Induced-hyperglycemia attenuates erythromycin-induced acceleration of hypertonic liquid-phase gastric emptying in type-I diabetic patients.
BACKGROUND
Erythromycin has been found to be a gastrointestinal prokinetic agent of hypertonic liquids, while acute hyperglycemia has been associated with delayed gastric emptying in diabetic patients.


OBJECTIVE
To investigate whether hyperglycemia, per se, reduces gastric motility during erythromycin-induced acceleration on gastric emptying of hypertonic liquids in diabetic patients.


METHODS
In 12 type-I diabetic patients following a hypertonic radiolabeled liquid meal, gastric emptying was measured scintigraphically during normoglycemia (5-8.9 mmol/l glucose) or hyperglycemia induced by intravenous (16-19 mmol/l) glucose infusion. The tests were performed on 4 separate days in random order after administering either placebo or 200 mg i.v. erythromycin.


RESULTS
In the hyperglycemic state compared to normoglycemia, the gastric emptying of the hypertonic liquid was reduced after placebo or erythromycin administration. The lag-phase duration (17.8+/-5.5 and 7.8+/-4.5 vs. 10.8+/-3.4 and 3.7+/-2.5 min, respectively, p<0.001), the overall gastric emptying time of the half meal (52.8+/-13 and 24.9+/-5.5 vs. 42.5+/-10.5 min and 16.6+/-6 min, respectively, p<0.001) and the retained percentage of liquid meal in the stomach at 60 and 100 min postprandially (p<0.001) were significantly increased.


CONCLUSIONS
The erythromycin-induced acceleration on gastric emptying of hypertonic liquids in diabetic patients is related to the plasma glucose level. The induced hyperglycemia reduces the erythromycin-induced acceleration of liquid-phase gastric emptying, decreasing the overall gastric emptying rate. In spite of the inhibitory effect of induced hyperglycemia on the gastric emptying of hypertonic liquids, erythromycin is still able to accelerate the emptying rate and could prove to be a useful prokinetic agent under hyperglycemic conditions.
Petrakis
I E
IE
1st Department of Surgery, 'Policlinico Umberto l', University of Rome 'La Sapienza', Rome, Italy. petrakis@post.com
Chalkiadakis
G
G
Vrachassotakis
N
N
Sciacca
V
V
Vassilakis
S J
SJ
Xynos
E
E
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects* / Q000502:physiology; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D006943:Hyperglycemia / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006982:Hypertonic Solutions / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011877:Radionuclide Imaging; D012016:Reference Values
D001786:Blood Glucose; D005765:Gastrointestinal Agents; D006982:Hypertonic Solutions; D004917:Erythromycin; D005947:Glucose