인슐린 비의존형 당뇨병 ( NIDDM ) 환자에서 신경계 합병증이 위배출 시간에 미치는 영향에 관하여 = Gastric Emptying in Patients with Non - insulin - Dependent Diabetes Mellitus인슐린 비의존형 당뇨병 ( NIDDM ) 환자에서 신경계 합병증이 위배출 시간에 미치는 영향에 관하여

다국어 초록 (Multilingual Abstract)

Diabetic gastroparesis is a well recognized complication of longstanding diabetics, which may manifest clinically as nausea, vomiting, abdominal pain and bloating. Gastroparesis is characterized by delayed gastric emptying as demonstrated by sequential imaging. But the etiology of diabetic gastroparesis is still uncertain. Among various possible causative factors, there is the greatest support for visceral autonomic neuropathy. In order to determine the relationship between diabetic gastroparesis and neurologic complications of diabetes, gastric emptying of technetium labeled liquid and solid meals was studied in 20 healthy adults for the control group and 54 diabetic patients, of which 18 were diabetics without neurologic complication (group A), 18 were diabetics combined with peripheral neuropathy (group B), 18 were diabetics with both peripheral and autonomic neuropathy (group C). The liquid meal was prepared with 300ml saline solution labeled with 500μCi of 99mTc-DTPA and the solid meal was prepared with cooked egg white labeled with 500 μCi of 99mTc-tin colloid. The results were as follows: 1) In control subjects, gastric emptying time (GET) was 19.4±7.0 minutes in the liquid meal test and 51.9±27.0 minutes in the solid meal test. In groups of no neuropathy (A) and peripheral neuropathy (B), GET was 23.3±13.8 minutes and 26.8±15.0 minutes each for liquid meals and 56.9±24.9 minutes and 62.3±32.0 minutes each for solid meals. Gastric liquid and solid emptying were similiar in groups A, B and controls. 2) In the group of peripheral and autonomic neuropathy (C), GET was 49.2±15.4 minutes and 106.5±36.6 minutes for liquid and solid meals respectively. GET of liquid and solid were prolonged markedly in group C (p<0.01 versus controls, group A and B). 3) We found 7 patients (29%) with diabetic gastroparenesis among 24 patients. Among these 7, 1 was in group B and 6 were in group C. Also, 7 patients with gastrointestinal symptoms were found, 2 were in group B and 5 were in group C. In the study, gastric emptying time was significantly delayed in group C and the frequncy of gastrointestinal symptoms was more common in this same group. There was a close relationship between diabetic nuropathy, especially autonomic neuropathy and gastroparesis. 4) Asymptomatic gastroparesis was not infrequent in diabetics. We found 3 patients (13%) with asymptomatic gastroparesis among 24 patients. 5) The duration of diabetes, age of the patient and diabetic control (blood sugar) were independent of gastroparesis, but, we found that diabetic gastroparesis had a significant correlation with the severity of neuropathy and the presence of symptoms. These findings suggest that visceral autonomic neuropathy is an important underlying factor in diabetic gastroparesis.