Diagnosis and pathogenic mechanism of diabetic gastroparesis
Yun Liu, Yan Sun, Qi-Ping Xue, Department of Geratol- ogy, the First Affiliated Hospital of Nanjing Medical Uni- versity, Nanjing 210008, Jiangsu Province, China Jian-Min Li, Department of Cell Biology, Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
AIM: To evaluate the clinical diagnosis and explore the pathogenic mechanisms of diabetic gastroparesis. METHODS: A total of 38 in-hospital patients with diabetes were included in this study. Bio- chemical method and radioimmunoassay (RIA) were used to detect the levels of plasma gluco- ses, glycosylated hemoglobin (GHG), gastrin, motilin and glucagons. The autonomic nerve function and barium strip emptying time were used to make diagnosis of diabetic gastroparesis. RESULTS: The levels of fast blood glucose (FBG), postprandial blood glucose (PBG) and GHG were significantly higher in diabetic pa- tients with abnormal gastric emptying than those with normal gastric emptying (FBG: 12.53 ± 4.13 mmol/L vs 7.12 ± 1.37 mmol/L, P 0.01; PBG: 19.79 ± 5.69 mmol/L vs 14.11 ± 4.21 mmol/ L, P 0.05; GHG: 9.73% ± 2.39% vs 7.26% ± 1.96%, P 0.05). Meanwhile, high levels of serum mo-tilin, gastrin, and glucagons were detected in diabetic patients with abnormal gastric empty- ing. The occurrence rate of autonomic nerve function abnormality was 62% (13/21) in dia- betic patients with abnormal gastric emptying, obviously higher than that in those with normal gastric emptying (24%, 4/17). The barium strip emptying time was significantly prolonged in patients with diabetic gastroparesis (7.93 ± 1.23 h vs 4.35 ± 1.01 h, P 0.001). CONCLUSION: Diabetic gastroparesis can be diagnosed by grading clinical symptom, ex- amining plasma glucoses, gastrin, motilin and glucagons, evaluating autonomic nerve function and barium emptying time. Hyperglycaemia, gut hormone abnormality, neuropathy, microan- giopathy, and metabolic disorder participate in the development of diabetic gastroparesis.