Colonic motility in patients with type 1 diabetes and gastrointestinal symptoms

Abstract

Background: Gastrointestinal (GI) symptoms are common in patients with diabetes mellitus (DM). The electromagnetic 3D-Transit system allows assessment of regional transit times and motility patterns throughout the GI tract. We aimed to compare GI transit times and detailed motility patterns of the colon in patients with DM and GI symptoms to those of healthy controls (HC). We further aimed to determine whether any abnormalities in motility were reversible by cholinergic stimulation. Methods: We compared 18 patients with DM with 20 HC by means of the 3D-Transit system. Patients were studied before and during oral administration of 60 mg pyridostigmine. Key results: Compared to HC, patients had prolonged gastric emptying (DM: 3.3 hours (interquartile range (IQR) 2.6-4.6); HC: 2.3 hours (IQR 1.7-2.7) (P < .01)), colonic transit time (DM: 52.6 hours (IQR 23.3-83.0); HC: 22.4 hours (IQR 18.9-43.6) (P = .02)), and whole gut transit time (DM: 69.4 hours (IQR 32.9-103.6); HC: 30.3 hours (IQR 25.2-49.9) (P < .01)). In addition, compared to HC, patients had prolonged transit time in the ascending colon (DM: 20.5 hours (IQR 11.0-44.0); HC: 8.0 hours (IQR 3.8-21.0) (P < .05)) and more slow retrograde movements in the colon (DM: 2 movements (IQR 1-4); HC: 1 movement (IQR 0-1) (P = .01)). In patients, pyridostigmine increased the number of bowel movements (P < .01) and reduced small intestine transit times (P < .05). Conclusions: Patients with DM and GI symptoms have longer than normal GI transit times. This is only partly reversible by pyridostigmine. The increased number of retrograde colonic movements in patients could potentially explain the abnormally long transit time in proximal colon.

Tapentadol results in less deterioration of gastrointestinal function and symptoms than standard opioid therapy in healthy male volunteers

“…18,31,32 However, we have seen delayed gastric emptying in a study of patients with type 1 diabetes. 33 A parallel study design with more subjects and a pretreatment motility assessment may have added additional power to the conclusions. However, the applied crossover design with a placebo treatment reduces the number of study participants and enables subjects to be their own control group making the study doable in the current settings.…”

Assessment of Gastrointestinal Autonomic Dysfunction: Present and Future Perspectives

“…3D-Transit has been applied to assess transit times and contraction patterns in various GI disorders and among these in patients with gastroenteropathy related to AD [112]. Patients with type 1 DM are shown to have prolonged gastric emptying time, colonic transit time, and whole gut transit time mainly due to an increased number of retrograde movements within the right colon [115]. Furthermore, widespread prolonged transit times, especially through the small intestine and right colon, and fewer antegrade mass movements have been found in PD [116].…”

Magnetic tracking of gastrointestinal motility

“…In healthy volunteer studies, use of the 3D-Transit capsule has provided normative values for regionspecific gastric, small intestinal, and segmental colonic GI transit times [52,55]. In volunteer and patient studies, the system has provided detailed information on colonic motility not available by any other ambulatory method [53,[56][57][58]. In clinical studies, the 3D-Transit system has been used to investigate transit times and movement patterns in patient groups including those with severe ulcerative colitis, Parkinson's disease, idiopathic gastroparesis, diabetes mellitus, and carcinoid diarrhea [55,57,[59][60][61].…”