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

我们认为，糖尿病胃肠病(或胃轻瘫)代表着正常饮食未能将胃从禁食状态切换到进食状态。根据这一想法，空肠喂养恢复了正常的喂养状态，并开启了胃部。这项研究将通过测量胃对喂食一顿试验餐的反应来检验这一假设，其中有没有事先将液体营养素直接注入空肠。这将在12名有胃瘫症状的患者、12名没有消化问题的糖尿病患者(糖尿病对照组)和12名健康志愿者(正常对照组)中进行。参与者将被允许进入研究单位进行两次成像研究。血糖水平将通过胰岛素/葡萄糖点滴进行控制，在镇静下，将通过内窥镜将喂养管插入空肠。然后，在患者或研究人员不知道给了哪种制剂的情况下，随机顺序将液体营养素(食物)或水注入空肠。之后，将进行一次标准的测试餐。参与者将自始至终报告消化症状。磁共振成像将提供胃功能的详细测量。血糖和控制胃功能和食欲的激素也将被测量。该项目的主要目的是评估空肠喂养在恢复胃功能和减少餐后糖尿病胃轻瘫症状方面的有效性。此外，通过测量在健康和疾病状态下在禁食和进食状态之间切换胃功能的激素，我们希望确定更有效地治疗这种令人痛苦的疾病的靶点。

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.