Pilot study on gastric electrical stimulation on surgery-associated gastroparesis: long-term outcome

OBJECTIVES: Patients with postgastric surgery gastroparesis are often unresponsive to conventional medical therapy. Gastric electrical stimulation (GES) with the use of high-frequency and low-energy neural stimulation is an approved technique for patients with idiopathic and diabetic gastroparesis. METHODS: We hypothesized that GES would improve symptoms, health resource utilization, and gastric emptying in six patients with postsurgical gastroparesis from a variety of surgical procedures. Patients were evaluated by means of the following criteria: symptoms, health-related quality of life, and gastric emptying tests at baseline over time. RESULTS: All patients noted improvements after device implantation for up to 46 months: the frequency score for weekly vomiting went from a baseline of 3.2 down to 0.4 immediately after treatment before settling at 1.4 by the long-term follow up. Total gastrointestinal symptom score went from 36.5 at baseline down to 12.3 before settling at 20.5 at long-term follow up. Improvements were also seen in health-related quality of life and solid and liquid gastric emptying. CONCLUSIONS: We conclude that GES is associated with clinical improvements in this group of patients with either postsurgical or surgery-associated gastroparesis. This pilot study with long-term outcomes offers evidence for a new therapy for otherwise refractory patients with gastroparesis associated with previous surgery.     

糖尿病胃轻瘫中医证型与胃动力改变的关系

背景糖尿病胃轻瘫(diabetic gastroparesis,DGP)的发病机制尚不十分清楚,其不同中医证型胃动力改变情况也尚未十分明了.目的探讨DGP中医证型与体表胃电图(EGG)改变的关系.设计以诊断为依据的病例对照研究.方法对38例3种不同中医证型的DGP患者进行体表EGG检测,并与正常人20例进行对照.主要观察指标糖尿病胃轻瘫肝胃不和型、脾胃虚弱型、胃阴不足型患者餐前餐后胃电参数与健康志愿者相应指标比较结果.结果DGP 3种中医证型的EGG餐前餐后主频及主功率、正常胃电慢波百分比、胃电节律紊乱百分比较正常人组间差异有显著性意义(t=2.054～2.680,P＜0.05;t=2.738～3.528,P＜0.01),以胃动过缓明显增加、正常节律减少为其特征.结论DGP的中医证型不同,胃电参数不一,胃肠动力功能存在明显差异,因此胃电参数可作为DGP中医辨证分型的客观依据之一,对康复措施的介入提供依据.     

超声评估糖尿病性胃轻瘫大鼠胃动力

目的 观察超声评估糖尿病性胃轻瘫(DGP)大鼠胃动力的价值。方法 将以普通饲料适应性饲养1周的26只SD大鼠随机分为模型组(n=18)和对照组(n=8),分别以高脂高糖饲料和普通饲料饲养1周。对模型组大鼠通过经腹腔注射1%链脲佐菌素(STZ)溶液联合不规律高脂高糖饲料法饲养建立DGP模型，对照组予以经腹腔注射等量柠檬酸缓冲溶液联合规律普通饲料法饲养。成功建模后检测2组大鼠血糖值；行超声检查，记录胃动力参数；以离体胃窦肌条实验和病理检查观察胃窦肌层最大收缩力和形态。结果 模型组16只造模成功、2只死亡。模型组大鼠糖耐量水平显著高于对照组(P均<0.05);胃窦最小收缩面积大于，而胃窦收缩幅度、胃窦动力指数、实验餐后30及60 min胃排空率均小于对照组(P均<0.05);离体胃窦平滑肌肌条最大收缩力小于对照组(P<0.001)。光镜下观察，模型组大鼠胃窦组织可见明显DGP病理改变。结论 超声可用于评估DGP大鼠胃动力。     

Effect of motilin on gastric emptying in patients with diabetic gastroparesis

OBJECTIVES: Because disturbances of gastric emptying are a serious complication in insulin-dependent diabetic subjects with regard to the maintenance of good metabolic control, we wanted to assess the effectiveness of motilin as a potential treatment for gastric emptying disturbances. RESEARCH DESIGN AND METHODS: The intestinal hormone motilin has been shown to accelerate gastric emptying in healthy subjects. Therefore, we examined the effect of intravenous motilin on gastric emptying of a 99mTc colloid-labeled semisolid test meal in 9 insulin-dependent diabetic patients with diabetic gastroparesis. All patients had a significantly delayed gastric emptying rate compared with a group of 11 healthy control subjects. RESULTS: During the infusion of motilin, gastric emptying was accelerated, and it was no longer significantly different from control values. CONCLUSIONS: These data demonstrate that motilin and related compounds such as erythromycin derivatives could be useful for the treatment of disturbed gastric emptying in diabetic subjects.     

