Gastric emptying and secretion in patients with diabetes mellitus

Abstract

EDITORIAL SYNOPSIS The gastric emptying rate tends to be slower in diabetics than in normal and peptic ulcer subjects.The older workers claimed that the gastric secretion of acid was diminished in diabetes mellitus but more recent investigators have found conflicting results. Marks, Shuman, and Shay (1959), using Kay's augmented histamine test, found an acid secretory output in diabetics which differed little from the normal range. In contrast, Dotevall (1961a, b) found that acid output in diabetics was less than in normal subjects, and concluded that this lower secretory output was related to the higher blood glucose levels existing in diabetics (consistent with the depressant effect of glucose upon the secretion of acid by normal subjects and dogs, a result which has been claimed by a number of workers). This was not, however, confirmed by others. Glucose did not reproduce the marked suppressive effect of glucagon upon gastric secretion (Aylett, 1962), although blood glucose levels were comparable.The investigation of gastric empyting in diabetics is of some interest, since in peptic ulcer subjects Aylett (1962) has shown a relationship between the rate of gastric emptying and change in the blood glucose level. It would be interesting to discover, therefore, whether diabetics with their higher range of blood glucose level would show a slow gastric emptying rate compared with that of normal or of peptic ulcer subjects.Results are reported in a group of diabetic patients in whom gastric secretion and emptying rate were studied, using water test meals. MATERIALS AND METHODSDetails of the modified Hunt test meal method have already been described (Aylett, 1962). The 'meals' consisted of 750 ml. of distilled water, marked with a known quantity of phenol red. A washout of 250 ml. of tap water preceded and followed the meal. The latter was poured into the stomach through a polythene stomach tube in situ. After allowing the meal to 'digest' for 20 minutes, the residue was recovered.'Present address: Manchester Royal Infirmary.

Gastric emptying in diabetic autonomic neuropathy.

“…Radiological and manometric abnormalities of oesophageal function commonly accompany gastric atony, but are usually asymptomatic and dysphagia is rare (Atkinson, 1976). Previous studies of gastric emptying using saline meals (Dotevall, 1961) or a modified Hunt test meal (Aylett, 1965) have shown that emptying is slower than normal in diabetics. However, in these studies the patients were unselected as regards autonomic neuropathy.…”

New clinical method for measuring the rate of gastric emptying: the double sampling test meal.

“…This test has the further advantage of measuring certain 'characteristics' of emptying which are more informative than emptying time alone. Modified Hunt techniques, such as that used by Aylett (1965), assume constant emptying pattern and characteristics in all stomachs.…”

Gastric emptying of solid meals in diabetics.

“…'4 Clinical improvement has been reported with oral antibiotics in some cases,5 6 and bacterial intestinal overgrowth has therefore been implicated. Nevertheless, pathological numbers of organisms have only occasionally been shown in the upper small intestine in such cases.4 7 8 It has recently been suggested that bile acid malabsorption may be implicated and that bile acid sequestrating agents, such as cholestyramine, may have useful therapeutic benefit.9…”

“…Aylett used liquid meals and an aspiration technique to show that gastric emptying tended to be slower in diabetics than in controls. 8 Recently it has become possible to measure the rate of emptying of isotopically labelled solid meals by external scanning. 9 We used this technique to compare the rate of gastric emptying in diabetic subjects, with or without autonomic neuropathy, with that in normal controls.…”