Abrahamsson H
Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
J Intern Med. 1995 Apr;237(4):403-9. doi: 10.1111/j.1365-2796.1995.tb01194.x.
Disturbed gastric and small intestinal motility is an often overlooked clinical problem. Delayed gastric emptying of liquid and/or solid food in patients with type 1 and type 2 diabetes (gastroparesis diabeticorum) occurs in approximately 50% of the patients. Also, the interdigestive gastric and small intestinal motility is often affected. There is only a weak correlation between symptoms and objectively measurable motor disturbances. Patients with severe upper gastrointestinal symptoms usually have disturbed motility, but most patients with impaired motility are asymptomatic. Recent studies have clearly shown that, in addition to autonomic neuropathy, acute metabolic derangements are likely to contribute to disturbed motility. Elevated glucose levels impair gastric and small intestinal motility during fasting and after food intake. Hyperinsulinemia per se has effects similar to hyperglycaemia on the stomach and small bowel, and may be a mediator of the effects of hyperglycaemia in healthy subjects. The impact of insulin on motility in diabetic patients is still unclear. Treatment of the gastric motility disorder should include a stabilization of gastric emptying. Different therapeutic modes may be useful, e.g. application of prokinetic drugs and optimizing the metabolic situation.
胃和小肠动力紊乱是一个常被忽视的临床问题。1型和2型糖尿病患者中，液体和/或固体食物的胃排空延迟（糖尿病性胃轻瘫）在约50%的患者中出现。此外，消化间期的胃和小肠动力也常受影响。症状与客观可测量的运动障碍之间仅有微弱关联。有严重上消化道症状的患者通常存在动力紊乱，但大多数动力受损的患者并无症状。最近的研究清楚表明，除自主神经病变外，急性代谢紊乱可能也导致动力紊乱。空腹和进食后，血糖水平升高会损害胃和小肠动力。高胰岛素血症本身对胃和小肠的影响与高血糖类似，可能是健康受试者中高血糖影响的介导因素。胰岛素对糖尿病患者动力的影响仍不明确。胃动力障碍的治疗应包括稳定胃排空。不同的治疗方式可能有用，如应用促动力药物和优化代谢状况。
