Abnormal postprandial duodenal chyme transport in patients with long standing insulin dependent diabetes mellitus

Abstract

Background: Patients with long standing diabetes mellitus frequently have upper gut dysmotility. Gastroparesis has been well studied, whereas detailed data on duodenal motor function are limited.

Aims: To characterise postprandial duodenal chyme transport in such patients.

Methods: Intraluminal multiple impedance measurement, recently introduced as a novel technique for investigation of chyme transport, was used to study postprandial duodenal chyme flow in 10 patients with long standing insulin dependent diabetes mellitus with gastroparesis, and 10 healthy volunteers.

Results: Four distinct transport patterns of chyme, termed bolus transport events (BTEs), were found in both groups and could be characterised as: short distance propulsive; simple long distance propulsive; retrograde; and complex long distance propulsive. Diabetic patients had significantly lower numbers of propulsive BTEs (p < 0.01), and higher proportions of retrograde BTEs and complex long distance BTEs (p < 0.05) than control subjects, whereas the proportion of simple long distance BTEs was significantly lower (p < 0.05). The mean propagation velocities of the BTEs were similar in both groups.

Conclusion: Abnormal postprandial duodenal chyme transport was found in patients with long standing insulin dependent diabetes mellitus. This is characterised by transport disorganisation and may result in disturbed chyme clearance.

Figure 1

: Classification algorithm for the bolus transport events.

Figure 2

: Impedance tracings of two healthy subjects using a combined catheter device. Numbers and positions of measuring segments are shown at the left, channels 1-14, impedance; channel 15, luminal pH; channel 16, luminal electrical conductivity. (A) During the late phase II of a migrating motor complex cycle; (B) during the postprandial state.

Figure 3

: Examples of postprandial impedance tracings, 10 minutes after the test meal using the standard catheter device. Numbers and positions of measuring segments are shown at the left. (A) Diabetic patient (30 year old man); (B) healthy subject (26 year old man); (C) patient with gastroparesis due to recurrent peptic ulcers (60 year old man); (D) patient with intestinal dysmotility due to progressive systemic sclerosis (55 year old woman).

Figure 4

: Examples of the main BTEs, observed postprandially. The numbers (maximum 16) and positions of the measuring segments in duodenum or jejunum are shown at the left margin. Top left panel, short distance propulsive BTE originating from proximal duodenum; top right panel, a simple long distance propulsive BTE starting from proximal duodenum; bottom left panel, a retrograde BTE starting from proximal jejunum; bottom right panel, a complex long distance propulsive BTE featuring one long distance propulsive component with two additional retrograde components starting from mid-duodenum during bolus propulsion.

Figure 5

: Ratios of the different classes of BTE in diabetic patients compared with healthy controls. Bars are median and interquartile range.