Diabetes mellitus and dyspepsia
Diabetes mellitus and dyspepsia
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糖尿病和消化不良
DOI：
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发表时间：
2011
期刊：
影响因子：
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通讯作者：
L. Duvnjak
中科院分区：
文献类型：
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作者：
L. Duvnjak
尽管糖尿病患者占主诉消化不良症状的人群的很大比例，但其在糖尿病中的发病机制仍然知之甚少。其发生与多种机制有关，包括自主神经病变、微血管病变、胰岛素和胰高血糖素的分泌改变、对胃肠道感染的易感性增加以及血糖控制不良。食管肠病变和胃轻瘫是糖尿病自主神经病变的胃肠道表现。胃轻瘫是指在没有机械性胃梗阻的情况下胃排空延迟，在5-12%的糖尿病患者中发生。它的特征是早期饱腹感、恶心、呕吐、腹胀和上腹部疼痛，尽管每个患者的表现不同，临床上可以保持沉默。血糖控制不佳本身可能会促进胃肠道症状。血糖浓度的变化会影响整个肠道的神经肌肉功能和对肠道产生的感觉的感知。从临床角度来看，与使用糖尿病药物相关的消化不良症状是一个非常重要的问题。二甲双胍、阿卡波糖和胰高血糖素样肽-1(GLP-1)类似物通常用于治疗2型糖尿病。同时存在的精神疾病、酒精摄入、使用胰岛素以外的药物以及口服降糖药，如抗胆碱类药物、抗抑郁药和钙通道阻滞剂也可能导致消化不良。诊断策略旨在排除其他疾病，特别是消化性溃疡和胃食道反流病。胃肠道梗阻应通过食管胃十二指肠镜检查或X线检查排除。核素扫描是测量胃排空的黄金标准。治疗策略侧重于血糖调节正常化和症状控制
Although diabetic patients represent a significant percentage of population complaining of dsypeptic symptoms its pathogenesis in diabetes remains poorly understood. Several mechanisms have been implicated in its development including autonomic neuropathy, microangiopathy, altered production of insulin and glucagon, increased susceptibility to gastrointestinal infections and poor glycemic control. Esophageal enteropathy and gastroparesis represent the gastrointestinal manifestations of diabetic autonomic neuropthy. Gastroparesis denotes delayed gastric emptying in the absence of mechanical obstruction of the stomach and occurs in 5-12% of diabetic patients. It is characterized with early satiety, nausea, vomiting, bloating and epigastric pain, although the presentation vary in individual patient and can be clinically silent. Poor glycemic control may in itself promote GI symptoms. Variations in blood glucose concentrations affect neuromuscular function throughout the gut and perception of sensations arising from the gut. Dyspeptic symptoms associated with the use of diabetes medications represent a very important issue from the clinical point of view. Metformin, acarbose and glucagone like peptide 1 (GLP-1) analogs are often prescribed for type 2 diabetes. Coexisting psychiatric disorders, alcohol intake, use of drugs apart from insulin and oral hypoglycemic agents such as anticholinergics, antidepressants and calcium-channel blockers may also contribute to dyspepsia. Diagnostic strategies are directed at excluding other disorders, in particular peptic ulcer and gastroesophageal reflux disease. Obstruction of the GI tract should be ruled out by esophagogastroduodenoscopy or a barium follow- through examination. Scintigraphy represents the gold standard for measuring gastric emptying. Treatment strategies focus on normalization of glucose regulation and control of symptoms