Samsom M, Roelofs J M, Akkermans L M, van Berge Henegouwen G P, Smout A J
Department of Gastroenterology, University Hospital Utrecht, The Netherlands.
Dig Dis Sci. 1998 Mar;43(3):491-6. doi: 10.1023/a:1018894520557.
Disordered gastric emptying occurs in 30-50% of patients with diabetes mellitus. Although the rate of gastric emptying is dependent on the integration of motor activity in different regions of the stomach, there is limited information about the function of the proximal stomach in diabetes mellitus. In the present study the response of the proximal stomach to a liquid meal was examined in eight diabetic patients with autonomic neuropathy and gastrointestinal symptoms and in 10 healthy volunteers, using an intragastric bag connected to an electronic barostat. Postprandial relaxation of the proximal stomach was measured as an increase of intragastric bag volume at a constant pressure level of 1 mm Hg above the intraabdominal pressure. During the experiment the blood glucose levels were maintained within the euglycemic range. Before ingestion of the meal the intragastric bag volume was larger in the diabetic patients than in the healthy volunteers, 234.4 +/- 29.1 ml vs 155.3 +/- 15.3 ml (P = 0.06). The maximum volume was not different in diabetics compared to the healthy controls (386.3 +/- 45.2 ml versus 399.0 +/- 35.2 ml). However, the maximum volume increase was significantly less in diabetics (143.7 +/- 38.6 ml) compared to the controls (231.4 +/- 30.5 ml, P < 0.04). Bloating was inversely correlated with the volume changes, which suggests that impaired relaxation of the proximal stomach may play a role in the genesis of this sensation. In conclusion, this study shows a lower fasting fundal tone and a decrease in volume change of the gastric fundus after a nutrient drink in patients with autonomic neuropathy due to type I diabetes mellitus. These abnormalities may play a role in the abnormal distribution of food, disordered liquid gastric emptying, and in the genesis of the sensation of bloating observed in these patients.
30%至50%的糖尿病患者会出现胃排空紊乱。尽管胃排空速率取决于胃不同区域运动活动的整合，但关于糖尿病患者近端胃功能的信息有限。在本研究中，使用连接到电子恒压器的胃内袋，对8名患有自主神经病变和胃肠道症状的糖尿病患者以及10名健康志愿者近端胃对液体餐的反应进行了检查。近端胃的餐后松弛通过在高于腹内压1毫米汞柱的恒定压力水平下胃内袋体积的增加来测量。实验期间，血糖水平维持在正常血糖范围内。在摄入餐食前，糖尿病患者的胃内袋体积大于健康志愿者，分别为234.4±29.1毫升和155.3±15.3毫升（P = 0.06）。与健康对照组相比，糖尿病患者的最大体积没有差异（386.3±45.2毫升对399.0±35.2毫升）。然而，与对照组（231.4±30.5毫升）相比，糖尿病患者的最大体积增加明显较少（143.7±38.6毫升，P < 0.04）。腹胀与体积变化呈负相关，这表明近端胃松弛受损可能在这种感觉的产生中起作用。总之，本研究表明，I型糖尿病所致自主神经病变患者空腹时胃底张力较低，摄入营养饮料后胃底体积变化减小。这些异常可能在这些患者食物的异常分布、液体胃排空紊乱以及腹胀感的产生中起作用。
