Chonnam Med J.  2009 Dec;45(3):175-181. 10.4068/cmj.2009.45.3.175.

Correlation between Predictors for Diabetic Gastroparesis and Gastric Emptying Scintigraphy

Affiliations
  • 1Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea. mychung@chonnam.ac.kr

Abstract

The objective of this study was to evaluate the prevalence of gastroparesis in diabetic patients with severe upper gastrointestinal symptoms and to examine the predictors of diabetic gastroparesis to improve the efficiency of gastric emptying scintigraphy. Gastric emptying of a solid meal (scintigraphy) was measured in 40 patients with diabetes (10 type 1 and 30 type 2) who had severe upper abdominal symptoms. All patients were evaluated for anthropometry, lipid profiles, glycated hemoglobin, cardiac autonomic neuropathy, and other chronic diabetic complications. Of the 40 patients who underwent scintigraphy, the gastric emptying of solids was delayed in 16 (40%) patients, and 24 (60%) patients had cardiac autonomic neuropathy. The BBV cardiac beat-to-beat variability test score correlated positively with the gastric emptying time [OR=6.78 (1.53-30.04), p=0.018]. The deep breathing test (abnormal E/I ratio), one of the BBV tests, correlated positively with the gastric emptying rate of solids [OR=7.00 (1.27-38.36), p=0.025]. However, delayed gastric emptying was not related to the type or duration of diabetes, abdominal symptoms, glycated hemoglobin, body mass index, lipid profiles, or other chronic diabetic complications. Our results suggest that the BBV test, especially the abnormal deep breathing test, is associated with an increased risk of diabetic gastroparesis in diabetic patients with gastrointestinal symptoms.

Keyword

Autonomic nervous system deseases; Diabetic neuropathies; Gastroparesis; Gastric emptying

MeSH Terms

Anthropometry
Body Mass Index
Diabetes Complications
Diabetic Neuropathies
Gastric Emptying
Gastroparesis
Hemoglobins
Humans
Meals
Prevalence
Respiration
Hemoglobins

Figure

  • Fig. 1 Correlation between clinical parameters and gastric emptying time.


