Orocecal Transit Time and Small Intestinal Bacterial Overgrowth in Diabetic Patients With Hypertension

Abstract

Hypertension is a perplexing multiorgan disease involving renal primary pathology and enhanced angiotensin II vascular reactivity. Hypertension is more common and severe in diabetic patients, placing them at increased risk of cardiovascular disease, stroke and end-stage renal disease. Diarrhoea, constipation & epigastric pain are common complaints in type 2 diabetic patients with hypertension. Delayed gastric emptying and disturbance of intestinal motility are frequent findings in type 2 diabetic patients. Impaired intestinal motility is often followed by small intestinal bacterial overgrowth (SIBO). The prevalence of SIBO & its association with orocecal transit time has not yet been studied in diabetic patients with hypertension. Gastrointestinal abnormalities in diabetic patients with hypertension may disturb gastrointestinal (GI) motility and as a result SIBO. Therefore, this study was planned. In this study, 57 diabetic patients with hypertension and 72 diabetic patients (who had GI symptoms) between the age range 30–70 years were enrolled. One hundred age and sex matched healthy volunteers with normal bowel habits were also taken for this study. Small intestinal bacterial overgrowth & orocecal transit time were studied by using non-invasive glucose and lactulose hydrogen breath tests respectively. Out of 57 patients of type 2 diabetic mellitus with hypertension, 30 (52.6%) were the males while 27 out of 57 (47.4%) females. 39 out of 72 (54.2%) were the males while 33 out of 72 (45.8%) females. In control group, 56 out of 100 (56%) were males while 44 out of 100 (44%) females. Glucose hydrogen breath test was suggestive of SIBO in 7 out of 57 (12.3%) in patients with type 2 diabetic mellitus with hypertension and in 8 out of 72 (11.1%) in type 2 diabetic patients while in 1 out of 100 (1%) in controls. The difference was statistically significant between diabetic patients with hypertension vs controls and diabetic patients vs controls. Range of orocecal transit time was 150 to 255 minutes in patients of type 2 diabetic mellitus with hypertension, who were suggestive of bacterial overgrowth while 75–180 minutes in patients of type 2 diabetic mellitus with hypertension, who were negative for glucose H2BT. Range of orocecal transit time was 135 to 240 minutes in patients of type 2 diabetic mellitus, who were suggestive of bacterial overgrowth while 60–180 minutes in patients of type 2 diabetic mellitus, who were negative for glucose H2BT. In control group, the range of orocecal transit time was 60–120 minutes. It appears from the results obtained in this study that the orocecal transit time was delayed in patients of type 2 diabetic mellitus with hypertension, and patients with diabetic mellitus (who were suggestive of bacterial overgrowth) as compared to the patients of type 2 diabetic mellitus with hypertension and patients with diabetic mellitus, who have negative glucose H2BT. When the mean ± SD (145.26 ± 47.21 minutes) of orocecal transit time of all type 2 diabetic patients with hypertension and mean ± SD (136.32 ± 52.37 minutes) of type 2 diabetic patients was compared with the mean ± SD (90.41 ± 15.36 minutes) of controls, it was significantly delayed. It appears that the orocecal transit time in type 2 diabetic patients with hypertension, and patients with diabetic mellitus was significantly delayed (resulting to SIBO) as compared to controls. Thus these patients should be treated with prokinetic agents and antibiotics.