, Volume 32, Issue 3, pp 151–159 | Cite as

Gastric and oesophageal emptying in patients with Type 2 (non-insulin-dependent) diabetes mellitus

  • M. Horowitz
  • P. E. Harding
  • A. F. Maddox
  • J. M. Wishart
  • L. M. A. Akkermans
  • B. E. Chatterton
  • D. J. C. Shearman


Gastric emptying of a digestible solid and liquid meal and oesophageal emptying of a solid bolus were measured with scintigraphic techniques in 20 randomly selected Type 2 (non-insulin-dependent) diabetic patients receiving oral hypoglycaemic therapy and 20 control subjects. In the diabetic patients, the relationships between oesophageal emptying, gastric emptying, gastrointestinal symptoms, autonomic nerve function and glycaemic control were examined. The percentage of the solid meal remaining in the stomach at 100 min (p<0.001), the 50% gastric emptying time for the liquid meal (p<0.05) and oesophageal emptying (p<0.05) were slower in the diabetic patients compared to the control subjects. Scores for upper gastrointestinal symptoms and autonomic nerve dysfunction did not correlate significantly (p>0.05) with oesophageal, or gastric emptying. The 50% gastric emptying time for the liquid meal was positively related (r=0.58, p<0.01) to the plasma glucose concentration at the time of the performance of the gastric emptying test and the lag period, before any solid food emptied from the stomach, was longer (p<0.05) in subjects with plasma glucose concentrations during the gastric emptying measurement greater than the median, compared to those with glucose concentrations below the median. These results indicate that delayed gastric and oesophageal emptying occur frequently in Type 2 diabetes mellitus and that delayed gastric emptying relates, at least in part, to plasma glucose concentrations.

Key words

Diabetes mellitus stomach oesophagus gastric emptying oesophageal emptying autonomic nerve function 


