Epidemiology, mechanisms, and management of diabetic gastroparesis.
Epidemiology, mechanisms, and management of diabetic gastroparesis.
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DOI：
10.1016/j.cgh.2010.09.022
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发表时间：
2011-01
影响因子：
12.6
通讯作者：
Farrugia, Gianrico
中科院分区：
文献类型：
--
作者：
Camilleri, Michael;Bharucha, Adil E.;Farrugia, Gianrico
最近的证据表明胃轻瘫对发病率和死亡率的重大影响，要求对这种情况进行优化管理。胃轻瘫影响营养状态，在糖尿病患者中，它还对血糖控制产生有害影响，并对器官产生继发性影响，导致死亡率增加。一线治疗包括恢复营养和药物（促动力药和止吐药）。回顾胃轻瘫的流行病学、病理生理学、影响、自然史、时间趋势和治疗，特别关注糖尿病胃轻瘫。目前的治疗方案，包括胃复安的利弊进行了讨论。二线方法包括手术、排气胃造口术或空肠造口术和胃电刺激;这些治疗大多基于开放标签治疗试验。在未来，针对潜在缺陷的药物和新的促动力剂，如新的5-HT 4激动剂（似乎没有心脏或血管效应），生长激素释放肽激动剂，新的胃起搏方法和干细胞疗法可能会带来更有效的治疗方法，以改善胃轻瘫患者的管理。
Recent evidence of the significant impact of gastroparesis on morbidity and mortality mandates optimized management of this condition. Gastroparesis affects nutritional state and, in diabetics, it also has deleterious effects on glycemic control and secondary effects on organs that lead to increased mortality. First-line treatment includes restoration of nutrition and medications (prokinetic and antiemetic). To review the epidemiology, pathophysiology, impact, natural history, time trends and treatment of gastroparesis with particular focus on diabetic gastroparesis. The pros and cons of current treatment options including metoclopramide are discussed. Second-line approaches include surgery, venting gastrostomy or jejunostomy, and gastric electrical stimulation; most of these treatments are based on open-label treatment trials. In the future, drugs that target the underlying defects and new prokinetics such as newer 5-HT4 agonists (which appear to be devoid of cardiac or vascular effects), ghrelin agonists, new approaches to pacing the stomach, and stem cell therapies may bring more effective treatments to ameliorate the management of patients with gastroparesis.