Gastrointestinal motility disorders in patients with diabetes mellitus (original) (raw)
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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...
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."
Scandinavian Journal of Gastroenterology, 1991
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."
The Tohoku Journal of Experimental Medicine, 1983
Lower esophageal sphincter pressure (LESP), gastric emptying, small bowel transit time and plasma motilin levels were measured in diabetics and normal subjects in order to investigate the disturbances of the alimentary tract motility and the participation of motilin in these motility disorders. Hypermotilinemia was observed in all diabetics with or without autonomic neuropathy. Low response of LESP to tetragastrin found in diabetics with autonomic neuropathy could not be explained by motilin. Gastric emptying was highly correlated with fasting plasma motilin levels and a significantly accelerated gastric emptying observed in diabetics without complications or diabetics with diarrhea was considered to be due to hypermotilinemia. On the contrary, no significant correlation was observed between small bowel transit time and plasma motilin levels, suggesting no participation of endogenous motilin in the regulation of small bowel transit.-lower esophageal sphincter pressure; gastric emptying; small bowel transit time; motilin; diabetic autonomic neuropathy Disturbances of the alimentary tract motility have been observed frequently in the patients with diabetes mellitus. Swallowing disorder in diabetics with neuropathy-gastroenteropathy (Mandelstram et al. 1969), significantly fast gastric emptying of a liquid meal in diabetics without complications (Dotevall 1961), and delayed small bowel transit time in diabetics with autonomic neuropathy (Scarpello et al. 1976) have been reported to date. On the other hand, motilin, discovered by Brown et al. (Brown 1967; Brown et al. 1972), is well known to affect lower esophageal sphincter (Itoh et al. 1976), gastric emptying (Christofides et al. 1979, 1981) and small bowel transit time (Ruppin et al. 1976). Motilin has been considered to be one of the most important gut hormones affecting the
Gut, 1997
Background-Hyperglycaemia delays gastric emptying, both in healthy controls and in patients with diabetes mellitus. The effect ofhyperglycaemia on antroduodenal motility in diabetes has not yet been studied. Aim-To investigate the gastrointestinal motor mechanisms involved in the hyperglycaemia induced retardation of gastric emptying in patients with type I diabetes mellitus and autonomic neuropathy. In eight diabetic patients antroduodenal manometry was performed simultaneously with scintigraphic measurement of emptying of a mixed solid-liquid meal, during euglycaemia (5-8 mmol/l glucose) and hyperglycaemia (16-19 mmol/l glucose), on separate days, in random order. Results-Hyperglycaemia decreased the cumulative antral motility index from 38-3 (range 24.2-47.6) to 30-8 (range 17.3-38.1) (p=0.025) and reduced the number of antral pressure waves propagated over .4-5 cm (p=0.04). Duodenal phase III-like activity was seen irrespective of the glycaemic state (in three patients during euglycaemia and in four patients during hyperglycaemia). Hyperglycaemia significandy affected gastric emptying of the solid meal: it prolonged the lag phase from 20-0 minutes to 28 5 minutes (p=0.02), increased the 50% emptying time from 73'5 minutes to 104'5 minutes (p=0'03), and increased the percentage of isotope remaining in the stomach after 120 minutes from 33.5% to 46.5% (p=0.02). The cumulative antral motility index was correlated with the 50% emptying time (r=0.75, p=002) during euglycaemia, but not during hyperglycaemia (r=0.28, p=0-31). Liquid emptying was not influenced by the blood glucose concentration. Conclusions-Hyperglycaemia reduces postprandial antral contractile activity and its organisation in patients with type I diabetes and autonomic neuropathy. These changes in antroduodenal motility are likely to constitute the mechanism through which gastric emptying of solids is delayed during high blood glucose concentrations in these diabetic patients.
Gut, 1992
Twenty six patients with insulin dependant diabetes meilitus underwent a gastric emptying test, a gail bladder contraction test, an orocaecal transit study, and a colon transit test. Eleven patients had signs of cardiovascular autonomic neuropathy, 15 patients were without signs of cardiovascular autonomic neuropathy. Mean gastric clearance of radioopaque markers ingested with a meal averaged 29-5 (2.3) markers per six hours in subjects without cardiovascular autonomic neuropathy compared with 17*8 (2.3) markers per six hours in patients with cardiovascular autonomic neuropathy (p<002). Gail bladder emptying in response to graded CCK8 stimulation was impaired in five of 11 patients with cardiovascular autonomic neuropathy, whereas it was normal in the patients without cardiovascular autonomic neuropathy (p<0.01). Oral caecal transit times were not significantly different in the two patient groups, whereas colonic transit was slower in the patients with cardiovascular autonomic neuropathy compared with the group without cardiovascular autonomic neuropathy (p<0-02). There was no correlation between disturbed gastric clearance, impaired gall bladder contraction, and prolonged colonic transit time in the patients with cardiovascular autonomic neuropathy nor was there a correlation between any disturbed motor function and age or duration ofdiabetes. It is concluded that autonomic neurophathy can affect motor functions throughout the gastrointestinal tract. Any disturbed motor function in the gut could therefore be one of the numerous expressions of diabetic neuropathy affecting the cardiovascular, the endocrine or the gastrointestinal system.
