Gastric Emptying In Diabetic Patients Research Articles

Determinants of gastric residual volume before elective surgery in diabetic patients: An observational study.

We investigated factors affecting the low- and high-risk groups for aspiration by measuring gastric volume with ultrasound in diabetic patients who fasted for elective surgery. The study was conducted as an observational study. Sixty-five patients scheduled for elective surgery, aged 18-86 years, with American Society of Anesthesiologists (ASA) scores II-III, and who have diabetes were included after local ethics committee approval. Written informed consent was obtained from all participants. Demographic data of cases were recorded. Patients whose gastric residual volume (GRV) was calculated using the pupils equal, round, reactive to light, and accommodation (PERLA) formula following gastric antrum measurement in the right lateral decubitus and supine position by ultrasound were categorized as low or high risk for aspiration. Thirty-one patients were in the low-risk group, and 34 patients were in the high-risk group. Sex, weight, body mass index (BMI), hemoglobin A1c (HbA1c) values, and duration of diabetes were not statistically significant (p > 0.5). Age (p = 0.006) and fasting blood glucose (FBG) (p = 0.005) were statistically significant. The risk of aspiration decreases with age. Hyperglycemia is related to delayed gastric emptying and a high risk for aspiration. The duration of fasting, GRV, and cross-sectional area (CSA) were statistically significant (p = 0.017, p = 0.000, and p = 0.000, respectively). Gastric emptying might be delayed in diabetic patients resulting in a high risk for aspiration pneumonia. The risk of aspiration increases in young diabetic patients, and preoperative FBG measurements can provide an idea about gastric emptying in diabetic patients. Gastric ultrasound (USG) may contribute to guidelines for determining more appropriate fasting times for other patient populations, such as obese, pregnant, or child patients.

Delayed Gastric Emptying in Diabetic Patients Undergoing Pancreaticoduodenctomy: A Procedure-targeted NSQIP Analysis

Introduction: Delayed gastric emptying (DGE) is a major source of morbidity after pancreaticoduodenctomy (PD). Patients with diabetes mellitus (DM) have a propensity for gastric dysmotility, however the relationship between DGE and DM is not clearly established. The aim of this study was to determine the incidence of DGE in patients with and without DM after PD.

Delayed gastric emptying in diabetic patients undergoing pancreaticoduodenectomy: A procedure-targeted nsqip analysis

Presenter: Alissa Greenbaum MD | Rutgers University Background: Delayed gastric emptying (DGE) is a major source of morbidity after pancreaticoduodenctomy (PD), occurring in up to 20% of patients. Patients with type I or II diabetes mellitus (DM) have a propensity for gastric dysmotility, however the exact relationship between DGE and DM is not clearly established. The aim of this study was to determine the incidence of DGE in patients with and without DM after PD. Methods: The American College of Surgeons National Quality Improvement Project (ACS-NSQIP) procedure-targeted pancreatectomy database was queried from 2014 to 2017 for patients undergoing PD and combined with the main ACS-NSQIP database. Patient demographic, clinical and perioperative variables were compared by DM status. The primary outcome was rate of DGE. A subset analysis of insulin-dependent DM (IDDM) and non-insulin-dependent DM (non-IDDM) patients was also performed. Statistical analyses were performed using chi-square, Mann Whitney-U tests, and logistic regression. Results: A total of 14,735 patients met inclusion criteria, including 10,930 non-DM patients (74.2%) and 3805 DM patients (25.8%). Median cohort age was 66 years and 53.7% were male (n=7918). DGE occurred in 17.1% of patients overall (n=2519); 17.2% in non-DM and 16.8% in DM patients (p=0.60). DM patients had a higher ASA class, increased rates of hypertension, increased proportion of pancreatic adenocarcinoma, larger duct size, harder gland texture, and required more frequent vascular resection (p<0.001). DM patients had equivalent rates compared to non-DM patients of post-operative superficial surgical site infection (7.8% in both; p=0.89), deep surgical site infection (1.4 vs 1.5%; p=0.56), urinary tract infection (3.2 vs 2.8%; p=0.23) and pneumonia (4.3 vs 3.6%; p=0.19), and lower rates of organ space infection (11.5 vs 14.0%; p<0.001) and pancreatic fistula (14.9 vs 19.0%; p<0.001). On subset analysis, IDDM had better outcomes compared to non-IDDM patients in organ space infections (8.8 vs 14.2%; p<0.001) and pancreatic fistula (11.7 vs 18.3%; p<0.001). Rates of DGE were 18.0% (n=337) in non-IDDM and 15.7% in IDDM patients (p=0.162). There were no significant differences in rates of reoperation, hospital length of stay, readmission rates or 30-day mortality. On multivariable logistic regression, male sex, advanced age, history of smoking, pancreatic fistula, and organ space infection were associated with DGE. DM status was not predictive of DGE. Conclusion: No differences in rates of DGE between DM and non-DM patients after PD were found, strengthening the hypothesis that DGE is a separate physiologic entity from diabetic gastroparesis. IDDM patients demonstrated better postsurgical outcomes compared to non-IDDM patients in terms of intra-abdominal infection and pancreatic fistula, suggesting a potential role of monitored insulin or hyperglycemia regulation in the development of these complications.

