Undeland K A, Hausken T, Svebak S, Aanderud S, Berstad A
Medical Department A, Haukeland University Hospital, Bergen, Norway.
Dig Dis Sci. 1996 Jan;41(1):9-16. doi: 10.1007/BF02208577.
Autonomous neuropathy in patients with diabetes is associated with dysmotility and abdominal discomfort. The disturbances resemble to some extent those seen in patients with functional dyspepsia. To gain further insight into the disorders, we compared patients with long-standing diabetes, patients with functional dyspepsia, and healthy individuals with respect to abdominal symptoms, width of gastric antral area, and autonomic nerve function. We investigated 42 type I diabetic outpatients by structured interview for abdominal discomfort, ultrasonography of the gastric antrum, assessment of vagal and sympathetic nerve function by respiratory sinus arrhythmia and skin conductance, and measurement of blood sugar and HbA1c. Immediately after a standard meal of soup with meat, 21 (50%) of the 42 patients with diabetes complained of abdominal discomfort (pain, bloating, fullness), which was significantly less frequent (95% CI of difference 0.03-0.5) than previously seen in patients with functional dyspepsia (76%), and significantly more frequent (95% CI of difference 0.3-0.6) than that seen in healthy individuals (4%). Bloating was the most marked postprandial complaint. Mean fasting antral area was significantly wider in patients with diabetes (mean 4.9 cm2, SD 1.7) compared to healthy individuals (mean 3.5 cm2, SD 1.2), 95% CI of difference 0.6-2.2 cm2. Mean postprandial antral area was 14.8 cm2 (SD 4.6) in the patients with diabetes, which is insignificantly wider than in patients with functional dyspepsia (mean 13.0 cm2, SD 4.0) but significantly wider (95% CI of difference 1.9-6.5 cm2) than that seen in healthy individuals (mean 10.6 cm2, SD 3.8). The mean respiratory sinus arrhythmia was 0.7 beats/min (SD 0.7) in the patients with diabetes, which was insignificantly lower than that seen in patients with functional dyspepsia (2.1 beats/min, SD 4.5), and significantly lower (99% CI of difference 3.8-7.1 beats/min) compared to healthy individuals (6.2 beats/min, SD 3.8). It is concluded that patients with diabetes have a wider gastric antrum and more discomfort after a meal than healthy individuals. Compared to patients with functional dyspepsia, patients with diabetes have a wider postprandial antrum but fewer symptoms. The very low vagal tone seen in patients with diabetes may play an important role in the pathogenesis of their gastric motility disturbance and postprandial abdominal discomfort.
糖尿病患者的自主神经病变与胃肠动力障碍和腹部不适有关。这些紊乱在一定程度上类似于功能性消化不良患者所出现的情况。为了进一步了解这些疾病，我们比较了长期糖尿病患者、功能性消化不良患者和健康个体在腹部症状、胃窦面积宽度和自主神经功能方面的差异。我们通过结构化访谈调查了42例I型糖尿病门诊患者的腹部不适情况，进行胃窦超声检查，通过呼吸性窦性心律不齐和皮肤电导评估迷走神经和交感神经功能，并测量血糖和糖化血红蛋白。在食用标准的肉汤餐后，42例糖尿病患者中有21例（50%）主诉腹部不适（疼痛、腹胀、饱胀），这一比例显著低于功能性消化不良患者（76%）（差异的95%置信区间为0.03 - 0.5），但显著高于健康个体（4%）（差异的95%置信区间为0.3 - 0.6）。腹胀是餐后最明显的主诉。糖尿病患者空腹时胃窦平均面积（平均4.9 cm²，标准差1.7）显著宽于健康个体（平均3.5 cm²，标准差1.2），差异的95%置信区间为0.6 - 2.2 cm²。糖尿病患者餐后胃窦平均面积为14.8 cm²（标准差4.6），略宽于功能性消化不良患者（平均13.0 cm²，标准差4.0），但显著宽于健康个体（平均10.6 cm²，标准差3.8）（差异的95%置信区间为1.9 - 6.5 cm²）。糖尿病患者呼吸性窦性心律不齐的平均值为0.7次/分钟（标准差0.7），略低于功能性消化不良患者（2.1次/分钟，标准差4.5），且显著低于健康个体（6.2次/分钟，标准差3.8）（差异的99%置信区间为3.8 - 7.1次/分钟）。结论是，糖尿病患者餐后胃窦比健康个体更宽且不适更多。与功能性消化不良患者相比，糖尿病患者餐后胃窦更宽但症状更少。糖尿病患者极低的迷走神经张力可能在其胃肠动力障碍和餐后腹部不适的发病机制中起重要作用。
