Diabetes patients have gastrointestinal discomfort, constipation, abdominal distension, nausea, obvious delay in gastric emptying, and gradually worsening symptoms... Have you considered Diabetes Gastroparesis?

　　What is Diabetes Gastroparesis?

　　Diabetes Gastroparesis (DGP) is one of the common complications of diabetes autonomic neuropathy and the most common digestive tract complication in diabetes patients. It is mainly caused by diabetes, such as gastric peristaltic rhythm disorder, delayed gastric emptying, but not accompanied by mechanical obstruction of the digestive system.

　　According to the latest epidemiological survey in China, the number of people suffering from diabetes in China has reached 160 million, and the prevalence rate is as high as 11.6%.

　　52% of type 2 diabetes outpatients had at least one chronic complication, and 74.6% of type 2 diabetes ward patients had at least one chronic complication.

　　Among all patients with gastroparesis, about 1 / 3 are patients with Diabetes Gastroparesis. Patients with a history of diabetes for more than 10 years have a greater chance of Diabetes Gastroparesis. About 30% - 50% of diabetes outpatients are accompanied by delayed gastric emptying.

　　Early detection and treatment are the key to reduce diabetes gastroparesis and improve patients' quality of life.

　　How to diagnose gastroparesis?

　　The guidelines for the prevention and treatment of type 2 diabetes in China (2020 Edition) pointed out that gastric outlet obstruction or other organic causes should be excluded before the diagnosis of gastroparesis. Electrogastrogram and scintigraphic scanning for measuring gastric emptying are helpful for diagnosis.

　　The diagnosis of gastroparesis should meet the following three criteria:

　　① Have symptoms of gastroparesis;

　　② The outlet obstruction caused by organic lesions of pylorus was excluded;

　　③ The diagnosis of delayed gastric emptying was confirmed.

　　Before the diagnosis of gastroparesis, in addition to focusing on typical gastrointestinal symptoms, clinical auxiliary examination is also essential.

　　▪ Endoscopy

　　Before the diagnosis of Diabetes Gastroparesis, the patients must pass gastrointestinal endoscopy to rule out mechanical obstruction, ulcer, tumor and other digestive tract organic diseases and other systemic diseases, and observe the emptying of gastric contents after fasting for 8h, so as to make the diagnosis of Diabetes Gastroparesis more intuitive.

　　▪ Barium meal radiography of digestive tract

　　X-ray examination after oral administration of barium can show gastrointestinal ulcer, gastric distension, delayed gastric emptying and other diseases. No barium was found to enter the duodenum 30 minutes after taking barium, or the barium in the stomach was not emptied 6 hours later, which suggested the possibility of gastroparesis in diabetes.

　　▪ Radionuclide emptying inspection

　　Radioactive gastric emptying imaging can objectively determine the gastric function under physiological conditions, and has the advantages of simplicity, non-invasive, repeatable, physiological and accurate positioning for the diagnosis of gastric function changes in patients with digestive tract diseases. However, this method requires high equipment, is expensive, and has certain radioactivity. It is rarely used in clinical practice, and is currently used for experimental research.

　　▪ Gastric emptying breath test

　　13C was combined with medium chain triglyceride (caprylic acid) as a marker and labeled in the test meal. After the test meal was taken orally, the marker was absorbed and metabolized in the body, oxidized to form 13CO2, and was exhaled out of the body. The tester collected breath samples, which could be used to estimate the half emptying time of the stomach after instrument analysis.

　　▪ Gastric manometry

　　After 8 hours of fasting, the measurer inserted the antrum pylorus duodenum manometer tube into the stomach of the subject under the guidance of X-ray, and measured the changes of intragastric pressure caused by gastric contraction during the postprandial interval (3 hours of fasting) and the digestive period (2 hours of postprandial), which can reflect the dynamic rhythm of the upper digestive tract.

　　▪ Electrogastrogram

　　After 8 hours of fasting, the subjects were taken to the supine position, and the electrodes coated with conductive paste were placed on the projections of the gastric body and antrum on the body surface of the subjects. The gastric electrical activities of the subjects were recorded 30 minutes after fasting and 30 minutes after eating. The main observations were the dominant frequency, the dominant power, the percentage of normal gastric electrical rhythm, the percentage of bradycardia, and the power ratio after/before eating to evaluate the gastric function of the patients.

　　▪ Ultrasonic examination

　　Ultrasonography can observe the contraction and emptying of the digestive tract wall in combination with the movement of the digestive tract and the flow of the contents. However, it has high technical requirements for the examiner and is mainly used to evaluate the emptying efficiency of liquid food. It is less accurate for obese patients or those with more gas in the stomach during detection.

　　How to treat gastroparesis?

　　The current treatment methods include traditional Chinese medicine, western medicine and non drug treatment.

