Abstract
Generalized gut transit abnormalities are observed in some diabetics with gastroparesis. Relations of gastric emptying abnormalities to colon contractile dysfunction are poorly characterized. We measured colon transit and contractility using wireless motility capsules (WMC) in 41 healthy subjects, 12 diabetics with gastroparesis (defined by gastric retention >5 hours), and 8 diabetics with normal gastric emptying (≤5 hours). Overall numbers of colon contractions >25 mmHg were calculated in all subjects and were correlated with gastric emptying times for diabetics with gastroparesis. Colon transit periods were divided into quartiles by time and contraction numbers were calculated for each quartile to estimate regional colon contractility. Colon transit in diabetics with gastroparesis was prolonged vs. healthy subjects (P<0.0001). Overall numbers of colon contractions in gastroparetics were lower than controls (P = 0.02). Diabetics with normal emptying showed transit and contraction numbers similar to controls. Gastric emptying inversely correlated with overall contraction numbers in gastroparetics (r = -0.49). Numbers of contractions increased from the 1st to 4th colon transit quartile in controls and diabetics with normal emptying (P≤0.04), but not gastroparetics. Numbers of contractions in the 3rd and 4th quartiles were reduced in gastroparetics vs. healthy controls (P≤0.05) and in the 4th quartile vs. diabetics with normal emptying (P = 0.02). Numbers of contractions were greatest in the final 15 minutes of transit, but were reduced in gastroparetics vs. healthy controls and diabetics with normal emptying (P≤0.005). On multivariate analyses, differences in numbers of contractions were not explained by demographic or clinical variables. In conclusion, diabetics with gastroparesis exhibit delayed colon transit associated with reductions in contractions that are prominently blunted in latter transit phases and which correlate with delayed gastric emptying, while diabetics with normal emptying show no significant colonic impairments. These findings emphasize diabetic gastroparesis may be part of a generalized dysmotility syndrome.
Highlights
Patients with long-standing diabetes mellitus experience a range of symptoms involving different regions of the gastrointestinal tract and show evidence of sensorimotor dysfunction in any gut segment [1]
There were significant age differences between groups (P
Our analyses suggest selective deficits in distal colon contractions in diabetics with gastroparesis might contribute to impaired defecation with consequent retardation of transit
Summary
Patients with long-standing diabetes mellitus experience a range of symptoms involving different regions of the gastrointestinal tract and show evidence of sensorimotor dysfunction in any gut segment [1]. Delays in colon transit have sometimes been reported in diabetics with constipation using radiopaque marker or scintigraphy techniques [11,12,13,14,15]. Adoption of wireless motility capsule (WMC) testing, investigated both for gastroparesis and constipation, has permitted routine quantification of transit in all gut regions in a single test [16,17,18,19,20]. Retrospective case series employing WMC techniques have uncovered significant numbers of patients with presumed idiopathic or diabetic gastroparesis who exhibit abnormal small intestinal and/or colonic transit, emphasizing the existence of unsuspected generalized dysmotility [21, 22]. Likewise in a prospective WMC investigation, some diabetics with gastroparesis exhibited prolongation of colon transit [20]
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