Proximal gastric compliance and perception of distension in type 1 diabetes mellitus: effects of hyperglycemia

Rayner, C.

doi:10.1016/s0002-9270(00)00798-x

Cited by 24 publications

(38 citation statements)

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“…Hyperglycaemia reduces PP secretion, probably by suppressing vagal cholinergic tone [28][29][30]. Secondly, in patients with Type I (insulin-dependent) diabetes mellitus, acute hyperglycaemia is still capable of inhibiting gastrointestinal motor functions [5,32]. In the present study hyperglycaemia significantly reduced plasma PP secretion both under basal conditions and postprandially, pointing to a decrease in vagal cholinergic tone.…”

Section: Discussionsupporting

confidence: 54%

Effects of hyperglycaemia and hyperinsulinaemia on proximal gastric motor and sensory function in humans

Petersen

Lam

et al. 2000

Clinical Science

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A B S T R A C TDuring acute hyperglycaemia, gastric emptying is delayed and the compliance of the proximal stomach is increased significantly. It is not known whether the effect of hyperglycaemia on proximal gastric motor function in healthy volunteers results from endogenous hyperinsulinaemia. Therefore we studied the effects of acute hyperglycaemia and hyperinsulinaemia on proximal gastric function, measured using an electronic barostat. Eight healthy volunteers were studied on three separate occasions during : (a) normoglycaemia, (b) hyperglycaemic hyperinsulinaemic clamping, and (c) euglycaemic hyperinsulinaemic clamping. Gastric compliance was significantly (P 0.01) increased during hyperglycaemia (44p5 ml/mmHg), and also during hyperinsulinaemia (38p4 ml/mmHg), compared with during normoglycaemia (31p3 ml/mmHg). During pressure distension, sensations of fullness were greater during hyperglycaemia and during hyperinsulinaemia compared with controls. At a set pressure of minimal distension pressure j2 mmHg, the intrabag volume was significantly higher during hyperglycaemia (292p36 ml ; P 0.05), but not during hyperinsulinaemia (161p35 ml), compared with during normoglycaemia (129p10 ml). Postprandial relaxation was significantly (P 0.01) decreased during hyperglycaemia (93p64 ml) and hyperinsulinaemia (101p64 ml) compared with normoglycaemia (224p56 ml). Thus not only hyperglycaemia, but also hyperinsulinaemia, influences proximal gastric compliance, postprandial relaxation and symptom perception.

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Section: Discussionsupporting

confidence: 54%

Effects of hyperglycaemia and hyperinsulinaemia on proximal gastric motor and sensory function in humans

Petersen

Lam

et al. 2000

Clinical Science

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“…In contrast, Rayner et al. 27 found no such difference in the euglycaemic state, although sensation scores were higher during ‘isovolumetric’ balloon distensions, and gastric compliance was higher in the hyperglycaemic state. Also, the accommodation response to a liquid meal in patients with diabetes was impaired in some 28,29 but not all studies 30 .…”

Section: Discussionmentioning

confidence: 87%

Visceral hypersensitivity and impaired accommodation in refractory diabetic gastroparesis

Kumar

Attaluri

Hashmi

et al. 2008

Neurogastroenterology Motil

103

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The pathophysiology of persistent gastrointestinal (GI) symptoms in patients with diabetic gastroparesis is poorly understood. Our aim was to evaluate gastric sensation and accommodation to a meal in patients with diabetic gastroparesis and refractory symptoms. We performed intermittent, phasic balloon distensions of the stomach using a gastric barostat device in 18 patients with diabetes and gastroparesis unresponsive to prokinetic therapy and in 13 healthy volunteers. We assessed the biomechanical, sensory and accommodation responses of the stomach, during fasting and after liquid meal. During balloon distension, the sensory thresholds for discomfort were lower (P < 0.02) in patients with diabetes than those in controls, in both the fasting and the postprandial states. The accommodation response to a meal was significantly impaired (P = 0.01) in patients with diabetes when compared to controls, although fasting gastric tone was similar (P = 0.08). Patients with diabetic gastroparesis and refractory GI symptoms demonstrate sensori-motor dysfunction of the stomach, comprising either impaired accommodation, gastric hypersensitivity or both. An objective evaluation of these biomechanical and sensory properties may provide valuable mechanistic insights that could guide therapy.

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“…For example, in diabetic gastroparesis, visceral afferents are affected in addition to motor efferents . Similar to the illusion of globus sensation with laryngeal sensory loss, patients with diabetic gastroparesis feel fuller than normal subjects with the same degree of gastric distention . Even if motility is intact, loss of sensation may cause failure, reduction, or discoordination of either skeletal or visceral muscle contractions.…”

Section: Discussionmentioning

confidence: 99%

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

Santoso

Paydarfar

2019

Head & Neck

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Background Although sensory feedback is a vital regulator of deglutition, it is not comprehensively considered in the standard dysphagia evaluation. Difficulty swallowing secondary to sensory loss may be termed “sensory dysphagia” and may account for cases receiving diagnoses of exclusion, like functional or idiopathic dysphagia. Methods and Results Three cases of idiopathic dysphagia were suspected to have sensory dysphagia. The patients had (1) effortful swallowing, (2) globus sensation, and (3) aspiration. Endoscopic sensory mapping revealed laryngopharyngeal sensory loss. Despite normal laryngeal motor function during voluntary maneuvers, laryngeal closure was incomplete during swallowing. The causes of sensory loss were identified: cranial neuropathy from Chiari malformation, immune‐mediated neuronopathy, and nerve damage from prior traumatic intubation. Conclusions Sensory loss may cause dysphagia without primary motor dysfunction. Sensory dysphagia should be classified as a distinct form of swallowing motility disorder to improve diagnosis. Increasing awareness and developing appropriate assessment tools may advance dysphagia care.

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Proximal gastric compliance and perception of distension in type 1 diabetes mellitus: effects of hyperglycemia

Abstract: In unselected patients with type 1 diabetes 1) the perception of gastric distension during euglycemia is increased compared with healthy controls, and 2) hyperglycemia increases proximal gastric compliance.

Cited by 24 publications

References 0 publications

Effects of hyperglycaemia and hyperinsulinaemia on proximal gastric motor and sensory function in humans

Effects of hyperglycaemia and hyperinsulinaemia on proximal gastric motor and sensory function in humans

Visceral hypersensitivity and impaired accommodation in refractory diabetic gastroparesis

Sensory dysphagia: A case series and proposed classification of an under recognized swallowing disorder

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