Gastrointestinal motor mechanisms in hyperglycaemia induced delayed gastric emptying in type I diabetes mellitus.

Samsom, Melvin; Akkermans, L.M.A.; Jebbink, R. J. A.; Isselt, H. Van; Vanberge-Henegouwen, G. P.; Smout, A. J. P. M.

doi:10.1136/gut.40.5.641

Cited by 151 publications

(115 citation statements)

References 23 publications

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“…27±29 Contractility of the antrum has been shown to play an important role in the gastric emptying of solids. 30,31 Recent observations suggest that the organization of antroduodenal pressure waves especially is an important determinant in the rate of gastric emptying. For instance, the acceleration of gastric emptying induced by cisapride correlated with an increase in the number of antral contractions with an extent ³ 6 cm.…”

Section: Discussionmentioning

confidence: 99%

Effects of a new motilide, ABT‐229, on gastric emptying and postprandial antroduodenal motility in healthy volunteers

Verhagen

Samsom

Maes³

et al. 1997

Aliment Pharmacol Ther

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Since 1984 many studies have described the effects of the macrolide antibiotic erythromycin on gastrointestinal motility. 1±3 Erythromycin was subsequently shown to be an agonist of the motilin receptor. 4 Motilin is a peptide gut hormone, which is produced in the duodenum and plays a role in the regulation of upper gastrointestinal motility. 5 In healthy humans, erythromycin induces contractions of the gastric antrum, enhances antropyloroduodenal co-ordination, induces antral phase III activity and enhances the tone of the gastric fundus. 6±12 In patients with diabetic or postvagotomy gastroparesis, erythromycin stimulates antral motility and normalizes gastric emptying. 3, 13±20 However, a major disadvantage of the use of erythromycin as a prokinetic drug is its antibacterial activity and the risk of inducing a resistant bacterial strain. Therefore, new erythromycin analogues have been developed, so-called motilides, which lack antibiotic activity. One of these, ABT-229 (8,9-anhydro-4¢¢-deoxy-3¢-N-desmethyl-3¢-N-ethylerythromycin B 6,9-hemiacetal), has a relatively high bioavailability after oral administration and strong prokinetic effects in vitro. 21 This study was designed to investigate the effects of two single oral doses (4 mg, 16 mg) of ABT-229 on the SUMMARY Background: ABT-229 is a recently developed derivative of erythromycin, devoid of antibiotic activity. We studied the effect of ABT-229 on gastric emptying and postprandial antroduodenal motility in healthy volunteers. Methods: Placebo, 4 and 16 mg ABT-229 were given as a single oral dose to nine healthy volunteers, in a randomized, 3-period crossover design. A solid meal (250 kcal) was given twice, 45 min after drug ingestion and 4 h later. Gastric emptying of each meal was studied using the 13 C-octanoic breath test. Antroduodenal motility was recorded during the total 9-h period.

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Section: Discussionmentioning

confidence: 99%

Effects of a new motilide, ABT‐229, on gastric emptying and postprandial antroduodenal motility in healthy volunteers

Verhagen

Samsom

Maes³

et al. 1997

Aliment Pharmacol Ther

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“…CO 2 production was corrected for age, sex, height, and weight using the algorithms of Schofield (22). Mathematical analysis of the 13 C values in the breath samples was performed using a generalized linear regression model adopted from Lee et al (18) and Viramontes et al (19).…”

Section: Data Analysis Of Breath Testmentioning

confidence: 99%

“…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.…”

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confidence: 99%

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

Vermeijden²,

et al. 2003

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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...

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“…However, the observed correlations have been relatively weak, and in other studies, no relationship was evident between the rate of gastric emptying and autonomic nerve function (6,9). Moreover, it has now been established that acute changes in blood glucose concentrations affect gastric emptying in patients with diabetes, that gastric emptying is slower during hyperglycemia when compared with euglycemia (14,15), and that gastric emptying is accelerated during hypoglycemia (16). Changes in the blood glucose concentrations that are within the normal postprandial range also influence gastric emptying, and the emptying of both solids and liquids is slower at a blood glucose concentration of 8 vs. 4 mmol/l in both healthy volunteers and patients with uncomplicated type 1 diabetes (17).…”

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confidence: 99%

Predictors of Delayed Gastric Emptying in Diabetes

et al. 2001

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OBJECTIVE -To define the predictors of the rate of gastric emptying in patients with diabetes.RESEARCH DESIGN AND METHODS -A total of 101 outpatients with diabetes (79 type 1 and 22 type 2) underwent measurements of gastric emptying of a solid/liquid meal (scintigraphy), upper gastrointestinal symptoms (questionnaire), glycemic control (blood glucose concentrations during gastric emptying measurement), and autonomic nerve function (cardiovascular reflexes).RESULTS -The gastric emptying of solid and/or liquid was delayed in 66 (65%) patients. Solid (retention at 100 min 64 Ϯ 3.2 vs. 50.2 Ϯ 3.6%, P Ͻ 0.005) and liquid (retention at 100 min 22.7 Ϯ 1.7 vs. 16.0 Ϯ 1.8%, P Ͻ 0.001) gastric emptying was slower in women than in men. Of all upper gastrointestinal symptoms (including nausea and vomiting), only abdominal bloating/fullness was associated with slower gastric emptying (P Ͻ 0.005). A multiple regression analysis demonstrated that both abdominal bloating/fullness and female sex were predictors of slower gastric emptying of both solids and liquids.CONCLUSIONS -We conclude that the presence of abdominal bloating/fullness but not any other upper gastrointestinal symptom is associated with diabetic gastroparesis and that gastric emptying is slower in diabetic women than in diabetic men. Diabetes Care 24:1264 -1269, 2001T he application of radioisotopic techniques to quantify gastric emptying has established that delayed gastric emptying (gastroparesis) occurs in 30 -50% of patients with longstanding diabetes (1-9), and diabetes and functional dyspepsia represent the two most common disorders associated with chronic gastroparesis (10). Diabetic gastroparesis is also recognized to represent a clinically important problem because of its potential sequelae of upper gastrointestinal symptoms, impaired oral drug absorption, and poor control of blood glucose concentrations (1). However, determinants of the rate of gastric emptying in patients with diabetes are controversial and poorly defined (1-9). Particularly, it is uncertain whether diabetic gastroparesis can be predicted based on clinical, demographic, or biochemical variables. In patients with diabetes, there is also a relatively poor relationship between gastric emptying of solids and gastric emptying of nutrient-containing liquid-meal components (2-4,7); delayed liquid gastric emptying frequently occurs and may be associated with normal solid emptying (7). Hence, the predictors of delay in liquid emptying may potentially differ from those associated with the delayed gastric emptying of solids.Previous studies have reported a relatively weak relationship between upper gastrointestinal symptoms and the rate of gastric emptying in patients with diabetes (2-7). Accordingly, it has been suggested that gastroparesis cannot be predicted based on symptoms and that objective measurement of gastric emptying is required for diagnosis (1,8). In most of these studies, symptoms have been evaluated using either a global symptom score and/or individual upper gastrointestinal symp...

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Gastrointestinal motor mechanisms in hyperglycaemia induced delayed gastric emptying in type I diabetes mellitus.

Cited by 151 publications

References 23 publications

Effects of a new motilide, ABT‐229, on gastric emptying and postprandial antroduodenal motility in healthy volunteers

Effects of a new motilide, ABT‐229, on gastric emptying and postprandial antroduodenal motility in healthy volunteers

Prevalence of Delayed Gastric Emptying in Diabetic Patients and Relationship to Dyspeptic Symptoms

Predictors of Delayed Gastric Emptying in Diabetes

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