Jejunal feeding for Diabetic Gastroparesis (J4G study): The effects of a gastric meal with and without prior jejunal feeding on gastric function and symptoms in patients with type I diabetes with gastro-enteropathy, diabetic controls and healthy volunteer

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We propose that diabetic gastroenteropathy (or gastroparesis) represents a failure of a normal meal to switch the stomach from the fasted to the fed state. According to this idea, jejunal feeding restores the normal fed state and switches on the stomach. This study will test this hypothesis by measuring the stomachs response to feeding to a test meal with and without prior infusion of a liquid nutrient directly into the jejunum. This will be done in 12 patients with symptoms of gastroparesis, 12 diabetic patients without digestive problems (diabetic controls) and 12 healthy volunteers (normal controls). Participants will be admitted twice to the research unit for imaging studies. The level of blood glucose will be controlled by an insulin/glucose drip and, under sedation, a feeding tube will be placed into the jejunum by endoscopy. Then, in random order, and without the patient or researcher knowing which preparation is given, either liquid nutrient (food) or water will be infused into the jejunum. After that a standard test meal will be taken. Participants will report digestive symptoms throughout. Magnetic resonance imaging will provide detailed measurements of stomach function. Blood glucose and hormones that control stomach function and appetite will be measured as well. The primary aim of this project is to assess how effective jejunal feeding is in normalizing stomach function and reducing the symptoms of diabetic gastroparesis after a meal. Additionally, by measuring the hormones that switch gastric function between the fasted and the fed states in health and disease, we hope to identify targets for more effective medical treatment of this distressing condition.