Gastrointestinal Motor Dysfunction, Symptoms, and Neuropathy in Noninsulin-Dependent (Type 2) Diabetes Mellitus

Abstract

Although relatively frequent. diabetic involvement of digestive tract motility has not been investigated extensively in different organs. The authors studied esophageal, gastric, and gallbladder motor function in 35 type 2 (noninsulin-dependent) diabetic patients to determine the extent of gut involvement. Of these patients, 27 (77%) had peripheral neuropathy, 12 (34%) had both peripheral and autonomic neuropathy, and 22 (63%) had gastrointestinal symptoms. Esophageal manometric abnormalities were recorded in 18 patients, and delayed radionuclide emptying of the esophagus was documented in 16 patients, with a 83% concordance between the two tests. Scintigraphic gastric emptying of solids was delayed in 56% of patients, whereas gallbladder emptying after cholecystokinin stimulation was reduced in 69% of them. In 74% of patients at least one of the viscera under investigation showed abnormal motor function; however, only 36% of patients displayed involvement of the three organs. Gastrointestinal symptoms, duration and therapy of diabetes, previous poor glycemic control, and retinopathy did not correlate with the presence or the extent of motor disorders. Neuropathy was not predictive of gastrointestinal involvement and its extent; however, when motor abnormalities were present in patients with neuropathy, these were usually more severe. Gastrointestinal motor disorders are frequent and widespread in type 2 diabetics, regardless of symptoms. Autonomic neuropathy has a poor predictive value on motor disorders (0.75 for the esophagus, 0.5 for the stomach, 0.8 for the gallbladder), thus suggesting the coexistence of other pathophysiologic mechanisms.

Monitoring of gallbladder and gastric coordination by EPI

“…Such data could also aid studies of gut hormone signaling (8,10) and the action of pharmacologic interventions (5,7). Importantly, such data could also help to clarify objectively the uncertain association between symptoms and gastrointestinal involvement in diseases such as diabetes with suspect visceral neuropathy (4) and hepatitis (4,9).…”

“…Such investigations have previously been conducted using gamma scintigraphy techniques (1,2,4,8), ultrasound (9), a combination of both ultrasound and scintigraphy (6), or ultrasound and the breath hydrogen test (3,5). However, such techniques suffer from known limitations such as poor spatial resolution, lack of three-dimensional capability, or use of radioactive materials ingested orally for the stomach and intravenously for the gallbladder.…”

Gastric Myoelectrical Activity in Patients with Diabetes

“…Changes in the normal digestive pattern occur in 30% to 50% of patients with diabetes (Annese et al, 1999;Enck & Frieling, 1997;Horowitz & Fraser, 1994, 1995Horowitz, Wishart, Jones, & Hebbard, 1996;Koch, 1999;Rothstein, 1999). Alterations in the normal digestive pattern cause a potential mismatch in circulating insulin and nutrient availability, which increases the number of hyper and hypoglycemic events (Berne, 1996;Enck & Frieling, 1997;Horowitz & Fraser, 1994;Horowitz et al, 1996;Koch, 1999).…”

“…Signs and symptoms reflecting alterations in normally coordinated movement of nutrients through the gastrointestinal tract such as nausea, vomiting, abdominal pain, anorexia, early satiety, or bloating usually occur in those patients experiencing alterations in digestion (Annese et al, 1999;Enck & Frieling, 1997;Horowitz & Fraser, 1994, 1995Horowitz et al, 1996;Koch, 1999;Keshavarzian, Iber, & Vaeth, 1987;Kong, Macdonald, & Tattersall, 1996;Rothstein, 1999). Gastric stasis or retention is another consequence of an altered digestive pattern that causes problems in patients with diabetes (Annese et al, 1999;Enck & Frieling, 1997;Horowitz & Fraser, 1994, 1995Horowitz et al, 1996;Koch, 1999;Rothstein, 1999).…”

“…Gastric stasis or retention is another consequence of an altered digestive pattern that causes problems in patients with diabetes (Annese et al, 1999;Enck & Frieling, 1997;Horowitz & Fraser, 1994, 1995Horowitz et al, 1996;Koch, 1999;Rothstein, 1999). In published reports, 20% to 76% of patients with diabetes complain of upper gastrointestinal symptoms (Annese et al, 1999;Berne, 1996;Enck & Frieling, 1997;Horowitz & Fraser, 1994, 1995Horowitz et al, 1996;Koch, 1999;Kong et al, 1996;Keshavarzian et al, 1987;Rothstein, 1999). An actual determination of the incidence and prevalence of gastric symptoms has not been obtained since symptom occurrence may be intermittent (Barkin et al, 1997;Enck & Frieling, 1997) and since only symptomatic patents are usually evaluated (Kong et al, 1996).…”