Preoperative carbohydrate loading in diabetic patients within an enhanced recovery after surgery programme for colorectal surgery – Are there any ill effects?

Objectives: Carbohydrate loading is one of the preoperative components of Enhanced Recovery After Surgery (ERAS) for colorectal surgery. Its purpose is to modulate stress response to surgery and decrease postoperative insulin resistance. However, the effects of hyperglycemia and delayed gastric emptying in diabetic patients have been raised. Consensus on its application in diabetic patients has yet to be reached. We report our experience on the use of preoperative carbohydrate loading in diabetic patients within an ERAS program for elective colorectal surgery.

Electroacupuncture at ST36 Protects ICC Networks via mSCF/Kit-ETV1 Signaling in the Stomach of Diabetic Mice.

Background. Electroacupuncture (EA) at ST36 has been used to regulate gastric motility and effectively improve gastric emptying in diabetic patients. Nevertheless, the specific mechanisms underlying the efficacy of this treatment remain unknown. The aim of this study was to assess the variations of interstitial cells of Cajal (ICC) and explore the changes in mSCF/KIT-ETV1 signaling in the antrum and corpus of diabetic mice after treatment with EA. Methods. Male C57BL/6 mice were randomized into five groups: control group, diabetic group (DM), diabetic-plus-sham EA group (SEA), diabetic-plus-low-frequency EA group (LEA), and diabetic-plus-high-frequency EA group (HEA). The expression levels of Ano1, c-Kit, and ETV1 were assessed by immunofluorescence in the antrum and corpus. Western blotting and PCR methods were further used to evaluate c-Kit, mSCF, and ETV1 expression. Results. (1) c-Kit and Ano1 were obviously decreased in the DM group, but c-Kit reduced much more than Ano1. (2) The mSCF, c-Kit, and ETV1 mRNA and protein levels were obviously decreased in the DM group in both the antrum and the corpus (P < 0.01), but they were significantly elevated in the LEA and HEA groups (P < 0.01). Conclusions. Ano1 is a reliable marker to detect ICC changes in diabetes; low- and high-frequency EA at acupoint ST36 can protect the networks of ICC possibly via normal activation of mSCF/KIT-ETV1 signaling.

Delayed gastric emptying in diabetic rats caused by decreased expression of cystathionine gamma lyase and H2 S synthesis: in vitro and in vivo studies.