Reference

1. Horowitz M, Maddox AF, Wishart JM, Harding PE, Chatterton BE, Shearman DJ. Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med. 1991. 18:229–234.
Article
2. Keshavarzian A, Iber FL, Vaeth J. Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol. 1987. 82:29–35.
3. Wegener M, Börsch G, Schaffstein J, Luerweg C, Leverkus F. Gastrointestinal transit disorders in patients with insulin-treated diabetes mellitus. Dig Dis. 1990. 8:23–36.
Article
4. Annese V, Bassotti G, Caruso N, De Cosmo S, Gabbrielli A, Modoni S, et al. Gastrointestinal motor dysfunction, symptoms and neuropathy in non insulin-dependent (type 2) diabetes mellitus. J Cli Gastroenterol. 1999. 29:171–177.
Article
5. Jones KL, Horowitz M, Wishart MJ, Maddox AF, Harding PE, Chatterton BE. Relationship between gastric emptying, intragastric meal distribution and blood glucose concentrations in diabetes mellitus. J Nucl Med. 1995. 36:2220–2228.
6. Yoon MK, Hwang KH, Choe WS, Lee BI, Lee JS. Reducing the scan time in gastric emptying scintigraphy by using mathematical models. Korean J Nucl Med. 2005. 39:257–262.
7. Tomi S, Plazińska M, Zagórowicz E, Ziólkowski B, Muszynski J. Gastric emptying disorders in diabetes mellitus. Pol Arch Med Wewn. 2002. 108:879–886.
8. Punkkinen J, Färkkilä M, Mätzke S, Korppi-Tommola T, Sane T, Piirilä P, et al. Upper abdominal symptoms in patients with type 1 diabetes: unrelated to impairment in gastric emptying caused by autonomic neuropathy. Diabet Med. 2008. 25:570–577.
Article
9. Koch CA, Uwaifo GI. Are gastrointestinal symptoms related to diabetes mellitus and glycemic control? Eur J Gastroenterol Hepatol. 2008. 20:822–825.
Article
10. Darwiche G, Almér LO, Björgell O, Cederholm C, Nilsson P. Delayed gastric emptying rate in type 1 diabetics with cardiac autonomic neuropathy. J Diabetes Complications. 2001. 15:128–134.
Article
11. Lydon A, Murray C, Cooke T, Duggan PF, O'Halloran D, Shorten GD. Evaluation of standard haemodynamic tests of autonomic function and HbA1C as predictors of delayed gastric emptying in patients with type 1 diabetes mellitus. Eur J Anaethesiol. 2000. 17:99–104.
Article
12. Agelink MW, Malessa R, Baumann B, Majewski T, Akila F, Zeit T, et al. Standardized tests of heart rate variability: normal ranges obtained from 309 healthy humans, and effects of age, gender and heart rate. Clin Auton Res. 2001. 11:99–108.
Article
13. Bannister R. Autonomic failure. Textbook of Clinical Disorders of The Autonomic Nervous System. 1999. 4th Oxford. Oxford University Press;194–195.
14. Ko SH, Kwon HS, Lee JM, Kim SR, Cho JH, Yoo KD, et al. Cardiovascular autonomic neuropathy in patients with type 2 diabetes mellitus. J Korean Diabetes Assoc. 2006. 30:226–235.
Article
15. Jones KL, Russo A, Stevens JE, Wishart JM, Berry MK, Horowitz M. Predictors of delayed gastric emptying in diabetes. Diabetes care. 2001. 24:1264–1269.
Article
16. Buysschaert M, Moulart M, Urbain JL, Pauwels S, de Roy L, Ketelslegers JM, et al. Impaired gastric emptying in diabetic patients with cardiac autonomic neuropathy. Diabetes Care. 1987. 10:448–452.
Article
17. Fraser RJ, Horowitz M, Maddox AF, Harding PE, Chatterton BE, Dent J. Hyperglycaemia slows gastric emptying in type 1 (insulin dependent) diabetes mellitus. Diabetologia. 1990. 33:675–680.
Article
18. Samsom M, Akkermans LM, Jebbink RJ, van Isselt H, van Berge-Henegouwen GP, Smout AJ. Gastrointestinal motor mechanisms in hyperglycemia induced delayed gastric emptying in type 1 diabetes mellitus. Gut. 1997. 40:641–646.
Article
19. Schvarcz E, Palmér M, Aman J, Horowitz M, Stridsberg M, Berne C. Physiological hyperglycaemia slows gastric emptying in normal subjects and patients with insulin dependent diabetes mellitus. Gastroenterology. 1997. 113:60–66.
Article
20. Camilleri M. Clinical practice. Diabetic gastroparesis. N Engl J Med. 2007. 356:820–829.
21. Schvarcz E, Palmér M, Aman J, Lindkvist B, Beckman KW. Hypoglycaemia increases the gastric emptying rate in patients with type 1 diabetes mellitus. Diabet Med. 1993. 10:660–663.
Article
22. De Block CE, De Leeuw IH, Pelckmans PA, Callens D, Máday E, Van Gaal LF. Delayed gastric emptying and gastric autoimmunity in type 1 diabetes. Diabetes Care. 2002. 25:912–917.
Article
23. Yoshida MM, Schuffler MD, Sumi SM. There are no morphological abnormalities of the gastric wall or abdominal vagus in patients with diabetic gastroparesis. Gastroenterology. 1988. 94:907–914.
Article
24. DeVon HA, Ryan CJ, Ochs AL, Shapiro M. Symptoms across the continuum of acute coronary syndromes: differences between women and men. Am J Crit Care. 2008. 17:14–24.
Article
25. Zhang QT, Hu DY, Yang JG, Zhang SY, Zhang XQ, Liu SS. Public knowledge of heart attack symptoms in Beijing residents. Chin Med J (Engl). 2007. 120:1587–1591.
Article
Full Text Links
  • CMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr