Effects of duodenal distension on antropyloroduodenal pressures and perception are modified by hyperglycemia

Abstract

Marked hyperglycemia (blood glucose ∼15 mmol/l) affects gastrointestinal motor function and modulates the perception of gastrointestinal sensations. The aims of this study were to evaluate the effects of mild hyperglycemia on the perception of, and motor responses to, duodenal distension. Paired studies were done in nine healthy volunteers, during euglycemia (∼4 mmol/l) and mild hyperglycemia (∼10 mmol/l), in randomized order, using a crossover design. Antropyloroduodenal pressures were recorded with a manometric, sleeve-side hole assembly, and proximal duodenal distensions were performed with a flaccid bag. Intrabag volumes were increased at 4-ml increments from 12 to 48 ml, each distension lasting for 2.5 min and separated by 10 min. Perception of the distensions and sensations of fullness, nausea, and hunger were evaluated. Perceptions of distension ( P < 0.001) and fullness ( P < 0.05) were greater and hunger less ( P < 0.001) during hyperglycemia compared with euglycemia. Proximal duodenal distension stimulated pyloric tone ( P < 0.01), isolated pyloric pressure waves ( P < 0.01), and duodenal pressure waves ( P< 0.01). Compared with euglycemia, hyperglycemia was associated with increases in pyloric tone ( P < 0.001), the frequency ( P < 0.05) and amplitude ( P < 0.01) of isolated pyloric pressure waves, and the frequency of duodenal pressure waves ( P < 0.001) in response to duodenal distension. Duodenal compliance was less ( P < 0.05) during hyperglycemia compared with euglycemia, but this did not account for the effects of hyperglycemia on perception. We conclude that both the perception of, and stimulation of pyloric and duodenal pressures by, duodenal distension are increased by mild hyperglycemia. These observations are consistent with the concept that the blood glucose concentration plays a role in the regulation of gastrointestinal motility and sensation.

The role of continuous subcutaneous insulin infusion therapy in patients with diabetic gastroparesis

“…Acute hyperglycaemia has been shown to induce relaxation of the proximal stomach, suppression of the frequency and propagation of antral pressure waves, and an increase in pyloric tone. Moreover, marked hyperglycaemia can also produce tachygastria and un-coordinated motor activity of different parts of the stomach [8,9]. Studies have also shown that acute hyperglycaemia slows gastric emptying of both solid and liquid nutrients in patients with established autonomic neuropathy and can also attenuate the prokinetic effect of intravenous erythromycin on gastric emptying [5,10].…”

Identification and Characterization of Glucoresponsive Neurons in the Enteric Nervous System

“…Thus, the excitability of glucoresponsive neurons is determined by the extracellular glucose concentration. This may explain why acute changes in the blood glucose concentration have a substantial effect on gastrointestinal motor reflexes (MacGregor et al, 1976) and visceral sensation (Lingenfelser et al, 1999). Although it has been assumed that the gastrointestinal motor symptoms and alterations in gut sensations observed in patients with diabetes mellitus were part of a generalized autonomic neuropathy, they may actually be produced by changes in the activity of enteric neurons.…”

Malabsorption, Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Type 2 Diabetic Patients: A Connection

“…Studies have shown that marked hyperglycemia, which is characteristic of diabetes, decreases the motility index and propagation of duodenal and jejunal waves [5], reduces the cycle length of interdigestive motor activity in the fasted state [6], and slows small-intestinal transit [7,8]. Elevation of the blood glucose to the upper end of the physiological range decreases duodenal compliance while increasing the stimulation of duodenal waves [9].…”