　　TCM treatment of Diabetes Gastroparesis often follows the principle of syndrome differentiation. Acupuncture, moxibustion, massage and point injection are used to help patients accelerate gastrointestinal peristalsis, control blood sugar and improve symptoms of Diabetes Gastroparesis.

　　In western medicine treatment, active control of blood sugar is an extremely important part of the treatment. Hyperglycemia is an important factor that causes diabetic gastroparesis. Delayed gastric emptying hinders food emptying, affects postprandial blood glucose, leads to fluctuation of blood glucose level, and forms malignant feedback. Therefore, CGM and insulin pump therapy for insulin dependent patients are conducive to strict glucose management.

　　In addition, Western medicine treatment will use commonly used digestive system drugs. For example, dopamine receptor antagonists, 5-hydroxytryptamine 4-receptor agonists and motilin receptor agonists are often used in clinic to increase gastric motility and promote gastric emptying; Procarbide is used to improve colonic movement, shorten colonic transit time, increase spontaneous defecation, and treat constipation.

　　At the same time, necessary nutritional support, water supplement and electrolytes are the first choice for treatment. Patients should take a small amount of low-fat and low fiber food for many times according to the recommendations of the nutritionist. Fat can slow down gastric emptying, and fiber can increase abdominal distension and satiety. In addition, it is also recommended that patients with gastroparesis eat separate meals and foods with more liquid content.

　　In addition to traditional Chinese medicine treatment and western medicine treatment, we also want to introduce a non drug treatment method - gastric electric pacing.

　　ICC is the pacemaker cell of gastrointestinal tract. The slow wave generated by ICC spreads to smooth muscle cells through electrical signals and spreads to the whole stomach, making the stomach produce rhythmic contraction. When the gastric myoelectric activity is disordered, the movement of gastrointestinal tract will also be abnormal. Gastric pacing is to stimulate ICC through external current, so that the original disorder of gastric myoelectric activity returns to normal, similar to the electrical defibrillation of the heart.

　　This treatment method acts on the gastrointestinal pacemaker on the body surface. For patients, it is non-invasive and painless, has good compliance, is more conducive to patients' acceptance, and can also be used as an auxiliary treatment to effectively alleviate the symptoms of Diabetes Gastroparesis.

　　Whether it is traditional Chinese medicine, western medicine or non drug treatment, in order to reduce clinical symptoms and help patients solve their problems as soon as possible, it is often necessary to adopt comprehensive treatment according to the specific situation of patients. A variety of treatments complement each other, give play to their respective advantages and remedy each other's shortcomings. Only in this way can the cure rate of Diabetes Gastroparesis be greatly improved and the quality of life of patients be greatly improved.

　　Integrated diagnosis and treatment machine:

　　Diabetes Gastroparesis

　　Recommended biofeedback gastrointestinal motility instrument

　　Is there any equipment integrating detection and treatment? have

　　Gastrointestinal electricity detection and analysis:

　　The Biofeedback Gastrointestinal Dynamometer of Kuancheng Technology automatically collects human gastrointestinal electrical signals by acting on gastrointestinal pacemaker points on the body surface through electrode sheets, calculates and analyzes the collected gastrointestinal electrical signals through special software, and objectively reflects the gastrointestinal peristalsis of patients and the strength of gastrointestinal motility.

　　This diagnostic method is non-invasive, painless, and has no side effects. It can be cross referenced with gastrointestinal endoscopy, X-ray barium meal and other morphological examinations, providing an objective basis for the comprehensive diagnosis, treatment and efficacy judgment of gastrointestinal diseases.

　　Treatment of functional gastrointestinal diseases:

　　The biofeedback gastrointestinal motility instrument is developed according to the basic principle of 'gastrointestinal pacing'. It uses modern electronic technology to generate gastrointestinal bioelectrical signals similar to the basic electrical rhythm of normal human gastrointestinal, acts on gastrointestinal acupoints on the surface of the body, causes the electrical activity of gastrointestinal pacing points to produce a 'follow effect', restores the normal rhythm, and achieves the purpose of treating a variety of functional gastrointestinal diseases.

　　Through multi center clinical treatment and observation, the effective rate of biofeedback gastrointestinal motility instrument in the treatment of functional constipation and postprandial discomfort syndrome is higher than 80%, bringing patients a new diagnosis and treatment experience.

　　Therefore, for the diagnosis and treatment of Diabetes Gastroparesis, we recommend a biofeedback gastrointestinal motility instrument integrating detection and treatment.

　　This product breaks the limitations of traditional medical treatment and greatly enriches the clinical diagnosis and treatment of Diabetes Gastroparesis. It has the advantages of non-invasive, painless, significant curative effect, safety and no side effects. It can be widely used in the detection and treatment of functional gastrointestinal diseases.