RELATIONSHIPS BETWEEN DYSPEPTIC SYMPTOMS AND GASTROINTESTINAL MOTILITY IN PATIENTS WITH TYPE-1 (INSULIN-DEPENDENT) DIABETES-MELLITUS

Reports on motor abnormalities in Type 1 (insulin-dependent) diabetes mellitus are inconsistent. In 20 Type 1 diabetic patients and in 11 co ntrol subjects antroduodenojejunal manometry was performed under eugly caemic conditions in order to examine the prevalence of gastric and sm all intestinal motor abnormalities in relation to dyspeptic symptoms a nd the degree of cardiac autonomic neuropathy. In diabetic patients co mpared to control subjects phase III (regular, high-amplitude contract ile activity at maximal frequency) involved the gastric antrum less of ten (12 vs 35 %, p < 0.05), the duration of phase I (motor quiescence) was shorter (6 +/- 1 vs 21 +/- 4 min, p < 0.002) and in phase II (irr egular motor activity) the frequency of duodenal and jejunal contracti ons was higher. After a meal the duration of the fed state was shorter in diabetic patients with symptoms during the study than in diabetic patients without symptoms and than in control subjects (57 +/- 27 vs 1 57 +/- 11 and 140 +/- 13 min, p < 0.02). Postprandial antral hypomotil ity was seen in diabetic patients with symptoms only in the first 30 m in after the meal. One hour after the meal the frequency of duodenal a nd jejunal contractions was again higher in diabetic patients. In diab etic patients compared to control subjects more burst activity (cluste rs of non-propagated high-amplitude contractile activity at maximal fr equency) was seen (7.9 +/- 1.6 vs 0.8 +/- 0.5 % of the total time of s tudy, p < 0.002). No correlation was found between manometric paramete rs and the degree of cardiac autonomic neuropathy. In conclusion, in T ype 1 diabetic patients with cardiac autonomic neuropathy a variety of gastric and small intestinal motor abnormalities can be found. The mo st important of these is hyperactivity in the interdigestive state. Th ese abnormalities correlate with symptoms, but are not related to the severity of cardiac autonomic neuropathy.