Digestive Diseases and Sciences

, Volume 40, Issue 9, pp 2037–2042 | Cite as

Compliance of the proximal stomach and dyspeptic symptoms in patients with type I diabetes mellitus

  • M. Samsom
  • G. A. M. Salet
  • J. M. M. Roelofs
  • L. M. A. Akkermans
  • G. P. Vanberge-Henegouwen
  • A. J. P. M. Smout
Esophageal, Gastric, and Duodenal Disorders


In the present study the function of the proximal stomach and its role in eliciting dyspeptic symptoms were evaluated in patients with diabetes mellitus. Eight type I diabetics with cardiovascular autonomic neuropathy and dyspeptic symptoms, and 10 healthy volunteers were studied using an electronic barostat device connected to a intragastric bag. The intragastric bag was inflated and deflated by stepwise pressure increments, creating pressurevolume curves. During the experiment the blood glucose concentrations were maintained within the euglycemic range in the diabetics. The volume-pressure curves showed a larger volume during the pressure increase in the diabetics than in the controls (P<0.01). This resulted in a significant difference in compliance (dV/dP), 57.2±4.2 ml/mm Hg in diabetics and 43.7±3.5 ml/MM Hg in controls (P<0.014). The volume-pressure curves during deflation of the intragastric balloon were different from the curves during inflation, creating a hysteresis loop. The area between the inflation and deflation curves was 827 ml/mm Hg in diabetics and 627 ml/mm Hg in the controls (P=0.21). Gastric distension induced more upper gastrointestinal sensations in the patients than in the volunteers: nausea (P<0.002), bloating (P<0.003), upper abdominal pain (P<0.001). In conclusion: this study showed that the compliance of the proximal stomach is increased in diabetic patients with autonomic neuropathy and gastrointestinal symptoms. This abnormality, probably due to autonomic neuropathy, is associated with increased symptom generation during gastric distension.

