Abstract
In patients with diabetes mellitus and gastroparesis, dysrhythmias of gastric myoelectrical activity, especially tachygastrias, are thought to be involved in the pathogenesis of dyspeptic symptoms. Using surface electrogastrography we studied the prevalence of these abnormalities, and their relationships to dyspeptic symptoms and the extent of cardiac autonomic neuropathy in 30 euglycemic patients with type I diabetes mellitus and 12 controls. Neither in the fasting nor in the postprandial state were differences in mean frequency of gastric electrical control activity and its variability found between patients and controls. In the fasting state, the power content of the 3 cpm component in the power spectrum of the electrogastrogram was even higher in patients than in controls (P=0.049). In the fasting state, second harmonics of the 3 cpm fundamental gastric signal were seen more often in patients than in controls (P=0.03). In patients with symptoms during the study, no second harmonics were found after the meal. The postprandial/fasting power ratio was decreased in patients with symptoms during the study as compared to patients without symptoms and controls (P<0.05). The incidence of dysrhythmias, such as tachygastrias and bradygastrias, was not higher in patients than in controls (17% and 8%, respectively). No correlation was found between electrogastrographic parameters and the severity of autonomic neuropathy or dyspeptic symptoms scored before the study. In conclusion, this study has shown that patients with type I diabetes mellitus and autonomic neuropathy studied under euglycemic conditions do not have grossly disturbed myoelectrical activity, except when symptomatic during the study.
Similar content being viewed by others
References
Feldman M, Schiller LR: Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 98:378–384, 1983
Horowitz M, Harding PE, Maddox AF, Maddern GJ, Collins PH, Chatterton BE, Wishart J, Shearman DJC: Gastric and oesophageal emptying in insulin-dependent diabetes mellitus. J Gastroenterol Hepatol 1:97–113, 1986
Abell TL, Camilleri M, Hench VS, Malagelada J-R: Gastric electro-mechanical function and gastric emptying in diabetic gastroparesis. Eur J Gastroenterol Hepatol 3:163–167, 1991
Loo FD, Palmer DW, Soergel KH, Kalbflesch JH, Wood CM: Gastric emptying in patients with diabetes mellitus. Gastroenterology 86:485–494, 1984
Sarna SK: Gastrointestinal electrical activity: Terminology. Gastroenterology 68:1631–1635, 1975
Smout AJPM, van der Schee EJ, Grashuis JL: What is measured in electrogastrography? Dig Dis Sci 25:179–187, 1980
Weber J, Kohatsu S: Pacemaker localization and electrical conduction patterns in the canine stomach. Gastroenterology 59:717–726, 1970
Hinder RA, Kelly KA: Human gastric pacesetter potential. Site of origin, spread and response to gastric transection and proximal gastric vagotomy. Am J Surg 33:29–33, 1977
Hamilton JW, Bellahsene BE, Reichelderfer M, Webster JG, Bass P: Human electrogastrograms. Comparison of surface and mucosal recordings. Dig Dis Sci 31:33–39, 1986
Abell TL, Malagelada J-R: Electrogastrography. Current assessment and future perspective. Dig Dis Sci 8:982–992, 1988
Diamant NE, Bortoff A: Nature of the intestinal slow-wave frequency gradient. Am J Physiol 16:301–307, 1979
Daniel EE, Sarna SK: The generation and conduction of activity in smooth muscle. Annu Rev Pharmacol Toxicol 18:145–166, 1978
Abell TL, Malagelada J-R, Lucas AR, Brown ML, Camilleri M, Go WLW, Azpiroz F, Callaway CW, Kao PC, Zinsmeister AR, Huse DM: Gastric electromechanical and neurohormonal function in anorexia nervosa. Gastroenterology 93:958–965, 1987
You CH, Chey WY, Lee KY, Menguy R, Bortoff A: Gastric and small intestinal myoelectric dysrhythmia associated with chronic intractable nausea and vomiting. Ann Intern Med 95:449–451, 1981
Stern RM, Koch KL, Stewart WR, Lindblad IM: Spectral analysis of tachygastria recorded during motion sickness. Gastroenterology 92:92–97, 1987
Koch KL, Stern RM, Vasey M, Botti JJ, Creasy GW, Dwyer A: Gastric dysrhythmias and nausea of pregnancy. Dig Dis Sci 35:961–968, 1990
Geldof H, van der Schee EJ, Smout AJPM, vam de Merwe JP, van Blankenstein M, Grashuis JL: Myoelectrical activity of the stomach in gastric ulcer patients: An electrogastrographic study. J Gastrointest Motil 1:122–130, 1989
Geldof H, van der Schee EJ, van Blankenstein M, Grashuis JL: Electrogastrographic study of gastric myoelectrical activity in patients with unexplained nausea and vomiting. Gut 27:799–808, 1986
Bortolotti M, Santi P, Barbara L, Burnelli F: Gastric myoelectrical activity in patients with chronic idiopathic gastroparesis. J Gastrointest Motil 2:104–108, 1990
Koch KL, Stern RM, Steward WR, Dwyer AE: Gastric emptying and gastric myoelectrical activity in patients with symptomatic diabetic gastroparesis: Effect of long-term domperidone treatment. Am J Gastroenterol 84:1069–1075, 1989
Telander RL, Morgan KG, Kreulen DL, Schmatz PF, Kelly KA, Szurszewski JH: Human gastric atony with tachygastria and gastric retention. Gastroenterology 75:497–501, 1978
You CH, Lee KY, Chey WY, Menguy R: Electrogastrographic study of patients with unexplained nausea, bloating and vomiting. Gastroenterology 79:311–314, 1980
Fraser RJ, Horowitz M, Maddox AF, Harding PE, Chatterton DE, Dent J: Hyperglycemia slows gastric emptying in type I (insulin-dependent) diabetes mellitus. Diabetologia 33:675–680, 1990
Ewing DJ, Classche BF: Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285:916–918, 1982
Bruijs PPM, van der Schee EJ, Smout AJPM, Akkermans LMA, van Strien HLCJ: Bedside system for cutanous recording and analysis of gastric myoelectrical and impedance signals. Med Biol Eng Comput 29:609–615, 1991
Geldof H, Van der Schee EJ: Electrogastrography; clinical applications. Scand J Gastroenterol 24:75–82, 1989
Cristensen J, Schedl HP, Clifton JA: The basic electrical rhythm of the duodenum in normal human subjects and in patients with thyroid disease. J Clin Invest 43:1659–1667, 1964
Schaap HM, Smout AJPM, Akkermans LMA: Myoelectrical activity of the Billroth II gastric remmant. Gut 31:984–988, 1990
Stoddard CJ, Smallwood RH, Duthie HL: Electrical arrhythmias in the human stomach. Gut 22:705–712, 1981
Mintchev MP, Kingma YJ, Bowes KL: Accuracy of cutaneous recordings of gastric electrical activity. Gastroenterology 104:1273–1280, 1993
Author information
Authors and Affiliations
Additional information
Supported by the Dutch Diabetic Foundation.
Rights and permissions
About this article
Cite this article
Jebbink, H.J.A., Bruijs, P.P.M., Bravenboer, B. et al. Gastric myoelectrical activity in patients with type I diabetes mellitus and autonomic neuropathy. Digest Dis Sci 39, 2376–2383 (1994). https://doi.org/10.1007/BF02087654
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02087654