Are patients with Hirschsprung's disease prediabetic?

Hirschsprung's disease (HD) is considered a focal disease usually confined to the distal colon and rectum. However, autonomic dysfunction and dysmotil ity in the upper gastrointestinal tract have been reported, suggesting that this disease is not only confined to the distal gastrointestinal tract. Th is study examines the fasting and postprandial levels of glucose and insuli n in adult patients with HD to elucidate whether there might also be an end ocrine involvement in this disease. Sixteen patients with surgically treate d HD during early childhood and 17 healthy subjects were studied. All subje cts ingested a caloric liquid meal containing glucose, lactose, maize oil, and water (2,020 kJ) after an overnight fast. Blood samples were collected at regular intervals for insulin and glucose analyses. Fasting levels of bo th glucose (P<.05) and insulin (P<.02) were significantly higher in patient s compared with healthy controls. Peak concentration of insulin following m eal intake was significantly higher in the patient group (P<.05), and peak concentration of glucose tended to be higher in patients compared with cont rols (P=.06). There was no correlation between body mass index and serum le vels of glucose or insulin. The present study shows that adult patients tre ated for HD during childhood have an impaired glucose and insulin homeostas is, indicating a mild degree of insulin resistance. This may imply suscepti bility towards development of non-insulin-dependent diabetes mellitus. Copy right (C) 2001 by W.B. Saunders Company.