Folwaczny C, Hundegger K, Volger C, Sorodoc J, Kühn M, Tatsch K, Landgraf R, Karbach U
Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians Universität München, Germany.
Z Gastroenterol. 1995 Sep;33(9):517-26.
The existence of gastrointestinal transit disorders in other intestinal segments beside the stomach in Type-1 diabetes mellitus (DM) and occurrence in Type-2 DM and in uremia has yet been confirmed only in few studies. Eleven healthy volunteers, 34 patients with Type-1, 32 patients with Type-2 DM in different stages of their disease and 34 non-diabetic patients with endstage-renal disease were investigated by use of the metal detector test. Patients were divided in three subgroups, depending on the duration of their disease: < 1 year: "Short", 1 - 10 years: "Middle", > 10 years: "Long". For comparison with the metal detector test scintigraphic studies of esophageal and gastric transit were performed in 17 patients and small intestinal transit was studied by use of the H2-lactulose breath test in 20 patients with long-standing DM Type-1. In Type-1 DM there is an increase of gastric (135 +/- 18, p < 0.01; 218 +/- 26, p < 0.0001 vs. 73 +/- 7 min.) and large intestinal transit times (79 +/- 18, P < 0.02; 76 +/- 11, p < 0.04 vs. 40 +/- 5 h) in patients with middle or long standing DM. In Type-2 DM similar transit disturbances occur (gastric emptying, long group: 120 +/- 15 min., p < 0.02; colonic transit, long group: 80 +/- 13 h, p < 0.01). In uremia transit disturbances were only found in patients with chronic ambulatory peritoneal dialysis (colonic transit: 71 +/- 9 h, p < 0.05). In 65% gastric scintigraphy and in 55% of cases the H2-lactulose breath test showed a prolongation of gastric emptying or a prolonged mouth-to-cecum transit. Transit disorders can occur in every stage of DM with preferential involvement of the stomach and the colon. These findings are of clinical relevance, since transit disturbances can result in instable metabolic condition.
1型糖尿病（DM）患者除胃部外其他肠段存在胃肠转运障碍，以及2型糖尿病和尿毒症患者出现胃肠转运障碍，目前仅有少数研究予以证实。采用金属探测器测试对11名健康志愿者、34名1型糖尿病患者、32名处于疾病不同阶段的2型糖尿病患者以及34名终末期肾病非糖尿病患者进行了调查。根据病程将患者分为三个亚组：<1年为“短病程组”，1 - 10年为“中病程组”，>10年为“长病程组”。为与金属探测器测试进行比较，对17例患者进行了食管和胃转运的闪烁扫描研究，对20例病程较长的1型糖尿病患者采用H2 - 乳果糖呼气试验研究小肠转运。在1型糖尿病中，中病程或长病程患者的胃转运时间增加（分别为135±18分钟，p<0.01；218±26分钟，p<0.0001，而对照组为73±7分钟），大肠转运时间增加（分别为79±18小时，P<0.02；76±11小时，p<0.04，而对照组为40±5小时）。在2型糖尿病中也出现类似的转运障碍（胃排空，长病程组：120±15分钟，p<0.02；结肠转运，长病程组：80±13小时，p<0.01）。在尿毒症患者中，仅在慢性非卧床腹膜透析患者中发现转运障碍（结肠转运：71±9小时，p<0.05）。65%的胃闪烁扫描和55%的病例中，H2 - 乳果糖呼气试验显示胃排空延长或口至盲肠转运时间延长。糖尿病各阶段均可出现转运障碍，以胃和结肠受累为主。这些发现具有临床意义，因为转运障碍可导致代谢状态不稳定。
