Upper gastrointestinal motility and symptoms in individuals with diabetes, prediabetes and normal glucose tolerance.
OBJECTIVE
Type 2 diabetes has been associated with upper gastrointestinal motility dysfunction, but the relationship with diabetes duration and glucose control is less well understood. Gastric emptying, oesophageal motility and gastrointestinal symptoms were examined in volunteers with diabetes, prediabetes (impaired fasting glucose [IFG] or impaired glucose tolerance [IGT]) and normal glucose tolerance (NGT).


METHODS
The study included 41 patients with type 2 diabetes, 17 individuals with IFG/IGT and 31 individuals with NGT. A gastric emptying breath test and high-resolution oesophageal manometry were performed. Gastrointestinal symptoms were assessed using questionnaires.


RESULTS
Gastric emptying was delayed in individuals with IFG/IGT (p < 0.05) but was normal in the diabetic group. Amongst the diabetic patients, gastric emptying rate was fastest in those with longer diabetes duration and the highest HbA1c levels (p < 0.001). Oesophageal motility variables were similar between the groups. However, the lower oesophagus resting pressure was reduced in patients with longer diabetes duration (p = 0.01). Abdominal pain/discomfort was more frequent amongst patients with diabetes (p = 0.04) but was unrelated to gastric emptying. Significant associations between various oesophageal motility variables and gastrointestinal symptoms were observed.


CONCLUSIONS
Gastric emptying and oesophageal motility are not generally altered in patients with type 2 diabetes. In more advanced disease stages, however, gastric emptying and oesophageal motility may be disturbed, probably as a consequence of autonomic neuropathy. Delayed gastric emptying in IFG/IGT individuals might be secondary to acute hyperglycaemia. Determination of gastric emptying and oesophageal manometry should be considered for the diagnostic workup of patients with diabetes and gastrointestinal symptoms.
Diabetes Division, Department of Medicine I, St Josef Hospital, Ruhr University Bochum, Gudrunstr. 56, 44791, Bochum, Germany.
Georgios C
GC
Boronikolos
Björn A
BA
Menge
Nina
N
Schenker
Thomas G K
TG
Breuer
Jan-Michel
JM
Otte
Sascha
S
Heckermann
Freimut
F
Schliess
Juris J
JJ
Meier
D000284:Administration, Oral; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000503:physiopathology*; D004947:Esophagus / Q000502:physiology; D005260:Female; D005746:Gastric Emptying; D005769:Gastrointestinal Motility; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008365:Manometry; D008875:Middle Aged; D019518:Postprandial Period; D011236:Prediabetic State / Q000503:physiopathology*; D011446:Prospective Studies; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D007004:Hypoglycemic Agents