Rapid distal small bowel transit associated with sympathetic denervation in type I diabetes mellitus.

Abstract

Background-The pattern of progression of a meal from the stomach to the caecum in diabetes mellitus is controversial and the differential roles of transit through the jejunum and the ileum have not been investigated in diabetes.Aims-To determine gastric emptying and transit rates through proximal and distal regions of the small bowel in type I diabetic patients. Subjects-The study included six diabetic patients with evidence of autonomic neuropathy (DM-AN group), 11 diabetics without autonomic dysfunction (DM group), and 15 control volunteers. Methods-Gastric emptying and small bowel transit of a liquid meal were evaluated scintigraphically in these subjects. Transit through regions ofinterest corresponding to the proximal and distal small intestine up to the caecum was determined and correlated with gastric emptying rates, cardiovascular measurements of autonomic function, and the occurrence of diarrhoea. Results-Gastric emptying and transit through the proximal small bowel were similar in the three groups. The meal arrived to the caecum significantly earlier in DM-AN patients (median; range: 55 min; 22->180 min) than in the DM group (100 min; 44->180 min, p<0.05) or in controls (120 miin; 80->180 min, p<0.02). Accumulation of chyme in the distal small bowel was decreased in DM-AN patients, who showed values for peak activity (30%; 10-55%) significantly lower than in the DM group (49%; 25-77%, p=0.02) and controls (50%; 30-81%, p=0.02). In DM patients (n=17), the time ofmeal arrival to the caecum was significantly correlated with both orthostatic hypotension (coefficient of contingency, C=0 53, p<0.01) and diarrhoea (C=0.47, p<0.05), but not with gastric emptying rates. Conclusions-Patients with type I diabetes mellitus and sympathetic denervation have abnormally rapid transit of a liquid meal through the distal small bowel, which may play a part in diarrhoea production.

Freqüência de sintomas digestivos em pacientes brasileiros com Diabetes Mellitus

“…No entanto, permanece incerto se a freqüência de cada manifestação clínica, individualmente, é significativamente superior à da população geral, de modo a garantir relevância clínica específica a cada um destes sintomas. Esta interpretação implica em questionar a associação entre sintomas digestivos e as alterações fisiopatológicas trazidas pelas complicações gastrintestinais do diabetes, tão bem demonstradas em inúmeros trabalhos [2][3][4][5][6][7][23][24][25] . A dissociação entre sintomas e alterações motoras no diabetes tem sido comprovada, por outro lado, em estudos que demonstram alta freqüência de refluxo gastro-esofageano 26 ou de retarde do esvaziamento gástrico 24 em diabéticos completamente assintomáticos.…”

“…No aparelho digestivo, em particular, é relativamente bem conhecida a ocorrência de complicações do Diabetes Mellitus, como os distúrbios da motilidade do tubo digestivo e as alterações da absorção de água e de eletrólitos 2,3 , bem como a litíase biliar e a esteatose hepática 4 . Em decorrência do comprometimento do tubo RESUMO -Sintomas sugestivos do comprometimento do tubo digestivo são comuns em pacientes diabéticos, mas estudos comparando as freqüências destes sintomas com as da população geral são escassos e não existem trabalhos dessa natureza com diabéti-cos brasileiros.…”

“…Dispepsia. digestivo, pacientes diabéticos podem apresentar quadros específicos, sendo alguns de grande relevância clínica, como a gastroparesia diabética [4][5][6] e a diarréia do diabéti-co [2][3][4] . Sintomas bem definidos, atribuíveis ao trato gastrointestinal, são comuns em pacientes diabéticos 2,[4][5][6][7][8][9][10][11][12] .…”

A rare cause of severe diarrhoea diagnosed by urine metabolic screening: aromatic L-amino acid decarboxylase deficiency

“…5 A shorter transit time in the distal small bowel has also been reported in diabetic patients with autonomic dysfunction. 6,7 The rapid passage of chyme into the large bowel results in impaired water and electrolyte absorption and hence diarrhoea, for which a defect in alpha-adrenergic activity is thought to play a key pathological role. 6,7 The autonomic features present in our patient (bilateral ptosis, and protracted periods of hypotension with bradycardia) are also compatible with AADC deficiency.…”

“…6,7 The rapid passage of chyme into the large bowel results in impaired water and electrolyte absorption and hence diarrhoea, for which a defect in alpha-adrenergic activity is thought to play a key pathological role. 6,7 The autonomic features present in our patient (bilateral ptosis, and protracted periods of hypotension with bradycardia) are also compatible with AADC deficiency. Moreover, the unexplained cardiac arrest could have been due to unopposed vagal tone; evidently, in AADC deficiency a stress as minor as catheter insertion can result in severe bradycardia and cardiac arrest.…”