This study aimed to evaluate the role of H2 S on gastric emptying rate (GER) and also to determine the effect of gastric distention on mRNA and protein expression of cystathionine β-lyase (CBS) and cystathionine γ-synthase (CSE) in diabetic-gastroparetic and normal rats. Adult normal rats intraperitoneally received either propargylglycine (PAG), L-cysteine or NaHS 30 min prior to GER marker (acetaminophen) to investigate H2 S involvement in GER and the same protocols were performed in diabetes-induced gastroparesis rats. The role of calcitonin gene related peptide (CGRP) neurons in the prokinetic effect of endogenous H2 S on GER was determined. The level of CBS and CSE expressions in response to gastric distention were also determined. The effect of H2 S on frequency and tension of spontaneous contractions of gastric smooth muscle strips was investigated. Our results showed that: (i) H2 S and L-cysteine increased GER in gastroparetic and normal rats. (ii) The increased levels of CSE expression in response to gastric distention in diabetic rats were lower than in normal rats. (iii) PAG inhibited the excitatory effect of capsaicin on GER and on tension of spontaneous contractions of strips. (iv) Hydrogen sulphide increased the frequency and tension of spontaneous contractions of gastric strip muscles in normal and diabetic rats. The results showed that delayed GER in diabetic rats can be due to down-regulation of H2 S biosynthesis enzyme, CSE and suggested that a potential prokinetic role for H2 S to treat the delayed gastric emptying in diabetic patients.

Decreased gastric motility in type II diabetic patients.

Background. To differentiate gastric motility and sensation between type II diabetic patients and controls and explore different expressions of gastric motility peptides. Methods. Eleven type II diabetic patients and health volunteers of similar age and body mass index were invited. All underwent transabdominal ultrasound for gastric motility and visual analogue scales. Blood samples were taken for glucose and plasma peptides (ghrelin, motilin, and glucacon-like peptides-1) by ELISA method. Results. Gastric emptying was significantly slower in diabetic patients than controls (T50: 46.3 (28.0–52.3) min versus 20.8 (9.6–22.8) min, P ≤ 0.05) and less antral contractions in type II diabetic patients were observed (P = 0.02). Fundus dimensions did not differ. There were a trend for less changes in gastrointestinal sensations in type II diabetic patients especially abdomen fullness, hunger, and abdominal discomfort. Although the serum peptides between the two groups were similar a trend for less serum GLP-1in type II diabetic patients was observed (P = 0.098). Conclusion. Type II diabetic patients have delayed gastric emptying and less antral contractions than controls. The observation that there were lower serum GLP-1 in type II diabetic patients could offer a clue to suggest that delayed gastric emptying in diabetic patients is not mainly influenced by GLP-1.

Tu1465 Measurement of Gastric Emptying in Diabetic Patients With Radiopaque Markers (Roms): Correlation With Scintigraphy and Upper GI Symptoms

Tu1465 Measurement of Gastric Emptying in Diabetic Patients With Radiopaque Markers (Roms): Correlation With Scintigraphy and Upper GI Symptoms

