Visceral hypersensitivity and impaired accommodation in refractory diabetic gastroparesis
Visceral hypersensitivity and impaired accommodation in refractory diabetic gastroparesis
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DOI：
10.1111/j.1365-2982.2008.01081.x
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发表时间：
2008-06-01
影响因子：
3.5
通讯作者：
Rao, S. S. C.
中科院分区：
文献类型：
--
作者：
Kumar, A.;Attaluri, A.;Rao, S. S. C.
糖尿病性胃轻瘫患者持续胃肠道（GI）症状的病理生理机制尚不清楚。我们的目的是评估伴有难治性症状的糖尿病胃轻瘫患者的胃感觉和对食物的适应。我们对18名糖尿病和胃轻瘫患者以及13名健康志愿者进行了间歇性、阶段性的胃球囊扩张，使用胃压力调节装置。我们评估了胃在禁食和流食后的生物力学、感觉和调节反应。在气球膨胀过程中，糖尿病患者的不适感觉阈值比对照组低（P < 0.02），无论是在禁食状态还是餐后状态。与对照组相比，糖尿病患者对膳食的调节反应明显受损（P=0.01），尽管空腹胃张力相似（P=0.08）。伴有难治性胃肠道症状的糖尿病胃轻瘫患者表现为胃感觉-运动功能障碍，包括调节功能受损、胃超敏反应或两者兼而有之。对这些生物力学和感官特性的客观评估可能提供有价值的机制见解，可以指导治疗。
The pathophysiology of persistent gastrointestinal (GI) symptoms in patients with diabetic gastroparesis is poorly understood. Our aim was to evaluate gastric sensation and accommodation to a meal in patients with diabetic gastroparesis and refractory symptoms. We performed intermittent, phasic balloon distensions of the stomach using a gastric barostat device in 18 patients with diabetes and gastroparesis unresponsive to prokinetic therapy and in 13 healthy volunteers. We assessed the biomechanical, sensory and accommodation responses of the stomach, during fasting and after liquid meal. During balloon distension, the sensory thresholds for discomfort were lower (P < 0.02) in patients with diabetes than those in controls, in both the fasting and the postprandial states. The accommodation response to a meal was significantly impaired (P=0.01) in patients with diabetes when compared to controls, although fasting gastric tone was similar (P=0.08). Patients with diabetic gastroparesis and refractory GI symptoms demonstrate sensori-motor dysfunction of the stomach, comprising either impaired accommodation, gastric hypersensitivity or both. An objective evaluation of these biomechanical and sensory properties may provide valuable mechanistic insights that could guide therapy.