  1. 1.
    Feldman M, Schiller LR (1983) Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 98: 378–384Google Scholar
  2. 2.
    Horowitz M, Harding PE, Maddox A, Maddern GJ, Collins PJ, Chatterton BE, Wishart J, Shearman DJC (1986) Gastric and oesophageal emptying in insulin-dependent diabetes mellitus. J Gastroenterol Hepatol 1: 97–113Google Scholar
  3. 3.
    Hollis JB, Castell DO, Braddom RL (1977) Esophageal function in diabetes mellitus and its relation to peripheral neuropathy. Gastroenterology 73: 1098–1102Google Scholar
  4. 4.
    Horowitz M, Harding PE, Chatterton BE, Collins PJ, Shearman DJC (1985) Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy. Dig Dis Sci 30: 1–9Google Scholar
  5. 5.
    Horowitz M, Maddox A, Harding PE, Maddern GJ, Chatterton BE, Wishart J, Shearman DJC (1987) Effect of cisapride on gastric and esophageal emptying in insulin-dependent diabetes mellitus. Gastroenterology 92: 1899–1907Google Scholar
  6. 6.
    Kassander P (1958) Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Int Med 48: 797–812Google Scholar
  7. 7.
    Channer KS, Jackson PC, O'Brien I, Corrall RJM, Coles DR, Rhys Davies E, Virjee JP (1985) Oesophageal function in diabetes mellitus and its association with autonomic neuropathy. Diabetic Med 2: 378–382Google Scholar
  8. 8.
    Buysschaert M, Moulart M, Urbain JL, Pauwels S, De Roy L, Ketelslegers JM, Lambert AE (1987) Impaired gastric emptying in diabetic patients with cardiac autonomic neuropathy. Diabetes Care 10: 448–452Google Scholar
  9. 9.
    Campbell IW, Heading RC, Tothill P, Buist, TAS, Ewing DJ, Clarke BF (1977) Gastric emptying in diabetic autonomic neuropathy. Gut 18: 462–467Google Scholar
  10. 10.
    Russell COH, Gannan R, Coatsworth J, Neilsen R, Allen F, Hill LD, Pope CE (1983) Relationship among esophageal dysfunction, diabetic gastroenteropathy and peripheral neuropathy. Dig Dis Sci 28: 289–293Google Scholar
  11. 11.
    Fox S, Behar J (1980) Pathogenesis of diabetic gastroparesis — a pharmacologie study. Gastroenterology 78: 757–763Google Scholar
  12. 12.
    Malagelada J-R, Rees WDW, Mazzotta LJ, Go VLW (1980) Gastric motor abnormalities in diabetic and postvagotomy gastroparesis; effect of metoclopramide and bethanechol. Gastroenterology 78: 286–293Google Scholar
  13. 13.
    Camilleri M, Malagelada J-R (1984) Abnormal intestinal motility in diabetics with the gastroparesis syndrome. Eur J Clin Invest 14: 420–427Google Scholar
  14. 14.
    Mearin F, Camilleri M, Malagelada J-R (1986) Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology 90: 1919–1925Google Scholar
  15. 15.
    Keshavarzian A, Iber FL, Vaeth J (1987) Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol 82: 29–35Google Scholar
  16. 16.
    Wright RA, Clemente R, Wathen R (1985) Diabetic gastroparesis: an abnormality of gastric emptying of solids. Am J Med Sci 289: 240–242Google Scholar
  17. 17.
    Achem-Karam SR, Funakoshi A, Vinik AI, Owyang C (1985) Plasma motilin concentration and interdigestive migrating motor complex in diabetic gastroparesis: effect of metoclopramide. Gastroenterology 88: 492–499Google Scholar
  18. 18.
    Smith B (1974) Neuropathology of the esophagus in diabetes mellitus. J Neurol Neurosurg Psychiatry 37: 1155–1161Google Scholar
  19. 19.
    Wooten RL, Meriwether TW (1961) Diabetic gastric atony: a clinical study. JAMA 176: 1082–1087Google Scholar
  20. 20.
    Loo FD, Palmer DW, Soergel KH, Kalbfleisch JH, Wood CM (1984) Gastric emptying in patients with diabetes mellitus. Gastroenterology 86: 485–494Google Scholar
  21. 21.
    Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. Br Med J 285: 916–918Google Scholar
  22. 22.
    Jeppsson J, Jerntorp P, Sundkvist G, Englund H, Nylund V (1986) Measurement of hemoglobin a1c by a new liquid-chromatographic assay: Methodology, clinical utility, and relation to glucose tolerance evaluated. Clin Chem 32: 1867–1872Google Scholar
  23. 23.
    Collins PJ, Horowitz M, Cook DJ, Harding PE, Shearman DJC (1983) Gastric emptying in normal subjects — a reproducible technique using a single scintillation camera and computer system. Gut 24: 1117–1125Google Scholar
  24. 24.
    Collins PJ, Horowitz M, Shearman DJC, Chatterton BE (1984) Correction for tissue attenuation in radionuclide gastric emptying studies: a comparison of a lateral image method and a geometric mean method. Br J Radiol 57: 689–695Google Scholar
  25. 25.
    Horowitz M, Maddern GJ, Chatterton BE, Collins PJ, Harding PE, Shearman DJC (1984) Changes in gastric emptying rates with age. Clin Sci 67: 213–218Google Scholar
  26. 26.
    Horowitz M, Collins PJ, Cook DJ, Harding PE, Shearman DJC (1983) Abnormalities of gastric emptying in obese patients. Int J Obes 7: 415–421Google Scholar
  27. 27.
