Gastroparesis of digestible and indigestible solids in patients with insulin-dependent diabetes mellitus or functional dyspepsia (original) (raw)
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Prevalence of Gastroparesis in Type 1 Diabetes Mellitus and its Relationship to Dyspeptic Symptoms
2010
Background and Aim: Gastroparesis and/or dyspeptic symptoms occur in around 50% of type 1 diabetic patients. The aim of our study was to evaluate the prevalence of gastroparesis in patients with type 1 diabetes using 13 Coctanoic acid breath test ( 13 C-OBT) and the relationship between dyspeptic symptoms and gastric emptying. Methods: Gastric emptying of solids was evaluated prospectively in euglycemic conditions in 69 type 1 diabetic patients (male/female: 36/33; mean age 49.5 ± 14.2 years; mean duration of diabetes 20.4 ± 8.2 years) and 40 healthy volunteers (male/female 17/23; mean age 34.3 ± 16 years) using 13 C-OBT. Dyspeptic symptoms, autonomic nerve function and Helicobacter pylori (H. pylori) status were assessed. Results: Solid gastric emptying was slower in diabetic patients (T1/2=125.36 ± 31.5min) than in healthy subjects (T1/2=88.5 ± 27.3 min) (p<0.05). Gastric emptying was slower in diabetic female compared to diabetic male patients (p<0.05). Body mass index (BMI) was the only independent predictor for delayed solid gastric emptying in a logistic regression model testing HbA1c, BMI, age, diabetes duration, H. pylori status, peripheral neuropathy, retinopathy, nephropathy, and autonomic neuropathy. Abdominal bloating and upper abdominal pain were associated with delayed gastric emptying. Conclusions: We found that 33.7% of type 1 diabetic patients had delayed gastric emptying that correlated with female gender, increased BMI, abdominal bloating and upper abdominal pain.
EMJ Diabetes, 2021
Gastrointestinal (GI) symptoms represent an important and often poorly appreciated reason of morbidity in diabetes mellitus. Diabetes can affect nearly all parts of the GI tract; however, data on the prevalence of ‘diabetic gastroenteropathy’ are inconsistent. The significance of disturbed GI motility in diabetes across the patient spectrum and pathophysiological basis also remain inadequately defined. Fluctuating glucose levels, altered drug pharmacokinetics, variable absorption of nutrients, and impaired quality of life are important consequences of GI dysfunction. Diabetic gastroparesis is the best characterised manifestation of GI motility disorder in diabetes. Since there is a poor correlation between subjective GI symptoms and objective motility findings, a diagnosis of delayed emptying in diabetes requires a proper measurement of gastric emptying. There are fewer studies on intestinal motility in diabetes than those on the stomach. Several established modalities exist for the...
Vomiting and Dysphagia Predict Delayed Gastric Emptying in Diabetic and Nondiabetic Subjects
Journal of Diabetes Research, 2014
Background.Gastroparesis is a heterogeneous disorder most often idiopathic, diabetic, or postsurgical in nature. The demographic and clinical predictors of gastroparesis in Israeli patients are poorly defined.Methods.During the study period we identified all adult patients who were referred to gastric emptying scintigraphy (GES) for the evaluation of dyspeptic symptoms. Of those, 193 patients who were referred to GES from our institution were retrospectively identified (76 (39%) males, mean age60.2±15.6years). Subjects were grouped according to gastric half-emptying times (gastricT1/2). Demographic and clinical data were extracted from electronic medical records or by a phone interview.Key Results.Gastric emptying half-times were normal (gastricT1/20–99 min) in 101 patients, abnormal (gastricT1/2100–299 min) in 67 patients, and grossly abnormal (gastricT1/2≥300 min) in 25 patients. Vomiting and dysphagia, but neither early satiety nor bloating, correlated with delayed gastric emptyi...
clinical practice Diabetic Gastroparesis
A 36-year-old man with a 20-year history of type 1 diabetes mellitus, background retinopathy, peripheral sensory neuropathy, and nephropathy presents with a history of several months of nausea and vomiting of undigested food and bile, during which time he lost 4 kg. On physical examination (performed 1 hour after the patient has eaten), his blood pressure is 130/80 mm Hg while he is lying down and 110/60 mm Hg while he is standing. His abdomen is not tender. There is epigastric distention, but no splash is audible when the upper abdomen is shaken. How should the gastrointestinal symptoms of this patient be evaluated and treated?
Diabetic Medicine, 2007
Aims/hypothesis Among diabetic patients, glucose homeostasis may be affected by abnormal gastrointestinal motility and autonomic neuropathy. This study analysed whether oesophageal dysmotility, delayed gastric emptying or autonomic neuropathy affect glucose homeostasis. Materials and methods Oesophageal manometry and gastric emptying scintigraphy were performed in 20 diabetic patients. Heart-rate variation during deep breathing (expiration/inspiration [E/I] ratio) and continuous subcutaneous glucose concentrations for a period of 72 h were also monitored in the same patients.
