the symptoms induced but also because it may contribute to inadequate glycaemic control and impaired absorption of orally administered drugs. Recent data suggest that abnormal blood glucose control, not only autonomic neuropathy, contribute to the pathogenesis of disordered gastric motility. In most cases diabetic gastroparesis is diagnosed clinically in the absence of demonstrable lesions of the upper gastrointestinal tract. To evaluate gastric emptying, scintigraphy is the 'gold standard'. Gastrokinetic drugs are of help in the treatment of gastroparesis: erythromycin is the first choice in acute presentations and cisapride for chronic symptoms. New macrolides with prokinetic action and devoid of antibacterial properties are very promising and should add another pharmacologic approach to control dyspepsia and gastroparesis in diabetic patients in the future.
约一半的胰岛素依赖型或非胰岛素依赖型糖尿病患者存在胃排空延迟（糖尿病性胃轻瘫）。他们中的一些人主诉上腹部疼痛、恶心、呕吐或餐后饱胀感（糖尿病性消化不良），尽管只有少数人症状严重。糖尿病性胃轻瘫不仅因其引发的症状具有临床相关性，还因为它可能导致血糖控制不佳以及口服药物吸收受损。最近的数据表明，血糖控制异常不仅与自主神经病变有关，还在胃动力紊乱的发病机制中起作用。在大多数情况下，糖尿病性胃轻瘫是在没有可证实的上消化道病变的情况下临床诊断的。评估胃排空时，闪烁扫描是“金标准”。胃肠动力药物有助于治疗胃轻瘫：急性发作时首选红霉素，慢性症状则用西沙必利。具有促动力作用且无抗菌特性的新型大环内酯类药物前景广阔，未来应会为控制糖尿病患者的消化不良和胃轻瘫增添另一种药物治疗方法。