Effect of Glucose Control on Delayed Gastric Emptying in Diabetic Patients

TO THE EDITOR: I read the report entitled Do HbA1C levels correlate with delayed gastric emptying in diabetic patients? by Reddy et al1 with great interest. The authors investigated the relationship between serum HbA1C and gastric emptying (GE), assessed by gastric emptying scintigraphy, in diabetics. Based on the data, the authors suggest that HbA1C is not as important as daily glycemic control in terms of GE in diabetics.1 I believe that the diabetic subjects in your study might have had symptoms of gastroparesis because they underwent gastric emptying scintigraphy. Diabetic patients in whom gastroparesis develops have often had diabetes for at least 10 years and typically have retinopathy, neuropathy and nephropathy.2 Additionally, the contribution of postprandial, as opposed to fasting, glycemia to overall glycemic control (indicated by HbA1C) is reportedly more closely associated with diabetic retinopathy and neuropathy than is either fasting blood glucose or HbA1C.3-5 Although your study had several limitations due to the fact that it was a retrospective study, information about postprandial glucose levels over the previous few months, such as that given by HbA1C, might be available.1 Thus, I am curious about the relationship between postprandial glucose and GE. Diabetic gastroparesis is usually chronic and, indeed, has been arbitrarily defined as persisting for more than 3 months. Therefore, investigation of the relationship between postprandial glucose levels over the previous 3 months and GE might be valuable. Although postprandial glycemia was reported to be more closely associated with diabetic neuropathy related to diabetic gastroparesis, overall glycemic control might also have importance in diabetic gastroparesis. Thus, despite negative results with respect to the relationship between HbA1C and GE in your study, I wonder whether categorical analysis of patients with abnormal HbA1C levels and GE times was performed according to variable criteria such as GE times of 90, 120 and 180 minutes (what is the normal criteria for T1/2 in your institution? The abstract states 120 minutes, whereas the main body of the paper states 90 minutes) or HbA1C levels of 7%, 8% and 9%. I am also curious about the relationship between HbA1C tendency and GE. That is, was the serum HbA1C level within the previous 3 months increased or decreased compared with the previous HbA1C? Despite several limitations of the present study, it provides interesting data about the relationship between HbA1C and GE in diabetics. Further studies with prospective settings are needed to reinforce the findings in this study.

Effect of Glucose Control on Delayed Gastric Emptying in Diabetic Patients: Author's Reply

TO THE EDITOR: We thank Dr. Kim for her interest in our paper.1 We agree regarding the issues raised in the correspondence to the editor. The study under discussion was a retrospective analysis of an available serum hemoglobin A1C (HbA1C) level near the performance of a gastric emptying scan. As a result of this limitation, assessment of preprandial or postprandial glucose values as well as duration of diabetes and presence of diabetic complications could not be performed.2-5

Do HbA1C Levels Correlate With Delayed Gastric Emptying in Diabetic Patients?

Background/AimsGastroparesis is characterized by delayed gastric emptying without obstruction. Diabetes is frequently associated with poor glycemic control and delayed gastric emptying. Gastric emptying scintigraphy (GES) is the standard for measuring gastric emptying. Serum hemoglobin A1C (HbA1C) measures prolonged glycemic control with normal as < 7% glycated. To date, no correlation of serum HbA1C level with gastric emptying, demonstrated by GES, in diabetics has been performed. The aim of the present investigation is to determine if a relationship exists between serum HbA1C levels and gastric emptying, assessed by GES, in diabetics.MethodsAll diabetics, having both GES and serum HbA1C level within 3 months from July 1, 2003 - June 30, 2008 were eligible for study. Demographic data collected included gender, age and ethnicity. Abnormal gastric emptying was defined as T½ > 120 minutes and serum HbA1C as percent glycated.ResultsNuclear Medicine GES database review revealed 431 examinations performed during the study interval. A total of 181 were not eligible due to the following: 29 duplicates, 22 diabetes not documented and 130 without HbA1C levels, resulting a study group of 250 cases. No significant correlation was observed between gastric emptying time, HbA1C or age. Among patients with HbA1C ≥ 7%, HbA1C was inversely related to age with a coefficient of correlation of r = -0.175 (p = 0.038).ConclusionsThere is no correlation observed between gastric emptying time, using GES, and serum HbA1C levels. In diabetics, serum HbA1C is not as important as daily glycemic control regarding gastric emptying.

