Diabetic Gastroparesis: An Abnormality of Gastric Emptying of Solids

Wright, Richard; Clemente, Rosa; Wathen, Ronald L.

doi:10.1097/00000441-198506000-00006

Cited by 71 publications

(33 citation statements)

References 10 publications

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“…Most of the latter studies [1,2,4] investigated, however, the influence of experimentally induced short-term and massive increases in blood glucose concentrations, whereas we evaluated the impact of sustained but in relation modestly heightened concentrations and of their reduction. No relation between fasting blood glucose concentration and gastric emptying was also found in previous studies in patients with Type I diabetes [5,7,9]. Against a major importance of pre-prandial blood glucose concentration also speaks the lack of a relation between emptying and HbA 1 c shown in this and an earlier study [9].…”

Section: Discussionsupporting

confidence: 52%

Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Holzäpfel¹,

Festa

Stacher-Janotta

et al. 1999

Diabetologia

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Previous investigations suggested the actual blood glucose concentration to be a determinant of the rate of gastric emptying. In healthy subjects, experimentally induced hyperglycaemia slowed emptying [1±3] and in patients with Type I (insulin-dependent) diabetes mellitus, emptying was slower during induced hyperglycaemia than in euglycaemia [3,4]. In cross-sectional investigations in diabetic patients, these relations between naturally occurring, longerlasting increases in blood glucose concentrations and gastric emptying were less clear or even indiscernible [5±9]. To explain the impact of actual, longer-lasting increases in blood glucose concentrations and of their reduction on gastric emptying, we studied gastric emptying in patients with Type II (non-insulin-dependent) diabetes mellitus and secondary failure to respond to oral hypoglycaemic therapy firstly before treatment readjustment and secondly 1 week thereafter, when glycaemia was greatly decreased. Diabetologia (1999) AbstractAims/hypothesis. Hyperglycaemia that is induced short-term slows gastric emptying in healthy subjects and patients with diabetes mellitus. Little information is available on the impact of longer-lasting, naturally occurring blood glucose increases and their reduction to euglycaemic values. We studied the relation between gastric emptying and pre-prandial and postprandial blood glucose concentrations in patients with Type II (non-insulin-dependent) diabetes mellitus and secondary failure to respond to oral hypoglycaemic treatment (a) before readjusting hypoglycaemic therapy and (b) 1 week thereafter. Methods. We studied 9 female and 1 male patient (age 60±78 years, BMI 21.9±32.5 kg/m 2 , diabetes duration 3±33 years, HbA 1 c 8.8±13.2 %). Gastric emptying of a radiolabelled semisolid 1168 kJ meal was recorded scintigraphically.Results. Blood glucose concentration pre-prandial and postprandial was considerably lower subsequent to than before therapy readjustment in all patients (fasting, 7.9 mmol/l ± 1.5 SD vs 11.7 ± 1.7 mmol/l; 60 min postprandial, 11.7 ± 2.0 vs 15.4 ± 2.2 mmol/l). By contrast, gastric emptying was unchanged (residual radioactivity in stomach 50 min postprandial 65.7 ± 14.1 % vs 66.5 ± 12.9 %). There was no relation between emptying and either fasting blood glucose concentration or its postprandial increase. Conclusion/interpretation. The data do not support a major impact of actual, longer-lasting, naturally occurring blood glucose concentrations upon the rate of gastric emptying in patients with Type II diabetes. [Diabetologia (1999

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Section: Discussionsupporting

confidence: 52%

Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Holzäpfel¹,

Festa

Stacher-Janotta

et al. 1999

Diabetologia

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“…For example, some studies have suggested that solid and liquid gastric emptying are often both delayed in patients with symptoms suggestive of gastroparesis (Campbell et al 1977;Horowitz et al 1985;Schade etal. 1983;Snape et al 1982), but Scarpello et al (1976) reported no difference in gastric emptying of a solid meal in diabetic subjects with or without autonomic neuropathy, and Loo et al (1984) and Wright et al (1985) reported delayed gastric emptying of solid food but relatively normal liquid gastric emptying in symptomatic patients. While to some extent these discrepant results may reflect variations in subject selection and gastric emptying methodology (particularly whether a nutrient or non-nutrient liquid meal was used), our study clearly demonstrates that there is a poor correlation between solid and liquid emptying in patients with diabetes mellitus -24% of the probands in our series had delayed gastric emptying of a nutrient liquid meal but normal solid gastric emptying.…”

Section: Discussionmentioning

confidence: 99%

“…Variations in blood glucose concentration may account for the poor reproducibility of estimations of gastric emptying (Leatherdale et al 1982) and also for the contradictory results regarding the prevalence of abnormal gastric emptying, particularly that of liquid meals (Horowitz et al 1986Loo et al 1984;Wright et al 1985), in diabetic patients. A recent study (Groop et al 1989) indicated that hyperglycaemia delays absorption of the oral hypoglycaemic drug glipizide, presumably by slowing gastric emptying.…”

Section: Discussionmentioning

confidence: 99%

Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus

et al. 1991

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In 87 randomly selected diabetic patients (67 type 1, 20 type 2) and 25 control subjects, gastric emptying of digestible solid and liquid meals and oesophageal transit of a solid bolus were measured with scintigraphic techniques. Gastrointestinal symptoms, autonomic nerve function and glycaemic control were evaluated in the diabetic patients. Gastric emptying and oesophageal transit were slower (P less than 0.001) in the diabetic patients compared with the control subjects, and each was delayed in about 40% of them. There was a relatively weak (r = 0.32; P less than 0.01) relationship between solid and liquid gastric emptying, and no significant correlation (r = 0.11, NS) between oesophageal transit and gastric emptying of the solid meal. Scores for upper gastrointestinal symptoms and autonomic nerve function correlated weakly (r = 0.21; P less than 0.05) with both oesophageal transit and gastric emptying. Gastric emptying of the liquid meal was slower (P less than 0.05) in patients with blood glucose concentrations greater than 15 mmol/l. These results indicate that gastric emptying in patients with diabetes mellitus should be assessed by liquid as well as by solid test meals and that oesophageal transit should not be used as a predictor of generalised diabetic gastroenteropathy.

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“…However, the utilization of more sensitive and sophisti cated techniques to measure gastric empty ing, especially the application of scintigraph ic methods, has produced some conflicting results. Whereas gastric emptying has been reported as being unchanged in diabetics with or without autonomic neuropathy [8], others have described reduced emptying rates of solid food, but normal liquid emptying in pre dominantly symptomatic diabetics [3,15,17], The majority of studies, however, has demonstrated delayed gastric emptying of both digestible solids and liquids [1,[18][19][20][21][22], Additionally, delayed gastric emptying of larger indigestible solids has been reported in up to 50% of diabetics with normal emptying of digestible solids and liquids [4]. To explain these divergent findings, it has therefore been suggested that concerning gastric emptying diabetics with gastroparesis are a heteroge neous group developing increasing gastric emptying disorders for both liquids and solids as the disease progresses [23].…”

mentioning

confidence: 99%

Gastrointestinal Transit Disorders in Patients with Insulin-Treated Diabetes mellitus

Wegener¹,

Börsch²,

Schaffstein

et al. 1990

Dig Dis

114

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Diabetic Gastroparesis: An Abnormality of Gastric Emptying of Solids

Cited by 71 publications

References 10 publications

Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Gastric emptying in Type II (non-insulin-dependent) diabetes mellitus before and after therapy readjustment: no influence of actual blood glucose concentration

Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus

Gastrointestinal Transit Disorders in Patients with Insulin-Treated Diabetes mellitus

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