Gastrointestinal Motility in Elderly Patients with Well-Controlled Type 2 Diabetes Mellitus
Arquivos de Gastroenterologia
Background: Gastrointestinal (GI) motility disorders in type 2 diabetes mellitus (T2DM) are common. However, the endpoints in well-controlled T2DM in elderly patients are barely understood. Objective: To evaluate GI transit and gastric myoelectric activity in elderly patients with T2DM who were undergoing treatment with metformin and to compare them with non-diabetic healthy controls. Methods: A total of thirty participants were enrolled in this study: young non-diabetic (n=10), elderly non-diabetic controls (n=10), and patients with T2DM managed with metformin (n=10). After fasting overnight, the participants ingested a standard meal and magnetic markers for non-invasive monitoring of GI transit and gastric contractility using the alternating current biosusceptometry and electrogastrography techniques. Results: Mean gastric emptying time, mean colon arrival time, and mean intestinal transit time were determined. There were no significant differences between the groups and in the pa...
The Relationship Between Clinical Factors and Gastrointestinal Dysmotility in Diabetes Mellitus
Neurogastroenterology & Motility, 1991
ABSTRACT Motility of the stomach and upper intestine was studied in 84 consecutive diabetic patients referred to the Mayo Clinic for evaluation of functional symptoms (nausea, vomiting, or epigastric pain in the absence of structural or mucosal abnormalities). Manometric abnormalities were found in 81 of 84 patients who successfully completed a 3-hour fast and 2-hour postprandial motility evaluation. Antral hypomotility was found in 9 patients, small intestinal dysmotility in 11, and gastric and small-intestinal dysmotilities in 61. The most common abnormalities were the absence of a fed motility pattern after ingestion of the meal and the presence of abnormal intestinal bursts during the fasting period. Clinical factors such as type and duration of diabetes, fasting serum glucose and glycosylated hemoglobin levels, daily dose of insulin therapy, presence of autonomic neuropathy, peripheral neuropathy, retinopathy, and vascular disease were not significantly associated with the severity of gastrointestinal dysmotility. However, there was a significant association between the number of extraintestinal diabetic complications and the severity of gastrointestinal dysmotility (p < 0.05). We conclude that clinical factors, by and large, are not helpful in predicting the severity of gastrointestinal dysmotility among symptomatic diabetic patients.
Decreased Gastric Motility in Type II Diabetic Patients
BioMed Research International, 2014
Background. To differentiate gastric motility and sensation between type II diabetic patients and controls and explore different expressions of gastric motility peptides. Methods. Eleven type II diabetic patients and health volunteers of similar age and body mass index were invited. All underwent transabdominal ultrasound for gastric motility and visual analogue scales. Blood samples were taken for glucose and plasma peptides (ghrelin, motilin, and glucacon-like peptides-1) by ELISA method. Results. Gastric emptying was significantly slower in diabetic patients than controls (T50: 46.3 (28.0-52.3) min versus 20.8 (9.6-22.8) min, ≤ 0.05) and less antral contractions in type II diabetic patients were observed ( = 0.02). Fundus dimensions did not differ. There were a trend for less changes in gastrointestinal sensations in type II diabetic patients especially abdomen fullness, hunger, and abdominal discomfort. Although the serum peptides between the two groups were similar a trend for less serum GLP-1in type II diabetic patients was observed ( = 0.098). Conclusion. Type II diabetic patients have delayed gastric emptying and less antral contractions than controls. The observation that there were lower serum GLP-1 in type II diabetic patients could offer a clue to suggest that delayed gastric emptying in diabetic patients is not mainly influenced by GLP-1.
Diabetic gastropathy and prokinetics
The American journal of gastroenterology, 2003
The treatment of diabetic gastropathy, which here refers to a clinical syndrome of upper GI tract symptoms suggestive of an upper motility disturbance in diabetes whether or not there is delayed gastric emptying, remains suboptimal. New prokinetics and other motility-modifying agents may prove useful, but adequate clinical trials will be required to establish a role for them. However, diabetic gastropathy seems to represent a heterogenous syndrome in terms of pathophysiology, which potentially complicates the design of new randomized, controlled trials. This review aims to provide guidelines for future trials in this field. The evidence that delayed gastric emptying is a cause of symptoms in diabetic gastropathy is critically evaluated. The trial evidence supporting the short and long term efficacy of prokinetics is reviewed. Based on the available literature, it is concluded that improvement in gastric emptying does not equate with symptom relief in diabetic gastropathy. It is sugg...