Troncon L E, Rosa-e-Silva L, Oliveira R B, Iazigi N, Gallo L, Foss M C
Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (U.S.P.), Brazil.
Dig Dis Sci. 1998 Jul;43(7):1421-9. doi: 10.1023/a:1018834025351.
Disordered gastric motility and emptying are well known complications of diabetes mellitus (DM), but the pattern of intragastric distribution of food has not been extensively studied in diabetics. We examined the partition of a liquid nutrient meal between the proximal and distal stomach and the relationships between intragastric distribution of food and gastric emptying (GE) and the symptoms in DM patients with and without autonomic neuropathy (AN). Fourteen healthy volunteers and 20 DM patients (13 with AN; 9 with dyspepsia symptoms) ingested a liquid nutrient meal (250 ml; 437 kcal) labeled with [99mTc]phytate. Anterior and posterior serial images of the stomach were taken for 90 min with a gamma camera. Regions of interest for the proximal and the distal halves of the stomach and for the total gastric area were defined. Counts from each region along time allowed estimation of GE and the proportion of activity retained in the proximal stomach after meal ingestion (initial) and throughout GE (mean). GE half-times in controls (median; range: 66 min; 29-90 min) were not significantly different from diabetics (76 min; 5->150 min, P > 0.10), but abnormal GE was found in 11 DM patients (seven delayed and four rapid). In DM patients, initial retention in the proximal stomach (42%; 16-79%) was significantly lower (P < 0.02) than in controls (55%; 44-71%). Mean retention in the proximal stomach throughout emptying also was significantly lower (P < 0.05) in DM patients (43%; 18-58%) than in controls (51%; 32-69%). There were no differences between subgroups of patients with normal, delayed, or rapid gastric emptying regarding mean meal retention in the proximal stomach. Patients with evidence of AN or with dyspepsia symptoms had significantly decreased retention of food in the proximal stomach throughout gastric emptying. We concluded that patients with diabetes mellitus have abnormally decreased retention of gastric contents in the proximal stomach after a liquid meal, which seems to be related to the occurrence of autonomic neuropathy and dyspepsia symptoms, but not to disordered gastric emptying.
胃动力和排空紊乱是糖尿病（DM）的常见并发症，但糖尿病患者胃内食物的分布模式尚未得到广泛研究。我们研究了液体营养餐后近端胃和远端胃之间的食物分配情况，以及有无自主神经病变（AN）的糖尿病患者胃内食物分布与胃排空（GE）及症状之间的关系。14名健康志愿者和20名糖尿病患者（13名有自主神经病变；9名有消化不良症状）摄入了用[99mTc]植酸盐标记的液体营养餐（250毫升；437千卡）。用γ相机对胃部进行90分钟的前后连续图像采集。定义了胃近端和远端半部以及整个胃区域的感兴趣区。各区域随时间的计数可用于估计胃排空情况以及餐后摄入时（初始）和整个胃排空过程中近端胃内保留的活性比例（平均值）。对照组的胃排空半衰期（中位数；范围：66分钟；29 - 90分钟）与糖尿病患者（76分钟；5 - >150分钟，P>0.10）无显著差异，但11名糖尿病患者存在胃排空异常（7名延迟排空，4名快速排空）。在糖尿病患者中，近端胃的初始保留率（42%；16 - 79%）显著低于对照组（55%；44 - 71%）（P<0.02）。糖尿病患者在整个排空过程中近端胃的平均保留率（43%；18 - 58%）也显著低于对照组（51%；32 - 69%）（P<0.05）。胃排空正常、延迟或快速的患者亚组在近端胃的平均餐食保留方面无差异。有自主神经病变证据或有消化不良症状的患者在整个胃排空过程中近端胃内食物的保留率显著降低。我们得出结论，糖尿病患者在摄入液体餐后近端胃内胃内容物的保留异常减少，这似乎与自主神经病变和消化不良症状的发生有关，而与胃排空紊乱无关。