Ghrelin Agonist TZP-101 Improves Symptoms and Gastric Emptying in Diabetic Patients with Gastroparesis

Purpose: TZP-101, a ghrelin agonist, has been shown to accelerate gastric emptying (GE) in diabetic patients with gastroparesis (GP) by 4-h scintigraphy. The goal was to evaluate TZP-101 effects on symptoms in diabetic patients with GP. Methods: USA and European Centers participated in a randomized, placebo controlled study of 76 diabetic patients with GP (presence of symptoms & demonstration of delayed GE). For 4 days, patients received a 30 min IV infusion of one of six TZP-101 doses (range 20-600μg/kg) or placebo (57 received TZP-101; 19 received placebo); elective hospitalization; efficacy was evaluated by: Gastroparesis Cardinal Symptom Index (GCSI) - daily; meal-related Gastroparesis Symptom Assessment (GSA) - daily; and Clinician Rated Symptom Assessment (CRSA) - end of treatment; gastric emptying; regular battery of safety assessment tests; 30-day follow up for efficacy and safety. Results: TZP-101 induced gradual symptom improvement over 4 days while placebo showed no change or gradual deterioration (vomiting & early satiety shown). Of all doses, the 80μg/kg dose was the most effective. At the end of dosing (80 μg/kg over placebo) the following symptoms improved significantly/trend toward significance: GCSI: vomiting (p=0.006), loss of appetite (p=0.034), early satiety (p=0.087); sustained effect on vomiting for 30 days (p=0.03); GSA (shown): postprandial fullness (p=0.007); CRSA: early satiety (p=0.089), abdominal distension (p=0.053), bloating (p=0.082). During the 30-day follow-up period, 3% of patients on TZP-101 vs. 10% on placebo were hospitalized due to GP. When GE was reassessed on the day after the 4th infusion, TZP-101 accelerated GE rate by 25% (vs. 8% on placebo); TZP-101 was safe and well tolerated for all doses studied. Conclusion: TZP-101, given IV for 4 consecutive days in diabetic GP patients, had a significant impact on vomiting, loss of appetite and fullness/early satiety as well as GE. Further TZP-101 evaluation in diabetic GP patients is anticipated since the results suggest a number of potential clinical benefits including improved glucose control and better nutrition. This research was supported by an industry grant from Tranzyme, Inc.Figure: Symptoms on day 4 - GSA.

Video Capsule Endoscopy in Diabetic Patients and its Effect on the Gastric and Small Bowel Transit Time

Purpose: Video capsule Endoscopy (VCE) is one of the most complex procedures in digestive endoscopy. Delayed gastric emptying in diabetic patients has been cited as a possible reason for incomplete small bowel examination during a VCE. Since this relationship is not yet clearly established we decided to investigate it further. Methods: Case records of 412 consecutive (May 03 - Mar 07) VCE performed at a community based hospital were reviewed retrospectively. 51(12.4%) patients did not meet the inclusion criteria and were excluded. The Gastric transit time (GTT) and the Small Bowel Transit Time (SBTT) of diabetic patients (n=90, 24.9%) were compared with non-diabetic using a SPSS students version 16 (Spss Inc, Chicago). Results are expressed as mean ± SD. T-test was used for statistical analysis, p≤0.05 being significant. Results: 361 adult patients (male = 159, Age = 65 ± 16.2 years) were included in the study. The caecum was visualised in 83/91 (91%) diabetics and 241/270 (89%) in non-diabetics (p=0.59). In our experience there was no significant difference in the GTT (33.4, 1- 240 min vs. 35.52, 1- 264 min, p=0.67) and the SBTT (229.53, 38- 455 min vs. 245.15, 37-424 min, p= 0.12) between the diabetic and the non-diabetic groups respectively. Conclusion: The diagnostic yield of capsule endoscopy is affected by several factors which are not yet completely understood. GTT and SBTT are not affected statistically in patients with diabetes when compared with nondiabetics. This study highlights the need to perform prospective multi-institutional randomized control trials to further explore this relationship.