    Kelly KA (1980) Gastric emptying of liquids and solids: roles of proximal and distal stomach. Am J Physiol 239: G71–76Google Scholar
  28. 28.
    Camilleri M, Malagelada JR, Brown ML, Becker G, Zinsmeister AR (1985) Relation between antral motility and gastric emptying of solids and liquids in humans. Am J Physiol 12: G580–585Google Scholar
  29. 29.
    Houghton LA, Read NW, Heddle R, Horowitz M, Collins PJ, Chatterton B, Dent J (1988) The relationship of the motor activity of the antrum, pylorus and duodenum to gastric emptying of a solid-liquid mixed meal. Gastroenterology 94: 1285–1291Google Scholar
  30. 30.
    Ewing J, Clarke BF (1986) Diabetic autonomic neuropathy — present insights and future prospects. Diabetes Care 6: 648–665Google Scholar
  31. 31.
    Ahn Y-H, Maturu P, Steinheber FU, Goldman JM (1987) Association of diabetes mellitus with gastric bezoar formation. Arch Int Med 147: 527–528Google Scholar
  32. 32.
    Leatherdale BA, Green DJ, Harding LK, Griffin D, Bailey CJ (1982) Guar and gastric emptying in noninsulin dependent diabetes. Acta Diabet Lat 19: 339–343Google Scholar
  33. 33.
    Sasaki H, Nagulesparan M, Dubois A, Straus E, Samloff IM, Lawrence WH, Johnson GC, Sievers ML, Unger RH (1983) Hypergastrinemia in obese noninsulin-dependent diabetes: a possible reflection of high prevalence of vagal dysfunction. J Clin Endocrinol Metab 56: 744–750Google Scholar
  34. 34.
    Oliveira RB, Troncon LEA, Meneghelli UG, Dantas RO, Godoy RA (1984) Gastric accomodation to distension and early gastric emptying in diabetics with neuropathy. Braz J Med Biol Res 17: 49–55Google Scholar
  35. 35.
    Feldman M, Smith HJ, Simon TR (1984) Gastric emptying of solid radiopaque markers: studies in healthy subjects and diabetic patients. Gastroenterology 87: 895–902Google Scholar
  36. 36.
    Sundkvist G, Lilja B (1985) Autonomic neuropathy in diabetes mellitus: a follow-up study. Diabetes Care 1985; 8: 129–133Google Scholar
  37. 37.
    Masaoka S, Lev-Ran A, Hill R, Vaki G, Hon EHG (1985) Heart rate variability in diabetes: relationship to age and duration of the disease. Diabetes Care 8: 64–68Google Scholar
  38. 38.
    Soler NG (1980) Diabetic gastroparesis without autonomic neuropathy, (letter). Diabetes Care 3: 200–201Google Scholar
  39. 39.
    Buysschaert M, Donckier J, Dive A, Ketelslegers J-M, Lambert AE (1985) Gastric and pancreatic polypeptide responses to sham feeding are impaired in diabetic subjects with autonomic neuropathy. Diabetes 34: 1181–1185Google Scholar
  40. 40.
    MacGregor IL, Gueller R, Watts HD, Meyer JH (1976) The effect of acute hyperglycaemia on gastric emptying in man. Gastroenterology 70: 190–196Google Scholar
  41. 41.
    Aylett P (1962) Gastric emptying and change of blood glucose level as affected by glucagon and insulin. Clin Sci 22: 171–178Google Scholar
  42. 42.
    Barnett JL, Owyang C (1988) Serum glucose concentration as a modulator of interdigestive gastric motility. Gastroenterology 94: 739–744Google Scholar
  43. 43.
    Hirano T, Niijima A (1980) Effects of 2-deoxy-d-glucose, glucose and insulin on efferent activity in gastric vagus nerve. Experienta 36: 1197–1198Google Scholar
  44. 44.
    Pfeifer MA, Weinberg CR, Cook DL, Reenan A, Halter JB, Ensinck JW, Porte D (1984) Autonomic neural function in recently diagnosed diabetic subjects. Diabetes Care 7: 447–453Google Scholar
  45. 45.
    Kjellen G, Svedberg JB, Tibbling L (1984) Solid bolus transit by esophageal scintigraphy in patients with dysphagia and normal manometry and radiography. Dig Dis Sci 29: 1–5Google Scholar
  46. 46.
    Klein HA, Wald A (1984) Computer analysis of radionuclide esophageal transit studies. J Nucl Med 25: 957–964Google Scholar
  47. 47.
    Loo FD, Dodds WJ, Soergel KH, Arndorfer RC, Helm JF, Hogan WJ (1985) Multipeaked esophageal peristaltic pressure waves in patients with diabetic neuropathy. Gastroenterology 88: 485–491Google Scholar
  48. 48.
    Clouse RE, Lustman PJ, Reidel WL (1986) Correlation of esophageal motility abnormalities with neuropsychiatrie status in diabetics. Gastroenterology 90: 146–1154Google Scholar
  49. 49.
    Channer KS, Roberts CJC (1985) The effect of delayed oesophageal transit on the absorption of acetaminophen. Clin Pharmacol Ther 37: 72–76Google Scholar

Copyright information

© Springer-Verlag 1989

Authors and Affiliations

  • M. Horowitz
    • 1
  • P. E. Harding
    • 2
  • A. F. Maddox
    • 1
  • J. M. Wishart
    • 1
  • L. M. A. Akkermans
    • 4
  • B. E. Chatterton
    • 3
  • D. J. C. Shearman
    • 1
  1. 1.Department of MedicineUniversity of AdelaideSouth Australia
  2. 2.Departments of EndocrinologyRoyal Adelaide HospitalAdelaideSouth Australia
  3. 3.Nuclear MedicineRoyal Adelaide HospitalAdelaideSouth Australia
  4. 4.Department of Experimental SurgeryUniversity HospitalUtrechtThe Netherlands

Personalised recommendations