The treatment of nonobstructive urinary retention with high-frequency transvaginal electrical stimulation

The usefulness of timed voiding, cholinergic medications, and high-frequency electrical stimulation in women with symptomatic urinary retention was evaluated. Results indicated that symptomatic urinary retention can be treated with behavioral modification and high-frequency electrical stimulation. Optimal results were found in younger women with stable bladders.     

饮食护理对糖尿病胃轻瘫病人胃排空的影响

2型糖尿病病人至少有5 0 %以上伴有糖尿病胃轻瘫(dia beticgastroparesis) [1] 。糖尿病胃轻瘫系指胃动力障碍,排空延迟,但不伴有机械性梗阻的一组综合征。主要表现为恶心、呕吐、上腹饱胀、嗳气、上腹痛、体重下降、胃潴留或因不消化的固体食物排空障碍形成胃石等。糖尿病胃轻     

Natural history of diabetic gastroparesis

OBJECTIVE: The major aim of this study was to evaluate the prognosis of diabetic gastroparesis. RESEARCH DESIGN AND METHODS: Between 1984 and 1989, 86 outpatients with diabetes (66 type 1, 20 type 2; 40 male, 46 female) underwent assessment of solid and liquid gastric emptying and esophageal transit (by scintigraphy), gastrointestinal symptoms (by questionnaire), autonomic nerve function (by cardiovascular reflex tests), and glycemic control (by HbAlc and blood glucose concentrations during gastric emptying measurement). These patients were followed up in 1998. RESULTS: Of the 86 patients, solid gastric emptying (percentage of retention at 100 min) was delayed in 48 (56%) patients and liquid emptying (50% emptying time) was delayed in 24 (28%) patients. At follow-up in 1998, 62 patients were known to be alive, 21 had died, and 3 were lost to follow-up. In the group who had died, duration of diabetes (P = 0.048), score for autonomic neuropathy (P = 0.046), and esophageal transit (P = 0.032) were greater than in those patients who were alive, but there were no differences in gastric emptying between the two groups. Of the 83 patients who could be followed up, 32 of the 45 patients (71%) with delayed solid emptying and 18 of the 24 patients (75%) with delay in liquid emptying were alive. After adjustment for the effects of other factors that showed a relationship with the risk of dying, there was no significant relationship between either gastric emptying or esophageal transit and death. CONCLUSIONS: In this relatively large cohort of outpatients with diabetes, there was no evidence that gastroparesis was associated with a poor prognosis.     

三黄脂消饮对糖尿病胃轻瘫大鼠血糖和胃排空率的改变

[摘要] 目的 研究三黄脂消饮对糖尿病胃轻瘫大鼠血糖和胃排空率的改变。方法 以三黄脂消饮治疗糖尿病胃轻瘫模型大鼠，并与正常组及模型组比较。结果 中药治疗后血糖下降，胃排空率增加。 结论 三黄脂消饮不仅可以降低糖尿病血糖水平，而且增加了并发症胃轻瘫的胃排空率，明显地改善了胃排空延迟，所以三黄脂消饮是治疗糖尿病胃轻瘫的有效药物。     

Chronic metoclopramide therapy for diabetic gastroparesis

OBJECTIVE: To review the safety and efficacy of chronic metoclopramide for diabetic gastroparesis. DATA SOURCES: Medical literature was accessed through MEDLINE (1965 to October 2002) and PubMed (1965 to October 2002). Key search terms included metoclopramide; diabetic gastroparesis; and dyskinesia, drug induced. DATA SYNTHESIS: Metoclopramide is often used for diabetic gastroparesis, despite the risk of tardive dyskinesia. Published information is limited regarding long-term efficacy and toxicity of metoclopramide. The literature was assessed concerning these topics. CONCLUSIONS: Limited data do not provide sufficient evidence to conclude whether metoclopramide is efficacious for chronic use. Routine monitoring may mitigate the risk associated with metoclopramide therapy.     