Key Words

stomach dyspepsia diabetes mellitus 


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  1. 1.
    Horowitz M, Harding M, Maddox A, et al: Gastric and esophageal emptying in insulin-dependent diabetes mellitus. J Gastroenterol Hepatol 1:97–113, 1986Google Scholar
  2. 2.
    De Caestecker JS, Ewing DJ, Tothill P, Clarke BF, Heading RC: Evaluation of oral cisapride and metoclopramide in diabetic autonomic neuropathy: An eight week double-blind crossover study. Aliment Pharmacol Ther 3:69–81, 1989PubMedGoogle Scholar
  3. 3.
    Camilleri M, Malagelada J-R: Abnormal intestinal motility in diabetes with gastroparesis syndrome. Eur J Clin Invest 14:420–427, 1984PubMedGoogle Scholar
  4. 4.
    Dooley CP, El Newihi HM, Zeidler A, Valenzuela JE: Abnormalities of the migrating motor complex in diabetics with autonomic neuropathy and diarrhea. Scand J Gastroenterol 23:217–223, 1988PubMedGoogle Scholar
  5. 5.
    Abell ThL, Camilleri M, Hench VS, Malagelada J-R: Gastric electromechanical function and gastric emptying in diabetic gastroparesis. Eur J Gastroenterol Hepatol 3:163–167, 1991Google Scholar
  6. 6.
    Malagelada J-R, Rees WDW, Mazzotta LJ, Go VLW: Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and bethanechol. Gastroenterology 78:286–293, 1980PubMedGoogle Scholar
  7. 7.
    Jebbink HJA, Bravenboer B, Akkermans LMA, van Berge-Henegouwen GP, Smout AJPM: Relationship between dyspeptic symptoms and gastrointestinal motility in patients with type I (insulin-dependent) diabetes mellitus. Diabetologia 36:948–954, 1993PubMedGoogle Scholar
  8. 8.
    Samsom M, Jebbink HJA, Akkermans LMA, van Berge-Henegouwen GP, Smout AJPM: Abnormalities of antroduodenal motility in type I (insulin-dependent) diabetes mellitus studied with an ambulatory monitoring technique. Gastroenterology 104:A562, 1994Google Scholar
  9. 9.
    Oliveira RB, Troncon LE, Menighelli UG, Dantas RO, Gody RA: Gastric accommodation to distension and early gastric emptying in diabetics with neuropathy. Braz J Med Biol Res 17:49–53, 1984PubMedGoogle Scholar
  10. 10.
    Urbain JL, Vekemans MC, Bouillon R, Van Cauteren J, Bex M, Mayeur SM, et al.: Characterization of gastric antral motility disturbances in diabetes using a scintigraphic technique. J Nucl Med 34:576–581, 1993PubMedGoogle Scholar
  11. 11.
    Azpiroz F, Malagelada JR: Importance of vagal input maintaining gastric tone in dog. J Physiol 384:511–524, 1987PubMedGoogle Scholar
  12. 12.
    DeFronzo RA, Tobin JD, Andres R: Glucose clamp technique: A method for quantifying insulin secretion and resistance. Am J Physiol 237:E214-E223, 1979PubMedGoogle Scholar
  13. 13.
    Ewing DJ, Clarke BF: Diagnose and management of diabetic autonomic neuropathy. Br Med J 285:916–918, 1982Google Scholar
  14. 14.
    Azpiroz F, Malagelada JR: Physiological variations in canine gastric tone measured by an electronic barostat. Am J of Physiol 248:G229-G237, 1985Google Scholar
  15. 15.
    EC Huskissom: Measurement of pain. The Lancet 9:1127–1131, 1974Google Scholar
  16. 16.
    Mearin F, Cucale M, Azpiroz F, Malagelade JR: The origin of symptoms on the brain-gut axis in functional dyspepsia. Gastroenterology 101:999–1006, 1991PubMedGoogle Scholar
  17. 17.
    Azpiroz F, Malagelada JR: Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology 92:934–943, 1987PubMedGoogle Scholar
  18. 18.
    Hebbard GS, Sun WM, Dent J, Horowitz M: Acute hyperglycemia increases proximal gastric compliance. Gastroenterology 106:A509, 1994Google Scholar
  19. 19.
    Fraser RJ, Horowitz M, Maddox AF, Harding PE, Chatterton BE, Dent J: Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 33:675–680, 1990PubMedGoogle Scholar
  20. 20.
    Fraser RJ, Horowitz M, Dent J: Hyperglycemia stimulates pyloric motility in normal subjects. Gut 32:475–478, 1990Google Scholar
  21. 21.
    Barnett JL, Owyang C: Serum glucose concentration as a modulator of interdigestive gastric motility. Gastroenterology 94:739–744, 1988PubMedGoogle Scholar
  22. 22.
    Duchen LW, Anjorin A, Watkins PJ, Mackay JD: Pathology of autonomic neuropathy in diabetes mellitus. Ann Intern Med 92:301–303, 1980PubMedGoogle Scholar
  23. 23.
    Hosking DJ, Moody F, Steward IM, Atkinson M: Vagal impairment of gastric secretion in diabetic autonomic neuropathy. Br Med J 2:588–590, 1975PubMedGoogle Scholar
  24. 24.
    Belai A, Lefebvre RA, Burnstock G: Motor activity and neurotransmitter release in the gastric fundus of streptozotocindiabetic rats. Eur J Pharmacol 194:225–234, 1991PubMedGoogle Scholar
  25. 25.
    Mathison R, Davidson JS: Modified smooth muscle response of jejeunum in streptozotocin-diabetic rats. J Pharmacol Exp Ther 244:1045–1055, 1988PubMedGoogle Scholar
  26. 26.
    Yoshida MM, Schuffler MD, Sumi SM: There are no morphologic abnormalities of the gastric wall or abdominal vagus in patients with diabetic gastroparesis. Gastroenterology 94:907–914, 1988PubMedGoogle Scholar
  27. 27.
    Feldman M, Schiller LR: Disorder of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 98:378–384, 1983PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • M. Samsom
    • 2
    • 1
  • G. A. M. Salet
    • 2
    • 1
  • J. M. M. Roelofs
    • 2
    • 1
  • L. M. A. Akkermans
    • 2
    • 1
  • G. P. Vanberge-Henegouwen
    • 2
    • 1
  • A. J. P. M. Smout
    • 2
    • 1
  1. 1.Department of SurgeryUniversity Hospital ItrechtUtrechtThe Netherlands
  2. 2.Department of GastroenterologyUniversity Hospital UtrechtUtrechtThe Netherlands

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