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In 87 randomly selected diabetic patients (67 type 1, 20 type 2) and 25 control subjects, gastric emptying of digestible solid and liquid meals and oesophageal transit of a solid bolus were measured with scintigraphic techniques. Gastrointestinal symptoms, autonomic nerve function and glycaemic control were evaluated in the diabetic patients. Gastric emptying and oesophageal transit were slower (P less than 0.001) in the diabetic patients compared with the control subjects, and each was delayed in about 40% of them. There was a relatively weak (r = 0.32; P less than 0.01) relationship between solid and liquid gastric emptying, and no significant correlation (r = 0.11, NS) between oesophageal transit and gastric emptying of the solid meal. Scores for upper gastrointestinal symptoms and autonomic nerve function correlated weakly (r = 0.21; P less than 0.05) with both oesophageal transit and gastric emptying. Gastric emptying of the liquid meal was slower (P less than 0.05) in patients with blood glucose concentrations greater than 15 mmol/l. These results indicate that gastric emptying in patients with diabetes mellitus should be assessed by liquid as well as by solid test meals and that oesophageal transit should not be used as a predictor of generalised diabetic gastroenteropathy.

SUMMARYThe gastric emptying of a mixed solid and liquid meal was assessed in 24 normal subjects using a single camera/computer system which allowed continuous monitoring of both solids and liquids. It was shown that variation in tissue attenuation caused by the changing depth of radionuclide within the stomach accounted for large errors in the measurement of gastric emptying (alteration in 50% emptying time of up to 65%). A technique for the correction of attenuation is described which used factors derived from a lateral image of the stomach. In all subjects, solid emptying was slower than liquid emptying and was characterised by a delay (lag period) which was followed by linear emptying. Liquid emptying usually followed a single exponential pattern. The effect of physiological changes induced by increasing the calorie content of the liquid component of the meal was assessed by giving either water, 10% dextrose or 25% dextrose. Liquid emptying was slowed and the lag period of solid was prolonged as the calorie content increased. Reproducibility was assessed in 19 subjects. For the three groups studied (water, 10% dextrose, 25% dextrose) the day-to-day variation in gastric emptying was not significant for any measured parameter, while statistically significant differences were present in solid and liquid emptying between subjects and groups.Radionuclide methods are being used increasingly to study the gastric emptying of both solid and liquid components of a meal and by these means disorders of gastric emptying and of the distribution of solid and liquid components of a meal within the stomach have been shown.

Gastric emptying of a digestible solid and liquid meal and oesophageal emptying of a solid bolus were measured with scintigraphic techniques in 20 randomly selected Type 2 (non-insulin-dependent) diabetic patients receiving oral hypoglycaemic therapy and 20 control subjects. In the diabetic patients, the relationships between oesophageal emptying, gastric emptying, gastrointestinal symptoms, autonomic nerve function and glycaemic control were examined. The percentage of the solid meal remaining in the stomach at 100 min (p less than 0.001), the 50% gastric emptying time for the liquid meal (p less than 0.05) and oesophageal emptying (p less than 0.05) were slower in the diabetic patients compared to the control subjects. Scores for upper gastrointestinal symptoms and autonomic nerve dysfunction did not correlate significantly (p greater than 0.05) with oesophageal, or gastric emptying. The 50% gastric emptying time for the liquid meal was positively related (r = 0.58, p less than 0.01) to the plasma glucose concentration at the time of the performance of the gastric emptying test and the lag period, before any solid food emptied from the stomach, was longer (p less than 0.05) in subjects with plasma glucose concentrations during the gastric emptying measurement greater than the median, compared to those with glucose concentrations below the median. These results indicate that delayed gastric and oesophageal emptying occur frequently in Type 2 diabetes mellitus and that delayed gastric emptying relates, at least in part, to plasma glucose concentrations.

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Gastric emptying was studied with a double radioisotopic method in 12 patients with insulin-dependent diabetes mellitus complicated by autonomic neuropathy and in 22 control subjects. In the diabetics, the acute and chronic effects of oral domperidone on gastric emptying, symptoms of gastroparesis, and glycemic control were assessed. Gastric emptying of solid and liquid was slower in diabetics than controls (P less than 0.001). Acute administration of domperidone increased the rate of both solid and liquid emptying (P less than 0.005). Domperidone was most effective in those patients with the greatest delay in gastric emptying. After chronic administration (35-51 days), domperidone had no significant effect on solid emptying (P greater than 0.05), but was still effective in increasing liquid emptying (P less than 0.025). Symptoms of gastroparesis were less after domperidone (P less than 0.001).