糖尿病性胃轻瘫临床研究进展

糖尿病性胃轻瘫(DGP)是糖尿病常见的慢性并发症。本文就糖尿病胃轻瘫的流行病学、发病机制、临床表现、诊断和治疗做一综述。     

New therapeutic approaches to diabetic gastroparesis.]

CASE HISTORY AND PHYSICAL EXAMINATION: A 24-year-old man with type 1 diabetes, nonresponding to standard treatment for severe gastroparesis, was admitted to hospital due to persisting nausea and vomiting. Further known complications included diabetic retinopathy, diabetic nephropathy with mild renal impairment, diabetic peripheral and cardiac autonomic neuropathy, and arterial hypertension. EXAMINATIONS: Gastric motility parameters were evaluated by functional scintigraphy. Gastric emptying was severely delayed showing first appearance of food in duodenum after 25 min. After 60 min, technetium activity in the stomach was still detected in considerable amounts. The 50% emptying time was 58 min (normal time 10-20 min). A detailed symptom score for gastroparesis, prospectively investigated by a standardized patient diary, showed a severe and complex clinical disturbance: the frequency of daily attacks of impulsive vomiting ranged from 2 to 21 and the mean daily duration of nausea was 7.5 h. A value of 3.4 on the scale for a premature feeling of satiety (range 0-4, normal = 0) was determined, as well as scores of 2.5 for symptoms of abdominal bloating (range 0-3, normal = 0) and 3.7 for general well-being (range 0-4, normal = 0). COURSE OF DISEASE AND TREATMENT: Pharmacological interventions with antibiotics, prokinetics, antiemetics and, as a second step, percutaneous gastrostomy (first invervention) and jejunostomy (second intervention) were not long-term effective in reducing the clinical symptoms described above. Therefore, a single intrapyloric injection with 100 U of botulinum toxin was performed leading to a prompt and significant improvement of symptoms and an adequate oral nutrient intake the day after the procedure. Determined by gastric scintigraphy 1 week later, this led to a significant reduction of the 50% emptying time (36 min) and to an improvement of the symptom score for gastroparesis as determined 4 weeks later: frequency of daily attacks of impulsive vomiting ranged from 0 to 1, mean daily duration of nausea was 1 h, premature feeling of satiety (score 1.9), symptoms of abdominal bloating (1.1), and general well-being (2.1). The beneficial effect of the botulinum toxin injection was unchanged over 3 months, slightly diminishing by 4.5 months. After a second round of botulinum toxin injection, again, prompt relief of most of the symptoms was achieved. Percutaneous jejunostomy was then revised. CONCLUSION: Intrapyloric injection of botulinum toxin is effective in improving the complex symptoms and clinical syndrome associated with diabetic gastroparesis resistant to conventional treatment. Upon waning of the therapeutic effect over time, the procedure can be repeated with success.     

A large splenic cyst mimicking diabetic gastroparesis

Splenic cysts are rare, many of which are asymptomatic and incidental finding. We report an interesting case of a large incidental splenic cyst in a young diabetic patient who presented with diabetic ketoacidosis and mimicking gastroparesis. The differential diagnosis and management of splenic cysts is discussed.     

Visceral afferent neuropathy in diabetic gastroparesis.

OBJECTIVE: To determine whether a lack of symptoms in diabetic patients with gastrointestinal motility disorders is associated with visceral afferent neuropathy. RESEARCH DESIGN AND METHODS: We investigated cerebral evoked potentials (EPs) after esophageal stimulation in 10 patients with motor dysfunction of the gastrointestinal tract and in 10 healthy control subjects. All patients had insulin-dependent diabetes mellitus (5 men, 5 women, age range 31-60 yr, diabetes duration 8-36 yr, 10 of 10 with polyneuropathy, 6 of 10 with cardiac autonomic neuropathy). Their esophageal and gastric motor disorders had been diagnosed by scintigraphy, and gastrointestinal stenosis had been excluded by gastroscopy. Only 2 patients had severe symptoms, whereas 6 patients complained of minor discomfort (distension, bloating), and 2 patients were symptom free. RESULTS: EPs were recorded after electrical stimulation of the esophagus (32 cm from the incisors) at intensity just above the perception threshold. All control subjects exhibited regular EPs at 0.1 ms/30 mA stimulation intensity. In 6 diabetic patients, no EPs were detected at 0.1 and 0.3 ms/30 mA, and the perception thresholds were significantly elevated. In 4 patients with normal perception threshold, EPs of regular shape but decreased amplitude were recorded. These patients had mild or severe gastroparetic complaints. CONCLUSIONS: These data show for the first time an association between a lack of symptoms in diabetic gastrointestinal motility disorders and visceral afferent neuropathy.     

