Gastric myoelectrical activity in patients with type I diabetes mellitus and autonomic neuropathy

Abstract

In patients with diabetes mellitus and gastroparesis, dysrhythmias of gastric myoelectrical activity, especially tachygastrias, are thought to be involved in the pathogenesis of dyspeptic symptoms. Using surface electrogastrography we studied the prevalence of these abnormalities, and their relationships to dyspeptic symptoms and the extent of cardiac autonomic neuropathy in 30 euglycemic patients with type I diabetes mellitus and 12 controls. Neither in the fasting nor in the postprandial state were differences in mean frequency of gastric electrical control activity and its variability found between patients and controls. In the fasting state, the power content of the 3 cpm component in the power spectrum of the electrogastrogram was even higher in patients than in controls (P = 0.049). In the fasting state, second harmonics of the 3 cpm fundamental gastric signal were seen more often in patients than in controls (P = 0.03). In patients with symptoms during the study, no second harmonics were found after the meal. The postprandial/fasting power ratio was decreased in patients with symptoms during the study as compared to patients without symptoms and controls (P < 0.05). The incidence of dysrhythmias, such as tachygastrias and bradygastrias, was not higher in patients than in controls (17% and 8%, respectively). No correlation was found between electrogastrographic parameters and the severity of autonomic neuropathy or dyspeptic symptoms scored before the study. In conclusion, this study has shown that patients with type I diabetes mellitus and autonomic neuropathy studied under euglycemic conditions do not have grossly disturbed myoelectrical activity, except when symptomatic during the study.

Effects of Epalrestat, an Aldose Reductase Inhibitor, on Diabetic Neuropathy and Gastroparesis

“…Recently, the usefulness of EGGhas also been reported (19)(20)(21)(22) perimentally, it has been demonstrated that EGGpatterns are similar to electrical activities and motion patterns directly recorded on the mucosalor serous surface of the stomach. A decrease in the amplitude of 3 cpm waves and an increase in the size of spectral componentsof bradygastria and tachygastria by EGGhave been reported in patients with diabetic gastroparesis (23).…”

Selective Reversal of Hyperglycemia-Evoked Gastric Myoelectric Dysrhythmias by Nitrergic Stimulation in Healthy Humans

“…Disturbances of gastric myoelectric activity are prominent in diabetics with nausea and vomiting (Jebbink et al, 1994a). The gastric slow wave regulates the direction of propagation and the maximal frequency of phasic contractions in the distal stomach, thus abnormal slow wave patterns are postulated to underlie many gastric dysmotility syndromes (Stern et al, 1987b).…”

“…Slow wave activity is measured using EGG, the findings of which show close correlations with recordings from serosal electrodes (Chen et al, 1994). Rhythm disturbances such as tachygastria and bradygastria are observed in up to 75% of patients with diabetic gastroparesis (Koch et al, 1989;Rothstein et al, 1993;Jebbink et al, 1994a). These dysrhythmias have been reported to improve, but not resolve, with eating suggestive of mediation by mealrelated mechanical or neurochemical factors (Mathur et al, 2001).…”

“…Several factors are proposed to underlie symptoms in patients with diabetic gastropathy including delayed gastric emptying, impaired antral contractions, pylorospasm, heightened sensitivity to distention, and abnormal gastric myoelectrical activity (Feldman and Schiller, 1983;Mearin et al, 1986;Jebbink et al, 1994a;Samsom et al, 1995). In nauseated diabetics, myoelectric abnormalities including tachygastria and bradygastria are prominent and relate to the degree of glycemic control (Jebbink et al, 1994b).…”

Abnormal Gastric and Small Intestinal Motor Function in Diabetes mellitus

“…EGG studies have shown that in diabetic patients dysrhythmias, mainly tachygastrias (>3.7 cycles per minute), are more prevalent than in healthy volunteers [20,33], Although the prevalence of dysrhythmias varies in EGG studies, they seem to occur preferen tially during symptomatic periods [34]. These mvoelectrical abnormalities may play an im portant role in the genesis of abnormal con tractile activity of the stomach and hence in delayed gastric emptying.…”