Delayed gastric emptying and gastric autoimmunity in type 1 diabetes.
OBJECTIVE
Delayed gastric emptying and/or gastrointestinal symptoms occur in 30-50% of diabetic patients. Known contributing factors are autonomic neuropathy and acute hyperglycemia, but the role of gastric autoimmunity has never been investigated, although 15-20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs). We studied gastric motility in diabetes in relation to PCA status, autonomic nerve function, HbA(1c), thyroid-stimulating hormone (TSH), Helicobacter pylori (HP), acid production, and gastric histology.


METHODS
Gastric emptying of solids and liquids (measured by (13)C-octanoic acid and (13)C-glycine breath tests, respectively) was tested in euglycemic conditions in 42 type 1 diabetic patients (male/female: 29/13; 15 PCA+; mean age 40 +/- 15 years; mean HbA(1c) 7.8 +/- 0.9%). Gastrointestinal symptoms, autonomic nerve function (Ewing tests), PCA status (indirect immunofluorescence), gastric histology, and acid secretion (pentagastrin) were assessed.


RESULTS
Solid gastric emptying was delayed in 40% and liquid emptying in 36% of patients. Gastric motility did not correlate with symptoms. PCA status, gastric morphology, and acid secretion were similar in those with and without gastroparesis. HbA(1c) level (beta = 1.34, P = 0.011) was the only risk factor for delayed solid emptying in a logistic regression model testing HbA(1c), autonomic nerve function, PCA, HP status, age, sex, diabetes duration, and TSH. Half-emptying time for liquids correlated with TSH level (r = 0.83, P < 0.0001) and autonomic neuropathy score (r = -0.79, P = 0.001).


CONCLUSIONS
We found that approximately 50% of type 1 diabetic patients studied had delayed gastric emptying that did not correlate with symptoms. Gastric autoimmunity did not contribute to diabetic gastroparesis. Metabolic control was worse in patients with delayed solid emptying.
De Block
Christophe E M
CE
Department of Endocrinology-Diabetology, Faculty of Medicine, University of Antwerp, University Hospital Antwerp, Edegem, Belgium. cdeblock@uia.ua.ac.be
De Leeuw
Ivo H
IH
Pelckmans
Paul A
PA
Callens
Dirk
D
Máday
Emöke
E
Van Gaal
Luc F
LF
D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D015551:Autoimmunity; D001944:Breath Tests; D002250:Carbon Radioisotopes; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D018589:Gastroparesis / Q000209:etiology / Q000276:immunology* / Q000503:physiopathology; D006442:Glycated Hemoglobin; D006801:Humans; D008297:Male; D008875:Middle Aged; D010295:Parietal Cells, Gastric / Q000276:immunology*; D012307:Risk Factors
D001323:Autoantibodies; D002250:Carbon Radioisotopes; D006442:Glycated Hemoglobin