Modified Fuzi Lizhong Decoction Alleviates Colonic Lesions and Modulates Gut Microbiota in Diabetic Gastroparesis

Introduction Diabetic gastroparesis (DGP) is a debilitating complication of diabetes mellitus. This study investigated the therapeutic effects of Modified Fuzi Lizhong decoction (MFZLZD) on DGP. Methods A DGP rat model was established through a high-fat diet combined with an irregular feeding schedule. Rats were treated with MFZLZD (5 or 20 g/kg) or mosapride (positive control; 1 mL/100 g) for 7 weeks. Body weight and gastric parameters (gastric emptying, peristalsis, and blood flow) were assessed. Histopathological alterations in gastric and colonic tissues were evaluated via HE staining, while goblet cell density was quantified by AB-PAS staining. The expression of tight junction proteins was analyzed using immunofluorescence. Finally, 16S rRNA sequencing of fecal samples was performed to characterize alterations in the gut microbiota. Results MFZLZD significantly increased body weight and effectively restored gastric function in DGP rats. Moreover, MFZLZD treatment attenuated gastric and colonic mucosal injury, preserved goblet cell populations, and upregulated tight junction protein expression. Gut microbiota diversity was altered in DGP rats and was partially restored following MFZLZD treatment. Changes in 33 key microbial taxa were observed between groups. Discussion MFZLZD improved gastric function and reinforced intestinal barrier integrity in DGP rats. The observed changes in gut microbiota composition suggest a potential association between alterations in the gut microbiota and the therapeutic effects of MFZLZD, although the underlying mechanisms remain unclear and require further investigation. Conclusion MFZLZD represents a promising therapeutic strategy for DGP and is associated with improvements in intestinal barrier integrity, gastric function, and gut microbiota composition.