T1272 Muscarinic Antagonist Reduced Tegaserod-Induced Contractions of Fundus But Not Antrum in Obese Type 2 Diabetic But Not Control Mice

Prokinetic drugs accelerate gastric emptying in diabetic patients with gastroparesis. Tegaserod, a 5-HT4 partial agonist, increases GI motility by enhancing Ach release from autonomic neurons innervating smooth muscle. Autonomic neuropathy, evident in animal models of diabetes, may alter the efficacy of prokinetic drugs which rely on effective neuromuscular transmission to increase motility. These studies examined the effect of tegaserod on motility of whole thickness rings of fundus and antrum from control (KK) and obese type 2 diabetic Agouti mice (KK.Cg-Aγ) using tissue bath set-up. Tissues were pretreated with vehicle or 4-DAMP (M3 muscarinic receptor antagonist), then treated with bethanechol or tegaserod (TG). Drug responses were quantified as area under the curve (g*s) or peak contraction (g). At 7 weeks after diabetes onset, diabetic mice were heavier (42±1g) than control mice (32±1g). Bethanechol (10 μM)-induced peak contractions of antrum, but not fundus, were reduced in diabetic as compared to control mice [antrum: control (n=11), 1.6±0.2; diabetic (n=10), 1.1±0.1*; *p<0.05][fundus: control (n=9), 2.9±0.3; diabetic (n=11), 2.8±0.3]. In both control and diabetic mice, TG treatment resulted in relaxation of antrum [0.1 μM: control (n=13), 1±1; diabetic (n=12), 3±2] [1.0 μM: control (n=14), -1±1; diabetic (n=12), -1±3] [10 μM: control (n=14), -6±2; diabetic (n=15), -5±3], but contraction of fundus [0.1 μM: control (n=13), 10±3; diabetic (n=11), 6±4] [1.0 μM: control (n=13), 18±6; diabetic (n=11), 31±11] [10 μM: control (n=13), 28±10; diabetic (n=13), 43±13]. 4-DAMP at 0.5 μM was equally effective, but at 1 μM was more effective, in reducing bethanechol (10 μM)induced contractions of fundus from diabetic mice [vehicle: (n=11), 380±58; 0.5 μM: (n= 8), 77±23; 1 μM: (n=8), 12±2*; *p<0.05] as compared to control mice [vehicle: (n=9), 374±53; 0.5 μM: (n=8), 55±14; 1 μM: (n=9), 20±3]. Using fundus, 4-DAMP at 0.5 μM, but not 1 μM, reduced TG (10 μM)-induced contractions in diabetic mice [vehicle: (n=13), 43±13; 0.5 μM: (n=14), 7±8*; 1 μM: (n=14), 13±7; *p<0.05], but not in control mice [vehicle: (n=13), 28±10; 0.5 μM: (n=11), 10±10; 1 μM: (n=11), 24±9]. 4-DAMP (0.5, 1, 10 μM) did not alter TG (10 μM)-induced relaxation of antrum from control or diabetic mice. In diabetic, but not control mice, TG-induced contractions of fundus were reduced by 4-DAMP, suggesting an additional non-cholinergicmechanism for TG-induced contraction in control mice. Both gastric region and type 2 diabetes may alter the effectiveness of prokinetic agents in accelerating gastric emptying. Supported by College of Health Sciences and ORSP at MWU.

W2065 Do HbA1C Levels Correlate with Delayed Gastric Emptying in Diabetic Patients?

W2065 Do HbA1C Levels Correlate with Delayed Gastric Emptying in Diabetic Patients?

Gastric emptying in diabetic patients by the 13C-octanoic acid breath test: role of insulin in gastric motility

Gastric emptying in diabetic patients by the 13C-octanoic acid breath test: role of insulin in gastric motility

Prevalence of delayed gastric emptying in diabetic patients and relationship to dyspeptic symptoms: a prospective study in unselected diabetic patients.

