Diabetic Gastroparesis

　　The physiological function of the stomach's movement includes three aspects: storing food; grinding and mixing food to form fine particles and fully mix it with gastric juice; and slowly and in small amounts, emptying the chyme into the small intestine at the speed most suitable for its digestion and absorption. The smooth muscle of the stomach wall has three layers: longitudinal, circular, and oblique, with the circular muscle being the thickest and most forceful in contraction. The antrum of the stomach has the most developed circular muscle and the most active contraction among all parts of the stomach. Therefore, the movement function of the antrum is the main driving force for stomach emptying. The stomach has two basic forms of movement: the stomach's tonic contraction and the stomach's peristalsis. The tonic contraction of the stomach is particularly evident in an empty stomach, which can maintain a certain pressure in the gastric cavity, maintain the pressure gradient between the stomach and the duodenum, and help in the emptying of gastric juice during the interdigestive period; the peristalsis of the stomach can be divided into the gastric emptying movement during the digestive period and the migrating motor complex (MMC) during the interdigestive period. After food enters the stomach, the gastric emptying movement begins about 5 minutes later, with the peristaltic wave starting from the cardia, spreading towards the antrum at a frequency of 3 times per minute, and then to the pylorus. Usually, one peristaltic wave can empty 1 to 3 ml of fine-grained chyme into the duodenum, and particles with a diameter greater than 1 mm often cannot pass through the pylorus. The migrating motor complex during the interdigestive period occurs after gastric emptying, presenting as a regular, periodic group of strong contraction activities. This type of contraction activity generally originates from the antrum or duodenum and spreads towards the oropharynx, possibly reaching the proximal colon. The frequency of the contraction activity is 3 times per minute in the antrum and 11 times per minute in the duodenum. The conduction speed of the contraction activity is about 2 to 5 cm/min. The MMC generally occurs 4 to 6 hours after a meal, and then occurs approximately every 2 hours, with each occurrence often accompanied by a peak secretion of gastric juice, bile, and pancreatic juice, as well as some gastrointestinal hormones (such as motilin). The occurrence process of MMC is divided into three phases: Phase I is the resting period, accounting for about 50% of the cycle; Phase II presents intermittent contraction activities, accounting for about 40% of the cycle; and Phase III is a group of continuous contraction activities, accounting for about 10% of the cycle. Eating can terminate the MMC. The mechanism of the occurrence of MMC has not been fully elucidated; many studies suggest that it is related to the cyclic release of the autonomic nervous system, gastrointestinal hormones (especially motilin), and the secretion process of digestive juices. The function of MMC is to empty the gastric contents during the interdigestive period (such as swallowed saliva, gastric mucus, desquamated gastric mucosa, food residue, and undigested solid food) into the small intestine and promote the emptying of the small intestine. Under normal circumstances, food stays in the small intestine for about 3 to 8 hours. Abnormalities in MMC can cause retention of gastric juice and duodenal juice during the interdigestive period, delayed small intestinal emptying, and excessive proliferation of bacteria in the small intestine and upper gastrointestinal tract.
　　Characteristics of gastrointestinal motor dysfunction in diabetic patients The delayed gastric emptying in diabetic patients has been confirmed by many studies, while research on gastrointestinal motility dysfunction during the interdigestive period in diabetic patients is relatively rare. Beijing Tongren Hospital's study on the gastrointestinal motility during the interdigestive period in 51 diabetic patients found that about 70% of diabetic patients have interdigestive gastrointestinal motility disorders. These motor disorders are mainly manifested as the absence of MMCⅢ phase, with the most obvious being the absence of the gastric antrumⅢ phase, which is replaced by the prolongation of theⅡ phase duration and the weakening of the gastric antrum contraction. In addition to gastric emptying and MMC abnormalities, diabetic patients also have significant abnormalities in gastric electrical activity. The gastric body also has tissue with pacemaker function, which can produce spontaneous rhythmic electrical activity, that is, slow wave potentials. The normal frequency of slow wave potentials is 3 times/min. Diabetic patients often manifest as gastric tachycardia (more than 4-5 times/min, and lasting for more than 1 min), bradygastric (less than 2 times/min, and lasting for more than 1 min), or mixed gastric electrical rhythm disorders (alternating between tachycardia and bradygastria). Although many diabetic patients have gastrointestinal motility dysfunction, few have obvious clinical manifestations. The severity of gastrointestinal motility dysfunction is not significantly related to age, course of disease, clinical manifestations, and some common complications (such as kidney, peripheral nerve, fundus lesions, etc.). The appearance of gastrointestinal motility dysfunction often precedes the appearance of clinical symptoms and complications.

