Abstract
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 < 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<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 < 0.05) with both oesophageal transit and gastric emptying. Gastric emptying of the liquid meal was slower (P < 0.05) in patients with blood glucose concentrations > 15 mmol/1. 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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Barnett JL, Owyang C (1988) Serum glucose concentration as a modulator of interdigestive gastric motility. Gastroenterology 94:739–744
Camilleri M, Malagelada J-R (1984) Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Eur J Clin Invest 14:420–427
Campbell JW, Heading RC, Tothill P, Buist TAS, Ewing DJ, Clarke BF (1977) Gastric emptying in diabetic autonomic neuropathy. Gut 18:462–467
Channer KS, Jackson PC, O'Brien I, Corrall RIM, Coles DP, Rhys Davies E, Virjee JP (1985) Oesophageal function in diabetes mellitus and its association with autonomic neuropathy. Diabetic Med 2:378–382
Collins PJ, Horowitz M, Cook DJ, Harding PE, Shearman DJC (1983) Gastric emptying in normal subjects — a reproducible technique using a single scintillation camera and computer system. Gut 24:1117–1125
Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285:916–918
Feldman M, Smith HJ, Simon TR (1984) Gastric emptying of solid radiopaque markers: studies in healthy subjects and diabetic patients. Gastroenterology 87:895–902
Fox S, Behar J (1980) Pathogenesis of diabetic gastroparesis —a pharmacologic study. Gastroenterology 78:757–763
Fraser R, Horowitz M, Graham S, Dent J (1989) Acute hyperglycaemia and antropyloroduodenal motility in humans (abstract). Gastroenterology 96:A157
Fraser R, Horowitz M, Maddox A, Harding P, Chatterton B, Dent J (1990) Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 33:675–680
Frusciante V, Modoni S, Bonazza A, De Cosmo S, Barbano F, Lucentini L, Vettori PGP (1988) Scintigraphic oesophageal clearance in diabetes: clinical usefulness. Nucl Med Commun 9:955–964
Groop LC, DeFronzo RA, Luizi L, Melander A (1989) Hyperglycaemia and absorption of sulphonylurea drugs. Lancet II:129–130
Hilsted J (1982) Pathophysiology in diabetic autonomic neuropathy: cardiovascular, hormonal, and metabolic studies. Diabetes 31:730–737
Hirano T, Niijima A (1980) Effects of 2-deoxy-{spd-glucose, glucose and insulin on efferent activity in gastric vagus nerve}. Experientia 36:1197–1198
Horowitz M, Harding PE, Chatterton BE, Collins PJ, Shearman DJC (1985) Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy. Dig Dis Sci 30:1–9
Horowitz M, Harding PE, Maddox A, Maddern GJ, Collins PJ, Chatterton BE, Wishart J, Shearman DJC (1986) Gastric and oesophageal emptying in insulin-dependent diabetes mellitus. J Gastroenterol Hepatol 1:97–113
Horowitz M, Maddox A, Harding PE, Maddern GJ, Chatterton BE, Wishart J, Shearman DJC (1987) Effect of cisapride on gastric and esophageal emptying in insulin-dependent diabetes mellitus. Gastroenterology 92:1899–1907
Horowitz M, Harding PE, Maddox A, Wishart JM, Akkermans LMA, Chatterton BE, Shearman DJC (1989) Gastric and oesophageal emptying in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia 32:151–159
Houghton LA, Read NW, Heddle R, Horowitz M, Collins PJ, Chatterton B, Dent J (1985) The relationship of the motor activity in the antrum, pylorus and duodenum to gastric emptying of a solid-liquid mixed meal. Gastroenterology 94:1285–1291
Jeppsson J, Jermorp S, Sundkvist G, Englund H, Nylund V (1986) Measurement of hemoglobin A1c by a new liquid-chromatographic assay: methodology, clinical utility and relation to glucose tolerance evaluated. Clin Chem 32:1867–1872
Keshavarzian A, Iber FL, Vaeth J (1987) Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol 82: 29–35
Kjellen G, Svedberg JB, Tibbling L (1984) Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiography. Dig Dis Sci 29:1–5
Leatherdale BA, Green DJ, Harding LK, Griffin D, Bailey CJ (1982) Guar and gastric emptying in non-insulin dependent diabetes. Acta Diabetol Lat 19:339–343
Loo FD, Palmer DW, Soergel KH, Kalbfleisch JH, Wood CM (1984) Gastric emptying in patients with diabetes mellitus. Gastroenterology 86:485–494
Malagelada J-R, Rees WDW, Mazzotta LJ, Go VLW (1980) Gastric motor abnormalities in diabetic and postvagotomy gastroparesis; effect of metoclopramine and bethanechol. Gastroenterology 78:286–293
Mearin F, Camilleri M, Malagelada J-R (1986) Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology 90:1919–1925
Meyer JH (1987) Motility of the stomach and gastroduodenal junction. In: Johnson LR (ed) Physiology of the gastrointestinal tract, 2nd edn, vol 1. Raven, New York, pp 613–630
Oliveira RB, Troncon LEA, Meneghelli UG, Dantas RO, Godoy RA (1984) Gastric accommodation to distention and early gastric emptying in diabetics with neuropathy. Braz J Med Biol Res 17:49–55
Russell COH, Gannan R, Coatsworth J, Neilsen R, Allen F, Hill LD, Pope CE (1983) Relationship among oesophageal dysfunction, diabetic gastroenteropathy and peripheral neuropathy. Dig Dis Sci 28:289–293
Saltzman MA, McCallum RW (1983) Diabetes and the stomach. Yale J Biol Med 56:179–187
Scarpello JHB, Barber DC, Hague RV, Cullen DR, Sladen GE (1976) Gastric emptying of solid meals in diabetics. Br Med J 2:671–673
Schade RR, Dugas MC, Lhotsky DM, Gavaler JS, Van Thiel DH (1985) Effect of metoclopramine on gastric liquid emptying in patients with diabetes mellitus. Dig Dis Sci 30:10–15
Siegel JA, Krevsky B, Maurer A, Charles ND, Fisher R, Malmud LS (1989) Scintigraphic evaluation of gastric emptying: are radiolabelled solids necessary? Clin Nucl Med 14:40–46
Snape WJ, Battle WM, Schwartz SS, Braunstein SN, Goldstein HA, Alavi A (1982) Metoclopramine to treat gastroparesis due to diabetes mellitus: a double-blind, controlled trial. Ann Intern Med 96:444–446
Wright RA, Clemente R, Wathen R (1985) Diabetic gastroparesis: an abnormality of gastric emptying of solids. Am J Med Sci 289:240–242
Author information
Authors and Affiliations
Additional information
Offprint requests to: M. Horowitz
Rights and permissions
About this article
Cite this article
Horowitz, M., Maddox, A.F., Wishart, J.M. et al. Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med 18, 229–234 (1991). https://doi.org/10.1007/BF00186645
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00186645