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OBJECTIVE -Data on the prevalence of abnormal gastric emptying in diabetic patients are still lacking. The relation between gastric emptying and dyspeptic symptoms assessed during gastric emptying measurement has not yet been investigated. The aim was to investigate the prevalence of delayed gastric emptying in a large cohort of unselected diabetic patients and to investigate the relation between gastric emptying and gastrointestinal sensations experienced in the 2 weeks before and during the test meal, prospectively.RESEARCH DESIGN AND METHODS -Gastric emptying was evaluated in 186 patients (106 with type 1 diabetes, mean duration of diabetes 11.6 Ϯ 11.3 years) using 100 mg 13 C-enriched octanoic acid added to a solid meal.RESULTS -Gastric emptying was significantly slower in the diabetic subjects than in the healthy volunteers (T 50 : 99.5 Ϯ 35.4 vs. 76.8 Ϯ 21.4 min, P Ͻ 0.003; Ret 120 min : 30.6 Ϯ 17.2 vs. 20.4 Ϯ 9.7%, P Ͻ 0.006). Delayed gastric emptying was observed in 51 (28%) diabetic subjects. The sensations experienced in the 2 weeks before the test were weakly correlated with the sensation scored during the gastric emptying test. Sensations assessed during the gastric emptying test did predict gastric emptying to some extent (r ϭ 0.46, P Ͻ 0.0001), whereas sensations experienced in the previous 2 weeks did not.CONCLUSIONS -This prospective study shows that delayed gastric emptying can be observed in 28% of unselected patients with diabetes. Upper gastrointestinal sensations scored during the gastric emptying tests do predict the rate of gastric emptying to some extent and sensation experienced during daily life does not. Diabetes Care 26:3116 -3122, 2003T he prevalence of delayed gastric emptying in patients with diabetes has been subject to debate for several decades. Cross-sectional studies using scintigraphic techniques to measure gastric emptying have shown delayed gastric emptying in patients with diabetes varying from 30 to 60% (1-11). However, there are several important limitations to these studies. First, the vast majority of these studies have been performed in small numbers of patients or in selected patients, which may account for the high percentage of patients showing delayed gastric emptying in some of these studies. Second, none of these studies has been performed during relative euglycemic conditions, whereas recent studies have provided evidence that hyperglycemia has a substantial effect on the rate of gastric emptying (12,13). After taking the aforementioned into account, the prevalence of delayed gastric emptying in diabetic patients who are not selected for gastrointestinal symptoms has yet to be determined.Previous studies have reported a weak association between gastric emptying and upper gastrointestinal symptoms experienced by patients in the period preceding the gastric emptying test, with the exception of the study performed by Jones et al. (10). They studied a large cohort of diabetic subjects over a period Ͼ10 years and reported that abdominal bloating and fullness were as...

Background-Studies have shown that an altered visceral perception threshold plays a role in the pathogenesis of upper gastrointestinal tract symptoms in dyspeptic patients. However, it is not clear whether the compliance and adaptive relaxation of the proximal stomach contribute to the symptoms. Aims-To investigate whether abnormal relaxation or adaptation of the proximal stomach during the interdigestive state and the postprandial phase could explain the symptoms of functional dyspepsia. Subjects-Twelve volunteers and 12 patients with dysmotility-like functional dyspepsia were included in the study. Methods-An electronic barostat was used to investigate adaptation to distension of the proximal stomach and accommodation in response to a liquid meal. Dyspeptic symptoms during distension and accommodation were assessed. Results-When the subjects were in the fasting state, the pressure-volume curve showed slightly higher compliance in the dyspeptic patients (p<0.05). Patients not only had a higher score for nausea, bloating, and pain but also the increase in nausea and pain scores with intragastric pressure was higher than in volunteers (p<0.05). The increase in intragastric bag volume in response to a meal was significantly lower in patients (p<0.05). Both bloating and pain significantly increased in the patients (p<0.05), but not in the healthy volunteers. Conclusions-Patients with functional dyspepsia show slightly higher compliance to mechanical distension. Their visceral perception of mechanical stress is enhanced. In contrast with the balloon distension, relaxation after a meal was less. Therefore the postprandial symptoms cannot be explained fully by greater global tension in the stomach wall, as assessed by the barostat technique. Visceral hypersensitivity plays a major role in the pathogenesis of the symptoms. (Gut 1998;42:823-829)