　　Diabetic gastroparesis patients may have recurrent formation of gastric stones due to delayed gastric emptying. When there is concurrent lower esophageal sphincter pressure reduction, symptoms of gastroesophageal reflux may occur, such as acid regurgitation, food regurgitation, and heartburn, and in severe cases, reflux esophagitis may occur.

　　Most diabetic gastroparesis patients have no obvious clinical symptoms, while a few patients may experience early satiety, nausea, vomiting, bloating, and other symptoms, the severity of which varies from person to person. The severity of symptoms in the same patient is also affected by various factors, and may be related to the decreased sensitivity of the传入neural pathway caused by diabetic autonomic neuropathy. Due to delayed gastric emptying, there may be recurrent formation of gastric stones. When there is concurrent lower esophageal sphincter pressure reduction, symptoms of gastroesophageal reflux may occur, such as acid regurgitation, food regurgitation, and heartburn; in severe cases, reflux esophagitis may occur. In addition to the above symptoms, it can also cause abnormal emptying of the small and large intestines, leading to symptoms such as abdominal pain, constipation, or diarrhea.

　　Autonomic neuropathy in diabetes is found in about 50% of diabetic patients, with abnormal autonomic function often affecting the digestive tract, leading to delayed gastric emptying and known as diabetic gastroparesis. The active and effective treatment of diabetes is the best way to prevent diabetic gastroparesis.

　　What examinations should be done for diabetic gastroparesis? Briefly described as follows:

　　1. Gastrointestinal barium meal examination

　　Barium meal examination can show significant delay in the emptying of barium, with barium often remaining in 50% after 4 hours or not being emptied after 6 hours.

　　2. Gastroscopy

　　Gastroscopy can show a large amount of retained food in the gastric cavity, poor peristaltic function, and can clearly determine whether there is organic disease.

　　3. Scintigraphy technique

　　The gastric half-emptying time, gastric emptying rate, and delay period in diabetic gastroparesis patients are significantly prolonged, so this method is the gold standard for gastric emptying measurement.

　　4. Gastrointestinal manometry

　　Gastrointestinal manometry is mainly used for the detection of gastrointestinal contraction function, including the time of onset of contraction activity, the intensity of contraction, the frequency of contraction, and the coordination of contraction.

　　5. Ultrasonic examination technique

　　Ultrasonic examination is a non-invasive examination that is easy for patients to accept, and it can dynamically observe the liquid gastric emptying, gastric peristalsis, and the passage of digested food through the pylorus, and can be repeated multiple times.

　　6. Gastric electrography technique

　　Radiological techniques can provide valuable information on gastric motility and emptying and can be used as an important screening test for diabetic gastroparesis, as well as for scientific research comparisons before and after the administration of prokinetic drugs.

　　7. Radiological techniques

　　Indirect information on interdigestive motility can be obtained by measuring the emptying of undigested and non-X-ray penetrable solid substances (encapsulated polyethylene beads).

　　What should be paid attention to in the dietary health care of patients with diabetic gastroparesis? Briefly described as follows:

　　Firstly, patients with diabetic gastroparesis should eat

　　Patients with this disease should eat more fresh vegetables, such as melons, fruits, sprouts, kelp, seaweed, and mushrooms, which have the effect of preventing vascular sclerosis.