Therapeutic effect of Weidong Kang on diabetic gastroparesis^＊

背景现代医学对糖尿病性胃轻瘫的发病机制尚未完全阐明,应用胃动康治疗可能获得一定的疗效.目的观察胃动康治疗糖尿病性胃轻瘫的临床疗效,并与吗丁啉的疗效进行对比.设计病例-对照观察.单位重庆师范大学校医院中医科,重庆市中医研究院.对象选择2001-04/2005-12重庆师范大学校医院和重庆市中医研究院门诊及住院的糖尿病性胃轻瘫患者60例,随机分为两组①治疗组(n=30)男20例,女10例,年龄31～58 岁,病程0.5～26 年.②对照组(n=30)男18例,女12例;年龄30～69 岁,病程0.5～20 年.所有患者对实验均知情同意.方法治疗组口服胃动康水煎剂(由厚朴、枳实、槟榔、大黄、柴胡、白术、石斛组成,100 mL/瓶,含生药100 mg,由重庆市中医研究院制剂室提供),3次/d,30 mL/次;对照组用吗丁啉,10 mg/次,3次/d.用药4周.分别于治疗前后观察两组患者的症状积分、胃液体半排空时间、疗效评价、生活质量得分及安全性.主要观察指标两组治疗前后的症状积分、胃液体半排空时间、疗效评价、生活质量得分及安全性比较.结果60例糖尿病性胃轻瘫患者全部进入结果分析.①消化不良症状改善情况治疗后,两组的症状积分和总积分均明显低于治疗前(P＜0.01),治疗组的上腹胀满、恶心呕吐、食欲减退及上腹痛症状积分均明显低于对照组(P＜0.05～0.01).②临床疗效治疗组总有效率90.0%(27/30),明显高于对照组[73.3%(22/30),P＜0.05].③胃液体半排空时间治疗组治疗后较治疗前有明显改善(P＜0 01).④SF-36生活质量改善情况治疗后,治疗组总体健康、躯体疼痛、活力及精神健康维度的得分明显高于治疗前(P＜0.05);对照组总体健康和精神健康维度得分明显高于治疗前(P＜0.05).⑤安全性评估治疗组治疗后实验室检查与治疗前比较,差异均不明显(P＞0.05).结论胃动康治疗糖尿病性胃轻瘫具有良好的临床疗效和安全性.     

糖尿病性胃轻瘫应用胃动康治疗的效果(英文)

