Gastrointestinal motor dysfunction, symptoms, and neuropathy in noninsulin-dependent (type 2) diabetes mellitus

Although relatively frequent, diabetic involvement of digestive tract motil ity has not been investigated extensively in different organs. The authors studied esophageal, gastric, and gallbladder motor function in 35 type 2 (n oninsulin-dependent) diabetic patients to determine the extent of gut invol vement. Of these patients, 27 (77%) had peripheral neuropathy, 12 (34%) had both peripheral and autonomic neuropathy, and 22 (63%) had gastrointestina l symptoms. Esophageal manometric abnormalities were recorded in 18 patient s, and delayed radionuclide emptying of the esophagus was documented in 16 patients, with a 83% concordance between the two tests. Scintigraphic gastr ic emptying of solids was delayed in 56% of patients, whereas gallbladder e mptying after cholecystokinin stimulation was reduced in 69% of them. In 74 % of patients at least one of the viscera under investigation showed abnorm al motor function; however, only 36% of patients displayed involvement of t he three organs. Gastrointestinal symptoms, duration and therapy of diabete s, previous poor glycemic control, and retinopathy did not correlate with t he presence or the extent of motor disorders. Neuropathy was not predictive of gastrointestinal involvement and its extent; however, when motor abnorm alities were present in patients with neuropathy, these were usually more s evere. Gastrointestinal motor disorders are frequent and widespread in type 2 diabetics, regardless of symptoms. Autonomic neuropathy has a poor predi ctive value on motor disorders (0.75 for the esophagus, 0.5 for the stomach , 0.8 for the gallbladder), thus suggesting the coexistence of other pathop hysiologic mechanisms.