Malabsorption, Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Type 2 Diabetic Patients: A Connection
Malabsorption, Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Type 2 Diabetic Patients: A Connection
复制标题
DOI：
10.1007/s12291-016-0569-6
复制
发表时间：
2017-03-01
影响因子：
2.1
通讯作者：
Sharma, Gaurav
中科院分区：
文献类型：
--
作者：
Rana, S. V.;Malik, Aastha;Sharma, Gaurav
2型糖尿病由以高血糖症为特征的功能障碍组成，其由对胰岛素作用的抗性和胰岛素分泌不足的组合引起。大多数糖尿病患者报告显著的胃肠道症状。糖尿病可影响从口腔到大肠和肛门直肠的整个胃肠道。蛋白质、碳水化合物、脂肪和大多数液体在小肠中被吸收。当由于细菌过度生长或肠道动力改变而导致营养素的适当吸收不发生时，可能会发生吸收不良。本研究计划测量2型糖尿病患者的各种吸收不良参数。在PGI，昌迪加尔的内分泌诊所入组了175名患者和175名年龄和性别匹配的健康对照。采用无创性乳糖氢呼气试验测定乳糖不耐症。使用标准方法估计尿d-木糖和粪便脂肪。分别采用无创乳果糖试验和葡萄糖呼气试验测定口盲部通过时间和小肠细菌过度生长。在入组的175例糖尿病患者中，87例为男性，而在175例健康受试者中，88例为男性。在14.8%的2型糖尿病患者和2.8%的对照组中观察到SIBO。与对照组相比，2型糖尿病患者的OCTT显著增加（p < 0.002）。观察到患有SIBO的患者的OCTT比没有SIBO的患者延迟更多（p < 0.003）。60%的糖尿病患者和39.4%的对照组存在乳糖不耐受.糖尿病患者尿d-木糖水平也较低，但糖尿病患者和对照组之间的72小时粪便脂肪排泄量无显着差异。SIBO阳性2型糖尿病患者尿D-木糖和乳糖不耐受较SIBO阴性2型糖尿病患者严重。从这项研究中，我们可以得出结论，延迟OCTT可能会导致SIBO，这可能会引发2型糖尿病患者吸收不良的过程。
Type 2 diabetes mellitus consists of dysfunctions characterized by hyperglycemia and resulting from combination of resistance to insulin action and inadequate insulin secretion. Most of diabetic patients report significant gastrointestinal symptoms. Entire GI tract can be affected by diabetes from oral cavity to large bowel and anorectal region. Proteins, carbohydrates, fats, and most fluids are absorbed in small intestine. Malabsorption may occurs when proper absorption of nutrients does not take place due to bacterial overgrowth or altered gut motility. The present study was planned to measure various malabsorption parameters in type 2 diabetic patients. 175 patients and 175 age and sex matched healthy controls attending Endocrinology Clinic in PGI, Chandigarh were enrolled. Lactose intolerance was measured by using non-invasive lactose hydrogen breath test. Urinary d-xylose and fecal fat were estimated using standard methods. Orocecal transit time and small intestinal bacterial overgrowth were measured using non-invasive lactulose and glucose breath test respectively. Out of 175 diabetic patients enrolled, 87 were males while among 175 healthy subjects 88 were males. SIBO was observed in 14.8 % type 2 diabetic patients and in 2.8 % of controls. There was statistically significant increase (p < 0.002) in OCTT in type 2 diabetic patients compared with controls. OCTT was observed to be more delayed (p < 0.003) in patients who were found to have SIBO than in patients without SIBO. Lactose intolerance was observed in 60 % diabetic patients and 39.4 % in controls. Urinary d-xylose levels were also lower in case of diabetic patients but no significant difference was found in 72 h fecal fat excretion among diabetic patients and controls. Urinary d-xylose and lactose intolerance in SIBO positive type 2 diabetic patients was more severe as compared to SIBO negative diabetic patients. From this study we can conclude that delayed OCTT may have led to SIBO which may have instigated the process of malabsorption among type 2 diabetic patients.