背景:现代医学对糖尿病性胃轻瘫的发病机制尚未完全阐明,应用胃动康治疗可能获得一定的疗效。目的:观察胃动康治疗糖尿病性胃轻瘫的临床疗效,并与吗丁啉的疗效进行对比。设计:病例-对照观察。单位:重庆师范大学校医院中医科,重庆市中医研究院。对象:选择2001-04/2005-12重庆师范大学校医院和重庆市中医研究院门诊及住院的糖尿病性胃轻瘫患者60例,随机分为两组:①治疗组(n=30):男20例,女10例,年龄31～58岁,病程0.5～26年。②对照组(n=30):男18例,女12例;年龄30～69岁,病程0.5～20年。所有患者对实验均知情同意。方法:治疗组口服胃动康水煎剂(由厚朴、枳实、槟榔、大黄、柴胡、白术、石斛组成,100mL/瓶,含生药100mg,由重庆市中医研究院制剂室提供),3次/d,30mL/次;对照组用吗丁啉,10mg/次,3次/d。用药4周。分别于治疗前后观察两组患者的症状积分、胃液体半排空时间、疗效评价、生活质量得分及安全性。主要观察指标:两组治疗前后的症状积分、胃液体半排空时间、疗效评价、生活质量得分及安全性比较。结果:60例糖尿病性胃轻瘫患者全部进入结果分析。①消化不良症状改善情况:治疗后,两组的症状积分和总积分均明显低于治疗前(P<0.01),治疗组的上腹胀满、恶心呕吐、食欲减退及上腹痛症状积分均明显低于对照组(P<0.05～0.01)。②临床疗效:治疗组总有效率90.0%(27/30),明显高于对照组[73.3%(22/30),P<0.05]。③胃液体半排空时间:治疗组治疗后较治疗前有明显改善(P<0.01)。④SF-36生活质量改善情况:治疗后,治疗组总体健康、躯体疼痛、活力及精神健康维度的得分明显高于治疗前(P<0.05);对照组总体健康和精神健康维度得分明显高于治疗前(P<0.05)。⑤安全性评估:治疗组治疗后实验室检查与治疗前比较,差异均不明显(P>0.05)。结论:胃动康治疗糖尿病性胃轻瘫具有良好的临床疗效和安全性。     

Treatment of erectile dysfunction by perineal exercise,electromyographic biofeedback,and electrical stimulation

BACKGROUND AND PURPOSE: Only a few investigators have described the involvement of the perineal muscles in the process of human erection. The aim of this research was to evaluate a re-education program for men with erection problems of different etiologies. SUBJECTS AND METHODS: Fifty-one patients with erectile dysfunction were treated with pelvic-floor exercises, biofeedback, and electrical stimulation. RESULTS: The results of the interventions can be summarized as follows: 24 patients (47%) regained a normal erection, 12 patients (24%) improved, and 6 patients (12%) did not make any progress. Nine patients (18%) did not complete the therapy. On the basis of several variables, a prediction equation was generated to determine the factors that would predict the effect of the interventions. The outcome was most favorable in men with venous-occlusive dysfunction. DISCUSSION AND CONCLUSION: Comparison of the results of the physical therapy protocol reported here with those obtained for other interventions reported in the literature shows that a pelvic-floor muscle program may be a noninvasive alternative for the treatment of patients with erectile dysfunction caused by venous occlusion.     

骶神经电刺激治疗顽固性排尿功能障碍

目的观察骶神经电刺激(sacral nerve stimulafion,SNS)治疗顽固性排尿功能障碍的临床效果.方法对1例确诊为顽固性排尿功能患者行骶3孔神经电刺激治疗.结果电刺激治疗8 d后及拔除电极后第1,4,8周,B超测定剩余尿量为0,尿失禁、尿频、尿急等临床症状均明显改善,每次排尿量正常.结论骶神经电刺激能有效地治疗顽固性排尿功能障碍.     

按摩并吗丁啉对糖尿病性胃轻瘫患者胃动素及胃排空时间的影响

目的　研究按摩并吗丁啉对糖尿病性胃轻瘫 (DGP)患者胃动素、胃排空时间的影响。方法　将 10 0例DGP患者随机分为治疗组与对照组 ,每组各 5 0例。对照组予吗丁啉片 ,治疗组予按摩配合吗丁啉治疗 ,观察 6周。结果　治疗组和对照组总有效率分别为 92 %和 78% (P <0 .0 5 ) ,两组胃动素、胃排空时间均降低 (P <0 .0 5 ) ,但治疗组优于对照组 (P <0 .0 5 )。结论　按摩并吗丁啉对降低DGP患者的血浆胃动素、胃排空时间具有积极作用。     

Understanding diabetic gastroparesis: a case study.

The purpose of this article is to present an overview of diabetic gastroparesis, defined as delayed gastric emptying in the absence of mechanical obstruction. Diabetic gastroparesis is a substantial and unrecognized problem. Failure to treat may result in a decreased quality of life and a potential increase for morbidity. The treatment protocol for diabetic gastroparesis combines dietary and pharmacologic measures. This article will discuss normal physiology of gastric emptying along with the pathogenesis of delayed emptying in patients with diabetes. Nursing implications for the care of the patient with diabetic gastroparesis is also presented along with commonly used pharmacologic agents.