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. 2021 Jul 30;27(3):390-399.
doi: 10.5056/jnm19195.

Gastric Emptying Time and Volume of the Small Intestine as Objective Markers in Patients With Symptoms of Diabetic Enteropathy

Mette W Klinge  1 , Nanna Sutter  1 , Esben B Mark  2 , Anne-Mette Haase  1 , Per Borghammer  3   4 , Vincent Schlageter  5 , Sten Lund  6   7 , Jesper Fleischer  7   8 , Karoline Knudsen  3 , Asbjørn M Drewes  2 , Klaus Krogh  1   7
Affiliations

Gastric Emptying Time and Volume of the Small Intestine as Objective Markers in Patients With Symptoms of Diabetic Enteropathy

Mette W Klinge et al. J Neurogastroenterol Motil. .

Abstract

Background/aims: Patients with diabetes mellitus (DM) often suffer from gastrointestinal (GI) symptoms, but these correlate poorly to established objective GI motility measures. Our aim is to perform a detailed evaluation of potential measures of gastric and small intestinal motility in patients with DM type 1 and severe GI symptoms.

Methods: Twenty patients with DM and 20 healthy controls (HCs) were included. GI motility was examined with a 3-dimensional-Transit capsule, while organ volumes were determined by CT scans.

Results: Patients with DM and HCs did not differ with regard to median gastric contraction frequency (DM: 3.0 contractions/minute [interquartile range {IQR}, 2.9-3.0]; HCs: 2.9 [IQR, 2.8-3.1]; P = 0.725), amplitude of gastric contractions (DM: 9 mm [IQR, 8-11]; HCs: 11 mm (IQR, 9-12); P = 0.151) or fasting volume of the stomach wall (DM: 149 cm3 [IQR, 112-187]; HCs: 132 cm3 [IQR, 107-154]; P = 0.121). Median gastric emptying time was prolonged in patients (DM: 3.3 hours [IQR, 2.6-4.6]; HCs: 2.4 hours [IQR, 1.8-2.7]; P = 0.002). No difference was found in small intestinal transit time (DM: 5 hours [IQR, 3.7-5.6]; HCs: 4.8 hours [IQR, 3.9-6.0]; P = 0.883). However, patients with DM had significantly larger volume of the small intestinal wall (DM: 623 cm3 [IQR, 487-766]; HCs: 478 cm3 [IQR, 393-589]; P = 0.003). Among patients, 13 (68%) had small intestinal wall volume and 9 (50%) had gastric emptying time above the upper 95% percentile of HCs.

Conclusion: In our study, gastric emptying time and volume of the small intestinal wall appeared to be the best objective measures in patients with DM type 1 and symptoms and gastroenteropathy.

Keywords: Diabetes mellitus; Diabetic neuropathies; Gastric emptying; Gastrointestinal motility; Organ size.

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Conflict of interest statement

Conflicts of interest: Vincent Schlageter is co-owner of Motilis Medica SA, he took part in the technical terms of improving the software for gastric analysis. Jesper Fleischer is the co-inventor of Vagus. Mette W Klinge, Nanna Sutter, Esben B Mark, Anne-Mette Haase, Per Borghammer, Sten Lund, Karoline Knudsen, Asbjørn M Drewes, and Klaus Krogh have no competing interests.

Figures

Figure 1
Figure 1
Intragastric movements of the 3-dimensional Transit electromagnetic capsule. Recordings from a healthy volunteer (A) and a patient with diabetes (B). Red dots show every 30 minute intervals position in the stomach.
Figure 2
Figure 2
Volumes of the gastric (A) and small intestinal walls (B) assesses with CT scans. The horizontal line shows the median. Diabetes patients had a significantly larger volume of the small intestinal wall (P = 0.003) but not of the stomach (P = 0.121). HCs, healthy controls; DM, patients with diabetes mellitus.
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