ABNORMALITIES IN GALLBLADDER DYNAMICS OF TYPE-1 (INSULIN-DEPENDENT) DIABETIC-PATIENTS WITH AUTONOMIC NEUROPATHY

The aim of this study was to evaluate gallbladder dynamics in insulin- dependent diabetic patients with and without autonomic neuropathy. Gal lbladder dynamics was studied by a scintigraphic method after a test m eal in 26 insulin-dependent diabetic patients and 10 normal individual s. The presence and severity of autonomic neuropathy were defined acco rding to the number of abnormal cardiovascular reflex tests: absent (n o abnormal test), mild (1-3 abnormal tests), and severe (4-5 abnormal tests). The time from the moment when the patient started to take the test meal to the beginning of gallbladder emptying was longer (P = 0.0 1) in diabetic patients with mild (N = 11, 12.1 +/- 7.6 min) and sever e neuropathy (N = 8, 11.0 +/- 10.6 min) than diabetic patients without autonomic neuropathy (N = 7, 3.9 +/- 4.4 min) and controls (N = 10, 4 .8 +/- 4.2 min). The ejection rate was higher (P = 0.02) in the group with severe autonomic neuropathy (N = 8, 5.1 +/- 3.3%/min) than diabet ic patients with mild (N = 11, 2.0 +/- 1.0%/min) or without autonomic neuropathy (N = 7, 1.8 +/- 0.8%/min) and controls (N = 10, 2.6 +/- 1%/ min). Thirty-two percent of the diabetic patients with autonomic neuro pathy presented increased perspiration, nausea and urgency to defecate after the ingestion of the test meal. A significant positive correlat ion of ejection rate with the presence of these symptoms (biserial poi nt correlation test = 0.67, P < 0.01) was also observed. These data su ggest that insulin-dependent diabetic patients with autonomic neuropat hy present abnormalities of gallbladder emptying that could be related to specific gastrointestinal symptoms.