PROXIMAL GASTRIC MOTOR-ACTIVITY IN RESPONSE TO A LIQUID MEAL IN TYPE-I DIABETES-MELLITUS WITH AUTONOMIC NEUROPATHY

Disordered gastric emptying occurs in 30-50% of patients with diabetes mellitus. Although the rate of gastric emptying is dependent on the i ntegration of motor activity in different regions of the stomach, ther e is limited information about the function of the proximal stomach in diabetes mellitus. In the present study the response of the proximal stomach to a liquid meal was examined in eight diabetic patients with autonomic neuropathy and gastrointestinal symptoms and in 10 healthy v olunteers, using an intragastric bag connected to an electronic barost at. Postprandial relaxation of the proximal stomach was measured as an increase of intragastric bag volume at a constant pressure level of 1 mm Hg above the intraabdominal pressure. During the experiment the bl ood glucose levels were maintained within the euglycemic range. Before ingestion of the meal the intragastric bag volume was larger in the d iabetic patients than in the healthy volunteers, 234.4 +/- 29.1 ml vs 155.3 +/- 15.3 ml (P = 0.06). The maximum volume was not different in diabetics compared to the healthy controls (386.3 +/- 45.2 ml versus 3 99.0 +/- 35.2 ml). However, the maximum volume increase was significan tly less in diabetics (143.7 +/- 38.6 ml) compared to the controls (23 1.4 +/- 30.5 ml, P < 0.04). Bloating was inversely correlated with the volume changes, which suggests that impaired relaxation of the proxim al stomach may play a role in the genesis of this sensation. In conclu sion, this study shows a lower fasting fundal tone and a decrease in v olume change of the gastric fundus after a nutrient drink in patients with autonomic neuropathy due to type I diabetes mellitus. These abnor malities may play a role in the abnormal distribution of food, disorde red liquid gastric emptying, and in the genesis of the sensation of bl oating observed in these patients.