Malecular Imaging and Radionuclide Therapy, 2017
Objective: Gastroparesis is defined as delayed gastric emptying and is a common medical condition in diabetic patients. Scintigraphy is commonly used as a standard diagnostic procedure for the quantitative assessment of gastroparesis. The aims of this study were to determine an optimum imaging time for the diagnosis of gastroparesis, to assess the prevalence of gastroparesis, to evaluate the correlation between endoscopy and scintigraphy findings as well as the correlation between gastric emptying with patient genders, blood glucose concentration, and functional dyspepsia. Methods: Gastric emptying was assessed in 50 diabetic patients with a mean age of 50.16 years. For evaluation of gastric emptying, a test meal containing 2 pieces of toast, 120 cc non-labeled water and fried egg labeled with 1 mCi of 99m Tc was given to each patient. The scintigraphy was performed immediately after ingestion and was repeated at 1, 1.5, 2 and 4 hours after ingestion. In some patients, an additional 90-minute dynamic scan was also acquired. Results: The prevalence of gastroparesis in this study population was determined as 64%. Also, the results of this study revealed that a 4-hour scan after ingestion is more relevant than a 90-minute dynamic scan for the evaluation of delayed gastric emptying. There was no statistically significant difference between 1-hour and 2-hour scans, 1-hour and 90-minute scans, 2-hour and 90-minute scans, 2-hour and 4-hour scans. Likewise there was no significant correlation between blood glucose levels, gender and calculated values of gastric emptying time in all groups. Conclusion: According to our findings, it can be suggested that the prevalence of gastroparesis is higher than that mentioned in some previous studies. Also, this study indicates that a gastric emptying scintigraphy at 2 and 4 hours after meal ingestion might provide the anticipated clinical information in diabetic patients with dyspepsia without other evident reasons.
Disordered gastric motor function in diabetes mellitus
Diabetologia, 1994
The application of novel investigative techniques has demonstrated that disordered gastric motility occurs frequently in diabetes mellitus. Gastric emptying is abnormal in about 50 % of diabetic patients and delay in gastric emptying of nutrient-containing meals is more common than rapid emptying. The blood glucose concentration influences gastric motility in diabetes. In IDDM patients, gastric emptying is retarded during hyperglycaemia and may be accelerated by hypoglycaemia. Gastroparesis therefore does not necessarily reflect irreversible autonomic neuropathy and blood glucose concentrations must be monitored when gastric motility is evaluated in diabetic patients. There is a poor relationship between gastric emptying and gastrointestinal symptoms and the mechanisms by which abnormal motility causes symptoms are unclear. The introduction of new gastrokinetic drugs has improved therapeutic options for the management of symptomatic patients with gastroparesis considerably. The contribution of disordered gastric emptying to poor glycaemic control is unclear, but the demonstration that the rate of gastric emptying is a major factor in normal blood glucose homeostasis suggests that this is likely to be significant. [Diabetologia (1994) 37: 543-551] Abbreviations: IDDM, insulin-dependent diabetes mellitus; NIDDM, non-insulin-dependent diabetes mellitus Prevalence and natural history "I believe that this syndrome -gastroparesis diabeticorum -is more often overlooked than diagnosed."
Pathophysiology of Diabetic Gastroparesis
Diabetes, 1997
Our understanding of the nature of diabetic gastroparesis has advanced in the last decade due to new investigational procedures (electrogastrography, visceral evoked potential recording), and transferring these insights into clinical routine will be our task in the future. Meanwhile, the clinical relevance of gastroparesis—whether overt or silent—remains unquestioned: proper gastric emptying is a prerequisite for adequate metabolic control, and its disturbance may result not only in further progression of the chronic complications of the disease, but also in the false assumption that these patients are not compliant with their doctor's management—the patients just may have delayed emptying of their stomach without noticing it.
Digestive Diseases and Sciences, 1996
Autonomous neuropathy in patients with diabetes is associated with dysmotility and abdominal discomfort. The disturbances resemble to some extent those seen in patients with functional dyspepsia. To gain further insight into the disorders, we compared patients with long-standing diabetes, patients with functional dyspepsia, and healthy individuals with respect to abdominal symptoms, width of gastric antral area, and autonomic nerve function. We investigated 42 type I diabetic outpatients by structured interview for abdominal discomfort, ultrasonography of the gastric antrum, assessment of w~gal and sympathetic nerve function by respiratory sinus arrhythmia and skin conductance, and measurement of blood sugar and HbAlc. Immediately after a standard meal of soup with meat, 21 (50%) of the 42 patients with diabetes complained of abdominal discomfort (pain, bloating, fullness), which was significantly less frequent (95c~ CI of difference 0.03-0.5) than previously seen in patients with functional dyspepsia (76%), and significantly more frequent (95% CI of difference 0.3-0.6) than that seen in healthy individuals (4%). Bloating was the most marked postprandial complain!. Mean fasting antral area was significantly wider in patients with diabetes (mean 4.9 cm-, SD 1.7) compared to healthy individuals (mean 3.5 cm-, SD 1.2), 95q: CI of difference 0.6-2.2 cm 2. Mean postprandial antral area was 14.8 cm~ (SD 4.6) in the patients with diabetes, which is insignificantly wider than in patients with functional dyspepsia (mean 13.0 cm 2, SD 4.0) but significantly wider (95% CI of difference 1.9-6.5 cm 2) than that seen in healthy individuals (mean 10.6 cruZ, SD 3.8). The mean respiratory sinus arrhythmia was 0.7 beats/rain (SD 0.7) in the patients with diabetes, which was insignificantly lower than that seen in patients with functional dyspepsia (2.1 beats/rain, SD 4.5), and significantly lower (99% CI of difference 3.8-7.1 beats/rain) compared to healthy individuals (6.2 beats/rain, SD 3.8). It is concluded that patients with diabetes have a wider gastric antrum and more discomfort after a meal than healthy individuals. Compared to patients with functional dyspepsia, patients with diabetes have a wider postprandial antrum but fewer symptoms. The very low vagal tone seen in patients with diabetes may play an important role in the pathogenesis of their gastric filotility disturbance and postprandial abdominal discomfort.