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Abnormal Intragastric Distribution of a Liquid Nutrient Meal in Patients with Diabetes Mellitus

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Abstract

Disordered gastric motility and emptying arewell known complications of diabetes mellitus (DM), butthe pattern of intragastric distribution of food has notbeen extensively studied in diabetics. We examined the partition of a liquid nutrient meal betweenthe proximal and distal stomach and the relationshipsbetween intragastric distribution of food and gastricemptying (GE) and the symptoms in DM patients with and without autonomic neuropathy (AN).Fourteen healthy volunteers and 20 DM patients (13 withAN; 9 with dyspepsia symptoms) ingested a liquidnutrient meal (250 ml; 437 kcal) labeled with[99mTc]phytate. Anterior and posterior serial images of thestomach were taken for 90 min with a gamma camera.Regions of interest for the proximal and the distalhalves of the stomach and for the total gastric areawere defined. Counts from each region along timeallowed estimation of GE and the proportion of activityretained in the proximal stomach after meal ingestion(initial) and throughout GE (mean). GE half-times in controls (median; range: 66 min; 29-90 min)were not significantly different from diabetics (76 min;5->150 min, P > 0.10), but abnormal GE was foundin 11 DM patients (seven delayed and four rapid). In DM patients, initial retention inthe proximal stomach (42%; 16-79% ) was significantlylower (P < 0.02) than in controls (55%; 44-71%). Meanretention in the proximal stomach throughout emptying also was significantly lower (P <0.05) in DM patients (43%; 18-58%) than in controls(51%; 32-69%). There were no differences betweensubgroups of patients with normal, delayed, or rapid gastric emptying regarding mean meal retentionin the proximal stomach. Patients with evidence of AN orwith dyspepsia symptoms had significantly decreasedretention of food in the proximal stomach throughout gastric emptying. We concluded that patientswith diabetes mellitus have abnormally decreasedretention of gastric contents in the proximal stomachafter a liquid meal, which seems to be related to the occurrence of autonomic neuropathy anddyspepsia symptoms, but not to disordered gastricemptying.

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REFERENCES

  1. Feldman M, Schiller IR: Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 98:378-384, 1983

    PubMed  Google Scholar 

  2. Horowitz M, Ede lbroek M, Frase r R, Maddox A, Wishart J: Disordered gastric motor function in diabetes mellitus. Recent insights into prevalence, pathophysiology, clinical relevance, and treatment. Scand J Gastroenterol 26:673-684, 1991

    PubMed  Google Scholar 

  3. Horowitz M, Smout AJPM: Disordered esophageal and gastric motility in diabetes mellitus. Adv Endocrinol Metabol 4:81- 114, 1993

    Google Scholar 

  4. Oliveira RB, Troncon LEA, Meneghelli UG, Dantas RO, Godoy RA: Gastric accommodation to distension and early gastric emptying in diabetics with neuropathy. Braz J Med Biol Res 17:49-55, 1984

    PubMed  Google Scholar 

  5. Phillips WT, Schwartz JG, McMahan CA: Rapid gastric emptying of an oral glucose solution in type 2 diabetic patients. J Nucl Med 33:1496-1500, 1992

    PubMed  Google Scholar 

  6. Frank JW, Swalow SB, Camilleri M, Thomforde GM, Dineen S, Rizza RA: Mechanism of accelerated gastric emptying of liquids and hype rglycemia in patients with type II diabetes mellitus. Gastroenterology 109:755-765, 1995

    PubMed  Google Scholar 

  7. Malagelada J-R, Azpiroz F: Determinants of gastric emptying and transit in the small intestine. InHandbook of Physiology, Section 6: The Gastrointestinal Tract, Vol 1, part 2. JD Wood (ed). Bethesda, Maryland, American Physiological Society, 1989, pp 909-937

    Google Scholar 

  8. Read NW, Houghton LA: Physiology of gastric emptying and pathophysiology of gastroparesis. Gastroenterol Clin North Am 18:359-373, 1989

