The company has been in the business for eight years and has been taking glucose-lowering medication to control fasting blood sugar at 8-10 mmol/L. Several times she went to the hospital, the doctor suggested changing the treatment plan to achieve better blood sugar control, but she did not feel any ill feeling and did not adjust her medication as prescribed by the doctor. In the past six months, Liu’s mother often felt fullness in the upper abdomen, nausea and vomiting, she thought the gastrointestinal tract is usually quite good ah, how recently appeared gastric disease? The company’s main business is to provide a wide range of products and services to the public. The first thing I heard was that diabetes can cause complications such as stroke, heart disease, amputation, and blindness, but what is diabetic gastroparesis? Diabetic gastroparesis is diabetic gastrointestinal dysfunction, which is the name given to a diabetic patient with delayed and inert gastric emptying, as if “paralyzed”. Generally speaking, after more than 5 years of diabetes (especially when the blood glucose level is poorly controlled), patients may develop gastroparesis. The clinical manifestations are chronic gastritis, gastric flaccidity and gastric retention. Typical symptoms are postprandial epigastric distention, flatulence, early satiety, anorexia, belching, nausea, vomiting, epigastric discomfort and pain, which are obvious after meals, but some patients may experience nausea and vomiting during prolonged fasting. Some patients may have no obvious clinical symptoms.
In 1945, Rundles first reported that delayed gastric emptying was associated with diabetes mellitus and that autonomic neuropathy was the cause of diabetic gastric dysfunction. 1958, Kassander introduced the term “gastroparesis diabeticorum”, stating that Delayed gastric emptying is not uncommon in diabetic patients, mostly in asymptomatic individuals, and has a detrimental effect on glycemic control.
The pathogenesis of diabetic gastroparesis is complex and still not well understood, and is mainly related to the following factors.
1, autonomic neuropathy The incidence of autonomic neuropathy in diabetic patients is 20% to 40%. Visceral autonomic nerves include vagus nerve and sympathetic nerve. In diabetic patients, segmental demyelination of vagus nerve axons occurs, which slows down the propagation of the basic electrical rhythm of the stomach and weakens the tense contraction of the fundus, which in turn causes a decrease in gastric peristaltic and secretory functions, resulting in delayed gastric emptying.
2, hyperglycemia Hyperglycemia can cause both neuropathy and inhibition of gastrointestinal motility, and the increase of blood glucose concentration in diabetic patients and delayed gastric emptying are causally related to each other.
In addition, abnormal gastrointestinal hormones, Helicobacter pylori (Hp) infection and psychological factors are closely related to diabetic gastroparesis.
At present, the diagnosis of diabetic gastroparesis is mostly based on functional gastrointestinal examination, and the commonly used functional gastrointestinal examination methods are.
This method is the gold standard of gastric emptying measurement. It was developed in 1966, and the gastric emptying rate (GERS) and gastric half-emptying time (GETl/2) can be measured at various times using 99mTc and 111In double-labeled solid and liquid test meals. In normal subjects, the gastric half-emptying time is 30-45 min for liquid foods and 60-110 min for solid foods, and there is generally a minimal delay in emptying before gastric emptying begins after a meal, which corresponds to the time required to grind the food to a fine particle that can pass through the pylorus. In diabetic gastroparesis, the gastric half-emptying time, the gastric emptying rate and the lag period are significantly longer.
2.Endoscopy Esophagogastroduodenoscopy can clearly exclude mucosal lesions, mechanical obstruction and the presence of fecal stone formation, and can observe the presence of food residue after 4-8 hours of fasting, making the diagnosis of gastroparesis more clear.
3.Ultrasound examination technique is a non-invasive examination, which is easily accepted by patients. It can dynamically observe liquid gastric emptying, gastric peristalsis and digested food passing through the pylorus, and can be repeated many times. Its limitations are that solid emptying cannot be observed and the determination of the gastric sinus area does not fully represent the true physiological state of the gastric sinus at that time, so it is less accurate than nuclear scan in food emptying measurement.
In addition, stable radioisotope breath test, gastric electrogram, MRI, CT, electrical impedance CT (impedance tomography) and positron emission topography can be used to detect delayed gastric emptying.
How to treat diabetic gastroparesis?
First, effective treatment of diabetes is the best way to prevent diabetic gastroparesis. The relationship between the level of blood glucose and gastric emptying is very close, so the blood glucose of diabetic patients should be actively controlled at the ideal level, which can partially improve the delayed gastric emptying of diabetic gastroparesis.
2, diet control and appropriate physical exercise. Diet should pay attention to low fat, many meals and few meals. Patients with early satiety, bloating, anorexia and vomiting should reduce the content of indigestible fiber in food, limit the intake of fiber, and eat less and more meals; while when constipation is the main problem, eat more food containing more fiber, such as coarse grains, beans and vegetables.
3, there is no cure for the special drugs, there is no successful way to restore the abnormal nerve function, but you can choose the appropriate drugs according to the different symptoms of symptomatic treatment.
Moxaburi Moxaburi is a new generation of gastrointestinal motility drug, a highly selective 5-HT4 receptor agonist, through the activation of cholinergic interneurons in the gastrointestinal tract and the 5-HT4 receptors in the intermuscular plexus, so that they release acetylcholine, producing the upper gastrointestinal tract prokinetic effect. With good immediate and long-term efficacy and no significant side effects, it is the best drug for the treatment of diabetic gastroparesis.
Erythromycin Macrolide antibiotics have the properties of gastric actin receptor agonists and have powerful pro-gastric motility. Intravenous administration is more effective than oral administration. It is advisable to start with a small dose, 40mg a day, and later increase to 100-200mg a day, which can significantly increase gastric emptying and improve gastric diplegia.
Domperidone, metoclopramide, promethazine, ohdansetron and granisetron have also been used in clinical practice.
The basic pathogenesis of diabetic gastroparesis is considered by the ancestral medicine to be the depletion of Yin and Qi over a long period of time, resulting in the weakness of the middle energy and the imbalance of the elevation of the spleen and stomach as the main cause. The use of northern ginseng, maidenhair, raw earth, yam, kudzu root, chicken internal gold, etc. to nourish yin and benefit the stomach; party ginseng, yam, astragalus, coke malt, coke hawthorn, etc. to strengthen the spleen and stomach often have a better effect. In addition, acupuncture at Neiguan, Zhongguancestor, Foot Sanli, and Gongsun points can also achieve good results in treating diabetic gastroparesis.
At present, there are many drugs and methods to treat diabetic gastroparesis, but they do not relieve the symptoms of all patients. It is believed that with the development of medicine, the combination of Chinese and Western medicine will be able to relieve the symptoms well and at the same time eliminate the causes of the disease, so that more patients with diabetic gastroparesis can be relieved of their pain as soon as possible.