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Visceral hypersensitivity and impaired accommodation in refractory diabetic gastroparesis
Author(s) -
Kumar A.,
Attaluri A.,
Hashmi S.,
Schulze K. S.,
Rao S. S. C.
Publication year - 2008
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/j.1365-2982.2008.01081.x
Subject(s) - gastroparesis , medicine , barostat , postprandial , stomach , diabetes mellitus , sensation , gastric distension , distension , gastroenterology , meal , pathophysiology , gastric emptying , endocrinology , biology , neuroscience
The pathophysiology of persistent gastrointestinal (GI) symptoms in patients with diabetic gastroparesis is poorly understood. Our aim was to evaluate gastric sensation and accommodation to a meal in patients with diabetic gastroparesis and refractory symptoms. We performed intermittent, phasic balloon distensions of the stomach using a gastric barostat device in 18 patients with diabetes and gastroparesis unresponsive to prokinetic therapy and in 13 healthy volunteers. We assessed the biomechanical, sensory and accommodation responses of the stomach, during fasting and after liquid meal. During balloon distension, the sensory thresholds for discomfort were lower ( P < 0.02) in patients with diabetes than those in controls, in both the fasting and the postprandial states. The accommodation response to a meal was significantly impaired ( P = 0.01) in patients with diabetes when compared to controls, although fasting gastric tone was similar ( P = 0.08). Patients with diabetic gastroparesis and refractory GI symptoms demonstrate sensori‐motor dysfunction of the stomach, comprising either impaired accommodation, gastric hypersensitivity or both. An objective evaluation of these biomechanical and sensory properties may provide valuable mechanistic insights that could guide therapy.