    PubMed  Google Scholar 

  9. Collins PJ, Horowitz M, Chatterton BE: Proximal, distal and total stomach emptying of a digestible solid meal in normal subjects. Br J Radiol 11:12-18, 1988

    Google Scholar 

  10. Urbain JL, Siegel JA, Cherkes ND, Maurer AH, Malmud LJ, Fisher RS: The two-component stomach: effects of meal particle size on fundal and antral emptying. Eur J Nucl Med 15:254-259, 1989

    PubMed  Google Scholar 

  11. Houghton LA, Mangnall YF, Read NW: Effect of incorporating fat into a liquid test meal on the relation between intragastric distribution and gastric emptying in human volunteers. Gut 31:1226-1229, 1990

    PubMed  Google Scholar 

  12. Collins PJ, Houghton LA, Read NW, Horowitz M, Chatterton BE, Heddle R, et al: Role of the proximal and distal stomach in mixed solid and liquid me al emptying. Gut 32:615-619, 1991

    PubMed  Google Scholar 

  13. Scott AM, Kellow JE, Shuter B, Cowan H, Corbett AM, Riley JW, et al: Intragastric distribution and gastric emptying of solids and liquids in functional dyspepsia: Lack of influence of symptom subgroups and H. pylori-associated gastritis. Dig Dis Sci 38:2247-2254, 1993

    PubMed  Google Scholar 

  14. Troncon LEA, Bennett RJM, Ahluwalia NK, Thompson DG: Abnormal intragastric distribution of food during gastric emptying in functional dyspepsia patients. Gut 35:327-332, 1994

    PubMed  Google Scholar 

  15. Urbain JL, Vekemans MC, Bonillon R, Van Caute ren J, Bex M, Mayeur SM, et al: Characterization of gastric antral motility disturbances in diabetes using a scintigraphic technique. J Nucl Med 34:576-581, 1993

    PubMed  Google Scholar 

  16. Jones KL, Horowitz M, Wishart JM, Maddox AM, Harding PE, Chatterton BE: Re lationship between gastric emptying, intragastric me al distribution and blood glucose concentrations in diabete s mellitus. J Nucl Med 12:2220-2229, 1995

    Google Scholar 

  17. Rosa-e-Silva L, Troncon LEA, Oliveira RB, Iazigi N, Gallo L Jr, Foss MC: Tre atment of diabetic gastropare sis with oral clonidine. Aliment Pharmacol Ther 9:179-183, 1995

    PubMed  Google Scholar 

  18. Rosa-e-Silva L, Troncon LEA, Oliveira RB, Foss MC, Braga FJHN, Gallo L Jr: Rapid distal small bowel transit associated with sympathe tic denervation in type I diabete s mellitus. Gut 39:748-756, 1996

    PubMed  Google Scholar 

  19. Unger HR, Foster DW: Diabete s Mellitus. InTextbook of Endocrinology. JD Wilson, DW Foster (eds). Philadelphia, WB Saunders, 1985, pp 1018-1080

    Google Scholar 

  20. Marin Neto JA, Gallo L Jr, Manço JC, Rassi A, Amorim DS: Postural reflexe s in chronic Chagas' disease. Cardiology 60:343-357, 1975

    PubMed  Google Scholar 

  21. Tothill P, McLoughlin GP, Holt S, Heading RC: The e ffect of posture on errors in gastric emptying me asurements. Phys Med Biol 25:1071-1077, 1980

    PubMed  Google Scholar 

  22. Marin Neto JA, Gallo L Jr, Manço JC, Rassi A, Amorim DS: Mechanisms of tachycardia on standing: Studies in normal individuals and in chronic Chagas' heart patients. Cardiovasc Re s 14:541-550, 1980

    Google Scholar 

  23. Santos-e-Fonseca CMC, Manço JC, Gallo L Jr, Barreira AA, Foss MC: Cholinergic bronchomotor tone and airway caliber in insulin-dependent diabetes mellitus. Chest 101:1038-1043, 1992