　　Patients with diabetes should formulate a dietary plan under the guidance of a diabetes doctor and a nutritionist according to their specific situation. Starchy foods (rice, noodles, sweet potatoes, potatoes, yams, etc.) should be taken as staple foods, and more vegetables and fruits should be eaten. Sugar, fats, and animal fats should be eaten in limited quantities, and milk and dairy products, meats, poultry eggs, and nuts should be eaten in moderate amounts according to need. Generally speaking, carbohydrates account for 55%-60% of the total calories in the diet of patients with diabetes, proteins account for 15%-20%, and fats account for 25%.

　　Secondly, patients with diabetic gastroparesis should avoid eating

　　The dietary adjustment for patients with this disease should be determined according to the specific situation. Generally speaking, the following issues should be paid attention to:

　　1. Control the intake of salt. The main components of salt are chlorine and sodium. If sodium intake is excessive, under the action of certain endocrine hormones, it can cause vasoconstriction of small arteries, leading to increased blood pressure. At the same time, sodium salt has the effect of absorbing water. If an excessive amount of sodium salt is ingested, the body's water retention will increase the burden on the heart. Therefore, it is advisable to have a daily dietary supply of sodium salt below 3 grams; it is better to eat less or not eat salty foods such as pickled vegetables, sauerkraut, and preserved bean curd.

　　2. Control the amount of energy supply. Hypertensive and cardiovascular patients should eat more low-calorie foods. Because when the total calorie intake is too high, the serum cholesterol level usually increases. If the patient is overweight, dietary restriction should be practiced.

　　3. Limit the intake of fat and cholesterol. In daily meals, try to avoid eating foods high in animal fat and cholesterol, such as animal fats, fatty meats, liver, kidney, brain, lung, egg yolks, fish roe, etc., and prefer vegetable oils and soy products. However, vegetable oils should not be consumed excessively, as excessive vegetable oils can also promote obesity in patients.

　　4. Avoid spicy foods. Try to use less ginger, chili, pepper powder, and other spicy seasonings in the diet. Strictly prohibit smoking and drinking, and avoid drinking strong tea and coffee and other bad habits.

　　Third, Diet Therapy for Diabetic Gastroparesis

　　1. Hawthorn and Lotus Leaf Tea

　　Take 15 grams of hawthorn and 12 grams of lotus leaf, add 1000 milliliters of water, and boil to 500 grams, then drink it as tea.

　　Effects: This formula has the effects of invigorating the spirit and clearing the mind for patients with dizziness, headache, and drowsiness. The lotus leaf has the effects of dispelling summer heat and clearing the mind. It is suitable for those with thirst, excessive drinking, and chest tightness.

　　2. Pueraria Lobata Porridge

　　Boil 30 grams of Pueraria lobata and 60 grams of glutinous rice to make porridge, and take it as a snack in the morning and evening.

　　Effects: The root of Pueraria lobata is cool in nature and has the effects of clearing heat, promoting saliva, and promoting blood circulation to remove blood stasis. It is suitable for those with thirst, excessive drinking, and chest tightness.

　　The following is a brief description of the treatment methods for diabetic gastroparesis:

　　1. Treatment of the Primary Disease

　　The level of blood glucose is closely related to the relationship with gastric emptying. It is necessary to actively control the blood glucose of diabetic patients at an ideal level, which can partially improve the delayed gastric emptying of diabetic gastroparesis.

　　2. Diet Therapy

　　It is better to eat in small portions and more frequently. A low-fat diet can alleviate the symptoms of gastric dysmotility. It is advisable to avoid eating indigestible vegetables to prevent the formation of plant stomach stones.

　　3. Drug Treatment

　　It is necessary to take gastric motility drugs regularly. The drugs should be taken about half an hour before meals to ensure that the blood drug concentration reaches its peak when eating. Common drugs include metoclopramide, domperidone, mosapride, itopride, and cimetidine.