A randomised control trial of gastric meal with and without prior jejunal feeding on GI symptoms and response in patients with diabetic gastroparesis, diabetic controls and healthy volunteers (J4G)
1st April 2012
About 1 in 20 patients with diabetes suffer from severe nausea, vomiting and pain on eating. This problem has been linked to slow stomach emptying (“gastroparesis”) and impacts on nutrition, diabetic (sugar) control, quality of life and life expectancy. Hospital admissions are frequent and costs are high. Investigations show no structural abnormality, infection or inflammation, rather abnormal stomach function underlies the condition.
Medical treatments for diabetic gastroparesis (DG) are rarely effective and feeding into the bowel beyond the stomach (“jejunal-feeding”) is sometimes required to support patients that are losing weight. Benefits follow improved nutrition; however, we noticed that some patients recovered immediately and could eat normally after jejunal-feeding: an effect like a medication. One explanation for these observations is that DG represents a failure of food taken by mouth to “switch-on the stomach”.
The primary aim of this study is to assess whether jejunal-feeding can improve DG symptoms after a meal. At the same time, digestive function will be visualized by Magnetic Resonance Imaging and hormones involved in “switching on” the stomach after a meal will be measured. Diabetic patients with and without DG and healthy volunteers (12 participants in each group) will be studied twice. On both occasions, a feeding tube placed into the jejunum by endoscopy. Then, in randomized order and without the patient or researcher knowing which is given, either liquid nutrient or water will be delivered into the jejunum. After that the tube will be removed and a test meal taken by mouth with patient symptoms and digestive function monitored throughout. By comparing and contrasting symptoms and digestive function after meals in each group we hope to identify new targets for effective medical treatment of this distressing condition. Additionally, DG patients will be kept under regular review to assess acceptance and long-term outcome of treatment, including jejunal feeding.
|Professor Robin Spiller||Robin's main interest is in the pathophysiology of functional GI diseases, particularly focusing on the role of infection and inflammation and alterations in serotonin metabolism in the irritable bowel syndrome. He has twice edited the British Society of…|
|Dr Luca Marciani||I graduated in Physics at the University of Genoa in Italy. I then worked in Milan and London before joining the University of Nottingham, where I was awarded my PhD in Physics. Following a series of multi-disciplinary research contracts and Fellowships…|