    PubMed  Google Scholar 

  24. Ewing DJ, Clarke BF: Diagnosis and management of diabetic autonomic neuropathy. BMJ 285:916-918, 1982

    PubMed  Google Scholar 

  25. Siegel S: Non-parametric Statistics for the Behavioural Sciences. New York, McGraw Hill, 1956

    Google Scholar 

  26. Undeland KA, Hausken T, Suebak S, Aande rud S, Be rstadt A: Wide gastric antrum and low vagal tone in patients with diabetes mellitus type 1 compared to patients with functional dyspepsia and healthy individuals. Dig Dis Sci 41:9-16, 1996

    PubMed  Google Scholar 

  27. Undeland KA, Hausken T, Aande rud S, Be rstadt A: Lower postprandial gastric volume response in diabetic patients with vagal neuropathy. Neurogastroenterol Motil 9:19-24, 1997

    Article  PubMed  Google Scholar 

  28. Hausken T, Berstadt A: Wide antrum in patients with nonulcer dyspepsia. Effect of cisapride. Scand J Gastroente rol 27:427-432, 1992

    Google Scholar 

  29. Nowak TV, Brosnan M: Abnormal gastric emptying and impaired inhibitory neuromuscular transmission in diabetic rodent stomach. J Gastrointest Motil 5:208, 1993

    Google Scholar 

  30. Malagelada J-R, Ree s WDW, Mazzotta LJ, Go VLW: Gastric motor abnormalities in diabetic and postvagotomy gastropare sis: Effect of metoclopramide and bethanecol. Gastroente rology 78:286-293, 1980

    Google Scholar 

  31. Fox S, Behar J: Pathogenesis of diabetic gastropare sis—a pharmacologic study. Gastroenterology 78:757-763, 1980

    PubMed  Google Scholar 

  32. Andrews PLR, Grundy D, Scratche rd T: Vagal afferent discharge from mechanore ceptors in different re gions of the ferret stomach. J Physiol 298:513-524, 1980

    PubMed  Google Scholar 

  33. Grundy D, Huston D, Rudge LJ, Scratcherd T: Prepyloric me chanisms regulating gastric motor function in the conscious dog. Q J Exp Physiol 74:857-865, 1989

    PubMed  Google Scholar 

  34. Werth B, Meyer-Wyss B, Spinas GA, Drewe J, Beglinge r C: Non-invasive asse ssment of gastrointestinal motility disorders in diabetic patients with and without cardiovascular signs of autonomic neuropathy. Gut 33:1199-1203, 1992

    PubMed  Google Scholar 

  35. Camilleri M, Malagelada J-R: Abnormal intestinal motility in diabetics with the gastropare sis syndrome. Eur J Clin Invest 14:420-427, 1984

    PubMed  Google Scholar 

  36. Nowak TV, Johnson CP, Kalbfleisch JH, Roza AM, Wood CM, We isbruch JP, Gorgel KH: Highly variable gastric emptying in patients with insulin dependent diabete s mellitus. Gut 37:23-29, 1995

    PubMed  Google Scholar 

  37. Mearin F, Camilleri M, Malage lada J-R: Pyloric dysfunction in diabetes with recurrent nausea and vomiting. Gastroenterology 90:1919-1925, 1986

    PubMed  Google Scholar 

  38. Koch KL, Stern RM, Stewart WR, Vasey MW: Gastric emptying and gastric myoe lectrical activity in patients with diabetic gastropare sis: Effect of long term domperidone. Am J Gastroente rol 84:69-75, 1989

    Google Scholar 

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Authors
  1. L. E. A. Troncon
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  2. L. Rosa-E-Silva
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  3. R. B. Oliveira
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  4. N. Iazigi
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  5. L. Jr. Gallo
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  6. M. C. Foss
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Troncon, L.E.A., Rosa-E-Silva, L., Oliveira, R.B. et al. Abnormal Intragastric Distribution of a Liquid Nutrient Meal in Patients with Diabetes Mellitus. Dig Dis Sci 43, 1421–1429 (1998). https://doi.org/10.1023/A:1018834025351

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