Since noncardiac chest pain is the only well-established indication for 24-hr esophageal pH and pressure recording, the analysis of the association between chest pain episodes and esophageal motility abnormalities or reflux is the most important part of data analysis in 24-hr monitoring. Until now, different time windows have arbitrarily been used by various research groups. The aim of this study was to determine the optimal time window for symptom analysis in 24-hr esophageal pH and pressure monitoring. For this purpose repetitive symptom association analysis was carried out, using time windows of various onsets and durations. For each time window, the symptom indices for reflux and dysmotility were calculated. The symptom index for both reflux and dysmotility showed a gradual increase for windows with increasingly early onset, following a pattern that would be predicted on the basis of Poisson's theory. However, both indices had a relatively sharp cutoff point at 2 min before the onset of pain. Both indices only showed a predictable gradual increase when the time window starting at -2 min was extended beyond the moment of pain onset. It is concluded that the optimal time window for symptom analysis in 24-hr esophageal pH and pressure recording begins at 2 min before the onset of pain and ends at the onset of pain.

Background and aims: The pathogenesis of asymptomatic diverticular disease (ADD) and symptomatic uncomplicated diverticular disease (SUDD) has not been elucidated. The aim of our study was to assess whether altered visceral perception or abnormal compliance of the colorectal wall play a role in these clinical entities. Methods: Ten ADD patients, 11 SUDD patients, and nine healthy controls were studied. Using a dual barostat device, sensations were scored and compliance curves obtained using stepwise intermittent isobaric distensions of the rectum and sigmoid, before and after a liquid meal. In addition, the colonic response to eating was assessed by monitoring the volumes of both barostat bags at operating pressure before and after the meal. Results: In the rectum, perception was increased in the SUDD group compared with controls (p = 0.010) and the ADD group (p = 0.030). Rectal compliance curves were not different between the groups. In the sigmoid colon, perception in the pre-and postprandial periods was increased in SUDD compared with controls (p = 0.018) but not when compared with ADD. Sigmoid volume-pressure curves had comparable slopes (compliance) in all groups but were shifted downwards in SUDD compared with ADD in the preprandial period (p = 0.026). The colonic response to eating (decrease in intrabag volume) was similar in all three groups, both in the rectum and sigmoid. Conclusion: Symptomatic but not asymptomatic uncomplicated diverticular disease is associated with heightened perception of distension, not only in the diverticula bearing sigmoid, but also in the unaffected rectum. This hyperperception is not due to altered wall compliance.

Stretching the stomach wall in young healthy subjects causes an increase in muscle sympathetic nerve activity and in blood pressure, the gastrovascular reflex. We compared healthy elderly subjects with healthy young subjects to find out whether the gastrovascular reflex attenuates in normal ageing and we studied whether there was a difference in autonomic function or gastric compliance that could explain this possible attenuation. Muscle sympathetic nerve activity, finger blood pressure and heart rate were continuously recorded during stepwise isobaric gastric distension using a barostat in eight healthy young (6 men and 2 women, 27 ± 3.2 years, mean ± s.e.m.) and eight healthy elderly subjects (7 men and 1 woman, 76 ± 1.5 years). Changes in cardiac output and total peripheral arterial resistance were calculated from the blood pressure signal. The baseline mean arterial pressure and muscle sympathetic nerve activity were higher in the elderly group (both P < 0.05) and muscle sympathetic nerve activity increase during the cold pressor test was lower in the elderly group (P = 0.005). During stepwise gastric distension, the elderly subjects showed an attenuated increase in muscle sympathetic nerve activity compared to the young subjects (P < 0.01). The older group tended to show a higher increase in mean arterial pressure (P = 0.08), heart rate (P = 0.06) and total peripheral arterial resistance (P = 0.09) The cardiac output rose slightly in both groups without significant difference between groups. The fundic compliance did not differ between groups. We conclude that stepwise gastric distension caused an increase in muscle sympathetic nerve activity in both groups, but the increase in the elderly was attenuated.

These data suggest that morphine administration affects antroduodenal motility in mechanically ventilated patients. The gastrointestinal motor pattern involved in impaired gastric emptying in morphine-treated patients is characterized by antral hypomotility and persisting duodenal activity fronts during continuous intragastric feeding. The observed motility patterns suggest that early administration of enteral feeding might be more effective into the duodenum or jejunum than into the stomach of mechanically ventilated patients.