Open Access, Peer-reviewed
pISSN 2233-7385
eISSN 2233-7393
    Chonnam Med J. 2009 Dec;45(3):175-181. Korean.
    Published online Dec 10, 2009.
    https://doi.org/10.4068/cmj.2009.45.3.175
    Copyright © 2009 Chonnam National University Medical School
    Original Article

    Correlation between Predictors for Diabetic Gastroparesis and Gastric Emptying Scintigraphy

    Kyung-Ju Lee, Kyoung-Ho Ryu, Jin-Ook Chung, Dong-Hyeok Cho, Dong-Jin Chung and Min-Young Chung
      • Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
    • corresp="yes" Corresponding author (Email: mychung@chonnam.ac.kr )
    Accepted November 25, 2009.

    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.

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

    Figures

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

    Tables

    Table 1
    Clinical characteristics of subjects

    Table 2
    Correlation between cardiovascular reflex tests and gastric emptying time

    Table 3
    Comparison of clinical characteristics between groups with and without diabetic gastroparesis

    Table 4
    Predictors for delayed gastric emptying time

    References

      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.
      1. Keshavarzian A, Iber FL, Vaeth J. Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol 1987;82:29–35.
      1. 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.
      1. 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.
      1. 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.
      1. 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.
      1. Tomi S, Plazińska M, Zagórowicz E, Ziólkowski B, Muszynski J. Gastric emptying disorders in diabetes mellitus. Pol Arch Med Wewn 2002;108:879–886.
      1. 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.
      1. Koch CA, Uwaifo GI. Are gastrointestinal symptoms related to diabetes mellitus and glycemic control? Eur J Gastroenterol Hepatol 2008;20:822–825.
      1. 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.
      1. 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.
      1. 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.
      1. Bannister R. In: Textbook of Clinical Disorders of The Autonomic Nervous System. 4th Oxford. Oxford University Press; 1999. Autonomic failure; pp. 194-195.
      1. 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.
      1. 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.
      1. 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.
      1. 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.
      1. 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.
      1. 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.
      1. Camilleri M. Clinical practice. Diabetic gastroparesis. N Engl J Med 2007;356:820–829.
      1. 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.
      1. 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.
      1. 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.
      1. 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.
      1. 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.
    MeSH Terms
    Anthropometry
    Body Mass Index
    Diabetes Complications
    Diabetic Neuropathies
    Gastric Emptying
    Gastroparesis
    Hemoglobins
    Humans
    Meals
    Prevalence
    Respiration
    Metrics
    Share
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    Tables
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