ABNORMALITIES OF ANTRODUODENAL MOTILITY IN TYPE-I DIABETES

OBJECTIVE - In the present study, a recently developed manometric tech nique was used to study antroduodenal motility in ambulant type I diab etic subjects. RESEARCH DESIGN AND METHODS - In 12 patients with type I diabetes, antro-duodenal manometry was performed for 20 h during the fasting period and the postprandial period after a standardized dinne r and breakfast. All patients had evidence of cardiac autonomic neurop athy and complained of dyspeptic symptoms. During the manometric study , the blood glucose levels were frequently monitored and kept close to euglycemia in the diabetic patients. The results were compared with 1 2 healthy control subjects. RESULTS - The migrating motor complex cycl es observed ia the diabetic subjects were longer than in the control s ubjects, 118.9 +/- 46.0 vs. 87.0 +/- 21.6 min (P < 0.05). This increas e was attributable to a prolonged phase II, 78.0 +/- 35.5 vs. 37.7 +/- 18.5 min (P < 0.05). In the diabetic subjects, antral phase III was s een significantly less than in the control subjects, 16.7 vs. 43.3% (P < 0.005). In 50% of the diabetic patients, total absence of antral ph ase III was observed-this phenomenon was not seen in the healthy contr ol subjects. After dinner, the antral motility index was less in diabe tic subjects compared with the healthy volunteers, indicating antral h ypomotility (P < 0.01). Six diabetic patients showed abnormal duodenal activity such as early recurrence of phase III and bursts after dinne r. No significant differences in antral motility index or in duodenal motility patterns were observed after breakfast. Six diabetic patients complained of dyspeptic symptoms after dinner, whereas none had dyspe ptic symptoms after breakfast. In 67% of the patients, nausea was repo rted after an early phase III or a burst. CONCLUSIONS - This study sho ws that prolonged ambulatory antroduodenal manometry is a feasible tec hnique in patients. Recording multiple migrating motor complexes showe d that interdigestive motor abnormalities of the stomach and duodenum are common in diabetic patients. Furthermore, it shows the occurrence of antral hypomotility and abnormal duodenal motility patterns after a high-calorie meal, with dyspeptic symptoms in diabetic patients being related to the composition of the meal.