Blunting of Colon Contractions in Diabetics with Gastroparesis Quantified by Wireless Motility Capsule Methods

Abstract

Generalized gut transit abnormalities are observed in some diabetics with gastroparesis. Relations of gastric emptying abnormalities to colon contractile dysfunction are poorly characterized. We measured colon transit and contractility using wireless motility capsules (WMC) in 41 healthy subjects, 12 diabetics with gastroparesis (defined by gastric retention >5 hours), and 8 diabetics with normal gastric emptying (≤5 hours). Overall numbers of colon contractions >25 mmHg were calculated in all subjects and were correlated with gastric emptying times for diabetics with gastroparesis. Colon transit periods were divided into quartiles by time and contraction numbers were calculated for each quartile to estimate regional colon contractility. Colon transit in diabetics with gastroparesis was prolonged vs. healthy subjects (P<0.0001). Overall numbers of colon contractions in gastroparetics were lower than controls (P = 0.02). Diabetics with normal emptying showed transit and contraction numbers similar to controls. Gastric emptying inversely correlated with overall contraction numbers in gastroparetics (r = -0.49). Numbers of contractions increased from the 1st to 4th colon transit quartile in controls and diabetics with normal emptying (P≤0.04), but not gastroparetics. Numbers of contractions in the 3rd and 4th quartiles were reduced in gastroparetics vs. healthy controls (P≤0.05) and in the 4th quartile vs. diabetics with normal emptying (P = 0.02). Numbers of contractions were greatest in the final 15 minutes of transit, but were reduced in gastroparetics vs. healthy controls and diabetics with normal emptying (P≤0.005). On multivariate analyses, differences in numbers of contractions were not explained by demographic or clinical variables. In conclusion, diabetics with gastroparesis exhibit delayed colon transit associated with reductions in contractions that are prominently blunted in latter transit phases and which correlate with delayed gastric emptying, while diabetics with normal emptying show no significant colonic impairments. These findings emphasize diabetic gastroparesis may be part of a generalized dysmotility syndrome.

Relating gastric scintigraphy and symptoms to motility capsule transit and pressure findings in suspected gastroparesis

“…Decreases in colon contractions related to delayed GET but not scintigraphic gastric emptying. Similarly, reduced numbers of colon contractions were noted in diabetics with delayed GET in post hoc analyses of the original WMC investigation, supportive of diffuse dysfunction in some patients with gastroparesis symptoms . The present study extended these findings to idiopathic patients.…”

“…Similarly, reduced numbers of colon contractions were noted in diabetics with delayed GET in post hoc analyses of the original WMC investigation, supportive of diffuse dysfunction in some patients with gastroparesis symptoms. 5,17 The present study extended these findings to idiopathic patients. The preservation of normal small bowel contractions and MI in those with delayed GET suggests this gut region is less susceptible to disruption in patients with generalized dysmotility.…”

“…The WMC pressure sensor estimates contractility in different gut regions . Reduced gastric and colon contractions have been defined in small gastroparesis cohorts . However, abnormalities of transit and contractility in different gut regions have not been contrasted in patients with diabetic versus idiopathic gastroparesis.…”

Diabetic Enteropathy: From Molecule to Mechanism-Based Treatment

“…The findings mirrored another cohort of adults with diabetes and established sensorimotor neuropathy, where 44% had abnormal transit in one or more segments, independent of symptomatology [ 51 ]. Therefore, accumulating evidence supports that gastroparesis can coexist with prolonged transit in the small and large bowels as well as low contractility of the colon [ 61 – 63 ]. Beyond pure measurement of transit times, it has recently been proposed that the change in pH across the ileocaecal junction may represent a surrogate marker for caecal fermentation, which itself may influence colonic transit times [ 51 ].…”

Contraindications for video capsule endoscopy

“…For this purpose, a specifically designed, non-imaging wireless motility capsule (SmartPill, Medtronic plc, Dublin, Ireland) has been developed. Data from sensors measuring pH, pressure, and temperature are transmitted wirelessly for up to 5 d allowing diagnosis of gastroparesis, and prolonged transit times in the small bowel, colon or combined disorders[24-27]. …”