ABNORMAL INTRAGASTRIC DISTRIBUTION OF A LIQUID NUTRIENT MEAL IN PATIENTS WITH DIABETES-MELLITUS

Disordered gastric motility and emptying are well known complications of diabetes mellitus (DM), but the pattern of intragastric distributio n of food has not been extensively studied in diabetics. We examined t he partition of a liquid nutrient meal between the proximal and distal stomach and the relationships between intragastric distribution of fo od and gastric emptying (GE) and the symptoms in DM patients with and without autonomic neuropathy (AN). Fourteen healthy volunteers and 20 DM patients (13 with AN; 9 with dyspepsia symptoms) ingested a liquid nutrient meal (250 mi; 437 kcal) labeled with [Tc-99m]phytate. Anterio r and posterior serial images of the stomach were taken for 90 min wit h a gamma camera. Regions of interest for the proximal and the distal halves of the stomach and for the total gastric area were defined. Cou nts from each region along time allowed estimation of GE and the propo rtion of activity retained in the proximal stomach after meal ingestio n (initial) and throughout GE (mean). GE half-times in controls (media n; range: 66 min; 29-90 min) were not significantly different from dia betics (76 min; 5-->150 min, P > 0.10), but abnormal GE was found in 1 1 DM patients (seven delayed and four rapid). In DM patients, initial retention in the proximal stomach (42%; 16-79%) was significantly lowe r (P < 0.02) than in controls (55%; 44-71%). Mean retention in the pro ximal stomach throughout emptying also was significantly lower (P < 0. 05) in DM patients (43%; 18-58%) than in controls (51%; 32-69%). There were no differences between subgroups of patients with normal, delaye d, or rapid gastric emptying regarding mean meal retention in the prox imal stomach. Patients with evidence of AN or with dyspepsia symptoms had significantly decreased retention of food in the proximal stomach throughout gastric emptying. We concluded that patients with diabetes mellitus have abnormally decreased retention of gastric contents in th e proximal stomach after a liquid meal, which seems to be related to t he occurrence of autonomic neuropathy and dyspepsia symptoms, but not to disordered gastric emptying.