Data on the prevalence of abnormal gastric emptying in diabetic patients are still lacking. The relation between gastric emptying and dyspeptic symptoms assessed during gastric emptying measurement has not yet been investigated. The aim was to investigate the prevalence of delayed gastric emptying in a large cohort of unselected diabetic patients and to investigate the relation between gastric emptying and gastrointestinal sensations experienced in the 2 weeks before and during the test meal, prospectively. Gastric emptying was evaluated in 186 patients (106 with type 1 diabetes, mean duration of diabetes 11.6 +/- 11.3 years) using 100 mg (13)C-enriched octanoic acid added to a solid meal. Gastric emptying was significantly slower in the diabetic subjects than in the healthy volunteers (T(50): 99.5 +/- 35.4 vs. 76.8 +/- 21.4 min, P < 0.003; Ret(120 min): 30.6 +/- 17.2 vs. 20.4 +/- 9.7%, P < 0.006). Delayed gastric emptying was observed in 51 (28%) diabetic subjects. The sensations experienced in the 2 weeks before the test were weakly correlated with the sensation scored during the gastric emptying test. Sensations assessed during the gastric emptying test did predict gastric emptying to some extent (r = 0.46, P < 0.0001), whereas sensations experienced in the previous 2 weeks did not. This prospective study shows that delayed gastric emptying can be observed in 28% of unselected patients with diabetes. Upper gastrointestinal sensations scored during the gastric emptying tests do predict the rate of gastric emptying to some extent and sensation experienced during daily life does not.

Ob/ob mice as a model of delayed gastric emptying

Diabetic gastroparesis is a well-recognized delay of gastric emptying in diabetic patients. We assessed the gastric emptying rate in ob/ob mice, a genetic model of obesity and diabetes. The basal gastric emptying rate in 22- to 27-week-old ob/ob mice was significantly lower than that in 10- to 11-week-old ob/ob mice ( P<.01). Our results indicate that the ob/ob mice are a useful model not only of glucose intolerance but also of delayed gastric emptying as a diabetic complication.

Gastric myoelectrical activity and gastric emptying in diabetic patients with dyspeptic symptoms.

Gastric myoelectrical activity and gastric emptying in diabetic patients with dyspeptic symptoms

Induced-Hyperglycemia Attenuates Erythromycin-Induced Acceleration of Hypertonic Liquid-Phase Gastric Emptying in Type-I Diabetic Patients

Background: Erythromycin has been found to be a gastrointestinal prokinetic agent of hypertonic liquids, while acute hyperglycemia has been associated with delayed gastric emptying in diabetic patients. Aim: To investigate whether hyperglycemia, per se, reduces gastric motility during erythromycin-induced acceleration on gastric emptying of hypertonic liquids in diabetic patients. Methods: In 12 type-I diabetic patients following a hypertonic radiolabeled liquid meal, gastric emptying was measured scintigraphically during normoglycemia (5–8.9 mmol/l glucose) or hyperglycemia induced by intravenous (16–19 mmol/l) glucose infusion. The tests were performed on 4 separate days in random order after administering either placebo or 200 mg i.v. erythromycin. Results: In the hyperglycemic state compared to normoglycemia, the gastric emptying of the hypertonic liquid was reduced after placebo or erythromycin administration. The lag-phase duration (17.8±5.5 and 7.8±4.5 vs. 10.8±3.4 and 3.7±2.5 min, respectively, p<0.001), the overall gastric emptying time of the half meal (52.8±13 and 24.9±5.5 vs. 42.5±10.5 min and 16.6±6 min, respectively, p<0.001) and the retained percentage of liquid meal in the stomach at 60 and 100 min postprandially (p<0.001) were significantly increased. Conclusions: The erythromycin-induced acceleration on gastric emptying of hypertonic liquids in diabetic patients is related to the plasma glucose level. The induced hyperglycemia reduces the erythromycin-induced acceleration of liquid-phase gastric emptying, decreasing the overall gastric emptying rate. In spite of the inhibitory effect of induced hyperglycemia on the gastric emptying of hypertonic liquids, erythromycin is still able to accelerate the emptying rate and could prove to be a useful prokinetic agent under hyperglycemic conditions.