Gastrointestinal neuroregulation in diabetic gastroenteropathy: Integrating molecular mechanisms and diagnostic approaches

Table 1 The advantages and limitations of the existing diagnostic methods for assessing gastrointestinal motility

Technology	Introduction to the methodology	Vantage	Disadvantage	Ref.
Wireless capsule endoscopy	A battery-powered capsule instrument, wearing a monitor, records data transmitted from the capsule until the capsule is excreted, for 3-5 days	Longer recording time, more comprehensive image recording	The capsule part is hard to swallow	[115]
Flexible piezoelectric sensors	It consists of 12 modules connected in series, each consisting of 10 polyimide polymers connected in parallel to detect GI pressure	Reduced risk of tissue perforation, device retention and GI tract obstruction	Invasive methods may cause trauma	[116]
Scintigraphy	Oral or gastric tube instillation of fluids containing trace amounts of radioisotopic 99mTc and capturing changes in the distribution of these tracers in the stomach by imaging equipment	Use of common foods; the ability to view intragastric meal distribution	Intolerance to standardized diets (most commonly eggs or gluten) in some patients	[117]
Mechanical magnetic gastrography	Magnetic imaging of the tracer was measured after administration of 5 μCi of a 99mTc -colloidal sulfur-labeled diet, punching the magnetic field (30mT over a 5 milliseconds period) for initial stimulation	Combining scintigraphy with magnetic resonance technology, biomagnetic imaging is safe and effective	Larger application costs	[118]
Gastric emptying breath test	Labeling of meals with carbon 13 into the stomach, conversion to coeliac radiolabeled substrate for digestion and absorption in the duodenum prior to entry into the duodenum, and then metabolism were measured in 7 breath samples taken over a 4-hour period to measure the percentage of 13 C	Safe, radiation-free and child-friendly; Non-invasive, high patient acceptance	Indirect measurements that may mask symptoms if combined with other conditions	[119]
Barium radiopaque marker	After fasting overnight, a capsule containing the barium marker was given in the middle of the test meal at 8:00 a.m. The first abdominal radiographs (posteroanterior views in supine and standing positions) were taken 2 hours later and then hourly until 6 hours after ingestion	Low equipment requirements, suitable for mass screening, visualization of stomach contents	Radiation exposure, long testing times are hard for patients to accept	[120]
Gastric power wave transform record	Long-term multi-channel recording signal processing integrates detection, segmentation, and summarization to monitor GI motility through spatiotemporal pattern recognition	Non-invasive, flexible, easy to operate, comfortable for long-term use	Can be affected by outside noise	[121]
High frequency intracavitary ultrasound	Integration of ultrasonic transducers with pressure catheters in conventional high-frequency ultrasound systems enables simultaneous acquisition of morphological and mechanical parameters for enhanced GI motility analysis	Observation of peristaltic contraction sequences; simultaneous observation of peristaltic anatomy and mechanics	Loss of acoustic coupling in air-filled organs during swallowing	[122]
Gastric sinus duodenal manometry	Perfusion of a gastroduodenal power catheter with high-resolution water, including 13 sensors 1 cm apart and 2 sensors 10 cm and 20 cm from the last of the 13 closely placed sensors, and confirmation of sensor placement by fluoroscopy across the gastric sinus duodenal (antropyloroduodenal) junction	Combined manual and automated quantitative methods for assessment are scientifically valid	A combination of other techniques is often needed to more accurately characterize gastric emptying	[123]
Body surface gastric labeling	High-resolution water-perfused power catheter with a 64-electrode array connected to a wearable reader to measure gastric electromyographic activity and associated contractions while performing validated symptom analysis	Complex bioamplifier and signal processing system for gastric electrophysiology with proven artifact detection and suppression	The reference range is not yet fully defined	[124]
Autonomic function testing	Includes changes in finger capillary pulsation position, cold vasoconstriction, and changes in electrocardiogram R-R interval during deep breathing	Non-invasive neurological function tests with high patient acceptance; does not involve dietary tests, less burden on patients with GI dysfunction	Indirect response to gastric emptying through autonomic function, influenced by neurologic factors	[125]
Time-series magnetic resonance imaging	Gastric emptying and motility were continuously assessed in a rapid image acquisition sequence. And 4D magnetic resonance imaging images were processed using a dedicated pipeline that included respiratory motion correction, gastric segmentation and partitioning, volumetric analysis of gastric emptying, and surface-reflection-based analysis of the frequency, amplitude, and phase relationships of gastric motility	Personalized gastric peristalsis and emptying curves to reveal peristaltic patterns; simultaneous assessment of multiple gastric parameters; algorithmic correction of respiratory motion errors	Gas in the stomach can have an effect on the results	[126]
Endoscopic combined constant voltage	Using an ultra-thin endoscope and a pressure-regulated endoscopic blow-in device, air is blown into the GI tract until a preset pressure is reached. Measurement of actual intragastric pressure using a fiber optic manometer placed in the stomach	GI manometry with observation of internal gastric changes	Complex and technically demanding, and may take a long time to complete the examination, increasing the patient's waiting time and discomfort	[127]
Satiation drinking test	Individuals consume fluids of known composition and/or calorie content at a rate for a predetermined period of time. At maximal satiety, the volume of liquid consumed is recorded, and gastric regulation and sensation are estimated	Simple operation and high patient acceptance	Possible patient discomfort due to overfeeding	[128]
Gastric electrostatic labeling	Skin electrodes were placed on the abdominal skin above the stomach to record gastric electromyographic activity	Non-invasive, radiation-free assay that directly reflects gastric electromyography activity	Motion artifacts and electrical disturbances in other internal organs can affect the results	[129]

GI: Gastrointestinal.