Characterization of Upper Gastrointestinal Symptoms, Gastric Motor Functions, and Associations in Patients with Diabetes at a Referral Center

Chedid, Victor; Brandler, Justin; Vijayvargiya, Priya; Park, Seon-Young; Szarka, Lawrence A.; Camilleri, Michael

doi:10.1038/s41395-018-0234-1

Cited by 54 publications

(59 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Initially described in patients with dumping syndrome after gastric surgery, iatrogenic dumping syndrome (ie, after gastric bypass surgery and fundoplication) is among the most common causes of rapid gastric emptying (GE). Other diseases (eg, diabetes mellitus (DM), autonomic neuropathy or postural orthostatic tachycardia syndrome [POTS]) and functional gastrointestinal disorders (eg, diarrhea, non‐ulcer dyspepsia, and cyclic vomiting syndrome) are also associated with rapid gastric emptying (GE) . Indeed, among patients with DM and upper gastrointestinal symptoms who undergo scintigraphy, approximately one in five have rapid GE .…”

Section: Introductionmentioning

confidence: 99%

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

Kuwelker

Muthyala

O’Connor

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

Aims Some patients with upper gastrointestinal symptoms have rapid gastric emptying (GE). We aimed to compare patients with normal and rapid GE and to identify phenotypes among patients with rapid GE. Methods Among 2798 patients who underwent GE scintigraphy, we compared patients with normal and rapid GE and separately, patients with rapid GE at 1 hour (GE1), 2 hours (GE2), or both (GE12). Results In 2798 patients, GE was normal (74%), delayed (18%), or rapid (8%). Among 211 patients with rapid GE, patterns were rapid GE1 (48%), 2 hours (17%), or 1 and 2 hours (35%); 42 (20%) had diseases that explain rapid GE. A combination of upper and lower gastrointestinal symptoms (54%) was more common that isolated upper (17%) or lower (28%) gastrointestinal symptoms (P < .001). Constipation was more prevalent in patients with rapid GE 2 (72%) than rapid GE 1 (47%) or rapid GE12 hours (67%) (P < .05). Among 179 diabetes mellitus (DM) patients, 15% had rapid GE, which was not associated with the DM phenotype. By multivariable analysis, insulin therapy (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.15‐0.88), and weight loss (OR, 0.10; 95% CI, 0.01‐0.78) were associated with a lower risk of rapid than normal GE in DM. Conclusions Eight percent of patients undergoing scintigraphy had rapid GE, which is most frequently associated with upper and lower gastrointestinal symptoms; constipation is common. Insulin therapy and weight loss were associated with a lower risk of rapid than normal GE in DM patients.

show abstract

Section: Introductionmentioning

confidence: 99%

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

Kuwelker

Muthyala

O’Connor

et al. 2020

Neurogastroenterology Motil

View full text Add to dashboard Cite

show abstract

“…Overall, 71.3% had DM2; one‐third of the patients were insulin‐requiring and had fairly well‐controlled diabetes [median HbA1c 6.7% (IQR 6.2; 7.9)]. Manifestations of diabetic triopathy (peripheral neuropathy, nephropathy, and retinopathy) and treatments are documented elsewhere . GA was abnormal (<428 mL) in 39% patients.…”

Section: Resultsmentioning

confidence: 99%

“…In 108 adults with DM1 or DM2 evaluated over a period of 18 years, we evaluated original two‐dimensional images obtained during measurements of GE of solids by scintigraphy and GA by SPECT. The demographics, symptoms, complications of diabetes, medications to treat diabetes, and concomitant medications are described in detail elsewhere . The study was approved by Mayo Clinic Institutional Review Board (IRB #16‐008776‐01).…”

Section: Methodsmentioning

confidence: 99%

“…From the medical records review of 108 adults with DM1 or DM2 presenting with UGI symptoms, we summarized symptom clusters as follows: nausea/vomiting, belching/heartburn, bloating/abdominal pain, fullness/satiety, and abdominal discomfort/pain …”

Section: Methodsmentioning

confidence: 99%

“…Impaired GA by noninvasive imaging has been documented in about 50% of 1287 patients and in 39% of individuals with diabetes mellitus type 1 or type 2 (DM1 or DM2) presenting with upper gastrointestinal (UGI) symptoms . With novel therapeutic approaches available to treat impaired accommodation, such as buspirone and acotiamide, a recent editorial emphasized the importance of measuring this aspect of gastric motor function and recommended the need to develop and validate a readily accessible method to assess GA …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Gastric accommodation measurements by single photon emission computed tomography and two‐dimensional scintigraphy in diabetic patients with upper gastrointestinal symptoms

Halawi

Brandler

Burton

et al. 2019

Neurogastroenterology Motil

Self Cite

View full text Add to dashboard Cite

Objective To compare estimates of gastric accommodation (GA) with single photon emission computed tomography (SPECT) to measurements based on intragastric meal distribution immediately post‐meal ingestion (IMD0). Methods We evaluated 108 diabetics with upper gastrointestinal (UGI) symptoms who had undergone gastric emptying of solids (GE) by scintigraphy and GA measurements by SPECT. Immediately after ingestion of a 99mTc‐labeled egg meal (time 0), we estimated IMD0 as radioactive counts or area of the proximal half of the stomach on two‐dimensional images. Gastric volume (GV) during fasting and after 300 mL Ensure® was measured by SPECT to quantify accommodation volume (AV) or postprandial to fasting volume ratio (GVR). From the measured proximal gastric area, we estimated the volume of proximal stomach (4/3 × π × r3). We performed regression analyses to assess relationships between IMD0 and GA (AV) and GVR. Results There was a significant correlation between area and radioactivity counts in the proximal stomach (r = 0.67, P < 0.001); however, there was considerable interpersonal variation [bias 0.20 (95% CI −0.07, 0.47)]. There were no significant correlations between total GV or AV or VR by SPECT and measurements using IMD0: proximal gastric counts, area, and estimated volume as continuous variables of dichotomized patient groups, based on published cutoff values. There were no significant differences in total gastric area or the IMD0 parameters (% area or % radioactive counts) between those with and without UGI symptoms except for fullness and satiety. Conclusions Intragastric meal distribution immediately post‐meal ingestion is not significantly correlated with GA measurement by SPECT.

show abstract

Upper Gastrointestinal Manifestations of Diabetes

Camilleri

2021

Clinical Dilemmas in Diabetes

View full text Add to dashboard Cite

Characterization of Upper Gastrointestinal Symptoms, Gastric Motor Functions, and Associations in Patients with Diabetes at a Referral Center

Abstract: Among referred diabetic patients with UGI symptoms, GE and GA testing identifies potential targets for individualizing treatment and avoidance of empirical trials for the 28% with no disturbance of GE and GA.

Cited by 54 publications

References 48 publications

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

Gastric accommodation measurements by single photon emission computed tomography and two‐dimensional scintigraphy in diabetic patients with upper gastrointestinal symptoms

Upper Gastrointestinal Manifestations of Diabetes

Contact Info

Product

Resources

About