AMBULATORY LONG-TERM JEJUNAL MANOMETRY IN DIABETIC-PATIENTS WITH CARDIAC AUTONOMIC NEUROPATHY

Concerning alteration of small bowel motility in diabetic patients wit h autonomic neuropathy controversial data were obtained with stationar y manometry and over a Limited period of time. The aim of our study wa s to examine ambulatory 24 h jejunal motility in 15 diabetic patients with cardiac autonomic neuropathy compared with data obtained in 50 he althy controls. Twenty-four hour motility was recorded in the proximal jejunum with a portable datalogger and tube-mounted miniature pressur e sensors. Diurnal and nocturnal fasting motility and the motor respon se to a standardized evening meal of 600 kcal were evaluated by visual and computer-aided analysis. The following abnormalities were found d uring fasting motility (n = number of patients): absence of phase III over 24 h (n = 2), retrograde migration or simultaneous occurrence of phase III (n = 5). During postprandial motility irregular bursts with tonic baseline elevation (n = 3) and contraction frequencies below the range of controls (n = 8) occurred. Furthermore patients exhibited an inversion of the normal relationship between phase I and phase II dur ing nocturnal MMC - cycles, and discrete clustered contractions were d iminished (P < 0.01) in the fasting and digestive state. All patients showed at least one abnormal manometric finding. We conclude that smal l bowel motility in diabetic autonomic neuropathy is characterized by disturbances in the generation and aboral migration of phase III, an a ltered circadian variability of the MMC cycle and by postprandial hypo motility.