TOPICAL QUESTIONS OF THE EARLY DIAGNOSTICS OF DIABETIC GASTROPARESIS IN THE PRACTICE OF A FAMILY PHYSICIAN
DOI:
https://doi.org/10.11603/1811-2471.2017.v1.i3.7955Keywords:
questionnaire, diabetes mellitus, diabetic gastroparesis, family physician.Abstract
Resume. The aim of the study was to investigate the issue of the early diagnostics of gastroparesis manifestations in patients with diabetes mellitus (DM) with the help of specific questionnaires. Materials and methods: 240 patients with DM were examined. They carried out a survey, as an early screening of motor dysfunction of the stomach, using two questionnaires: the evaluation of symptoms typical for diseases of the upper gastrointestinal tract «Patient Assessment of Upper Gastrointestinal Disorders-Symptoms» (PAGI-SYM) and the index definition of gastroparesis manifestations «Gastroparesis Cardinal Symptom Index» (GCSI). The assessment of the reliability of the survey results was completed with the determination of the coefficient of internal compliance and criteria validity through the correlations between questionnaires scales and the 13C-octane acid breath test (13C-OABT), which was determined with the help of the correlation coefficient. Statistical analysis of the results was performed using SPSS15. Results: the symptoms of the diabetic gastroparesis (DG) were found in 36.7% of people with DM type 1 and in 43.3% of patients with DM type 2. The relation between the clinical manifestations of complications and the results of 13C-OABT was established. It was suggested the diagnostic algorithm: a thorough study of the patient’s complaints and anamnesis of life and disease, physical examination with the subsequent use of GCSI questionnaires and the evaluation of the results. If the total score is from 1 to 11 – light degree of DG, from 12 to 22 points – of the medium gravity, 23-33 – severe, and more than 34 points – very severe. To evaluate the M-EF of the stomach 13C-OABT was performed: normal index – the time of semiejection (Т ½) of gastric contents in the duodenum is 40-75 minutes, the acceleration of motility, if the T ½ is less than 40 minutes, the mild slowdown motility – 75-95 minutes, from 96 to 115 minutes – moderate slowdown, more than 115 minutes – severe slowdown. This diagnostic algorithm contributes to timely diagnosis of the early signs of DG by a family physician. Conclusion: The routine use of specific questionnaires helps to prevent unjustified over diagnostics and allows to determine the degree of severity of gastroparesis in patients with diabetes and the effectiveness of therapy.References
Zviahintseva, T. D., Chernobai, A. I. (2015). Functional disorders of organs of the digestive system and their combinations in the light of modern conceptions. [Funktsionalʹni zakhvoryuvannya orhaniv travlennya ta yikh poyednannya u svitli suchasnykh uyavlenʹ: vid patohenezu do likuvannya.]. Modern Gastroenterology - Suchasna hastroenterolohiya,, 3(83), 61-72. [in Ukrainian].
Ismailov, S.I., Muminova, S.U. (2016). The role of questionnaires in the evaluation of quality of life of patients with diabetes mellitus (literature review). [Rolʹ oprosnykov v otsenke kachestva zhyzny patsyentov s sakharnym dyabetom (obzor lyteratury).] International journal of endocrinology - Mezhdunarodnyy éndokrynolohycheskyy zhurnal, 2(74), 152-157. [in Russian].
Makhov, V. M., Mel'nychenko, H. A., Budennaya, Y. Yu., Volodyna, V. T., Hlynkyna, Y. V., Zylov, A. V. (2014). Dyabetycheskyy hastroparez. [ Dyabetycheskyy hastroparez.]. RMZh - RMZh, 15, 1133-1136. [in Russian].
Perederyy, V.H.& Tkach, S. M. (2012). Nervno-mushechnaya funktsyya zheludka v norme y pry patolohyy: sovremennue metodu dyahnostyky y korrektsyy: metod. posob. (ISBN 978-966-2443-12-7). [Nervno-myshechnaya funktsyya zheludka v norme y pry patolohyy: sovremennye metody dyahnostyky y korrektsyy: metod. posob. (ISBN 978-966-2443-12-7).]. RPKh «FERZ'». - RPKH «FERZʹ»., 48 s. [in Russian].
Trukhan D.Y., Tarasova L.V., Trukhan L.Yu. (2013). Hastroenterolohycheskye narushenyya u patsyentov s sakharnum dyabetom. [Hastroénterolohycheskye narushenyya u patsyentov s sakharnym dyabetom.] Spravochnyk vracha obshchey praktyky - Spravochnyk vracha obshchey praktyky, 8, 51–59. [in Russian].
Camilleri, M., Bharucha, A. E., & Farrugia, G. (2011). Epidemiology, mechanisms, and management of diabetic gastroparesis. Clinical Gastroenterology and Hepatology, 9(1), 5-12.
Darwiche, G., Mohammed, S.K., Aldawi, N., Skaria, S. & Tesfa, Y. (2014). Gastroparesis among Type 1 and Type 2 Diabetic Patients in the United Arab Emirates. Journal of Diabetes Mellitus, 4, 96-106.
http://dx.doi.org/10.4236/jdm.2014.42016.
Halland, M., Bharucha, A. E. (2016). Relationship Between Control of Glycemia and Gastric Emptying Disturbances in Diabetes Mellitus. Clin. Gastroenterol. Hepatol., 14 (7), 929-936.
Horváth, V. J., Izbéki, F., Lengyel, C., Kempler, P. & Várkonyi, T. (2014). Diabetic Gastroparesis: Functional/Morphologic Background, Diagnosis, and Treatment Options . Curr Diab Rep , 14, 527. http://dx.doi.org/10.1007/s11892-014-0527-8.
Kashyap, P., Farrugia, G. (2010). Diabetic Gastroparesis: what we have learned and had to unlearn in the past 5 years. Gut, 59, 1716-1726.
Kindt S., Dubois D., Oudenhove L. V., Caenepeel P., Arts J., Bisschops R. & Tack J. (2009). Relationship between symptom pattern, assessed by the PAGI-SYM questionnaire, and gastric sensorimotor dysfunction in functional dyspepsia. Neurogastroenterol Motil, 21, 1183-e105. doi: 10.1111/j.1365-2982.2009.01374.
Krishnan, B., Babu, S., Walker, J., Walker, A.B. & Pappachan, J.M. (2013). Gastrointestinal Complications of Diabetes Mellitus. World Journal of Diabetes, 4, 51-63. http://dx.doi.org/10.4239/wjd.v4.i3.51.
Majanović, S. K., Zelić, M., Belančić, A., Girotto, N., Licul, V. & Štimac, D. (2017). Diabetic gastroparesis – from diagnosis to gastric electrical stimulation treatment. Medicina fluminensis, 1 (53), 50-55. doi: 10.21860/medflum2017_173380.
Pop-Busui, R., Boulton, A.J.M., Feldman, E. L., Bril, V., Freeman, R., Malik, R. A., Sosenko, J. M. & Ziegler, D. (2017). Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care, 40, 136-154. doi: 10.2337/dc16-2042.
Revicki D. A., Camilleri M., Kuo B., Norton N. J., Murray L., Palsgrove A. & Parkman H. P. (2009). Development and content validity of a gastroparesis cardinal symptom index daily diary. Alimentary Pharmacology & Therapeutics, 30, 670-680. doi:10.1111/j.1365-2036.2009.04078.
