Premium
Regional gastrointestinal pH profile is altered in patients with type 1 diabetes and peripheral neuropathy
Author(s) -
Wegeberg A.M. L.,
Brock C.,
Brock B.,
Farmer A. D.,
Hobson A. R.,
Semler J. R.,
Scott S. M.
Publication year - 2018
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/nmo.13407
Subject(s) - medicine , gastroenterology , gastroparesis , bloating , diabetes mellitus , glycemic , type 2 diabetes , nausea , gastric emptying , irritable bowel syndrome , hydrogen breath test , peripheral neuropathy , insulin , endocrinology , breath test , stomach , helicobacter pylori
Background Gastrointestinal ( GI ) symptoms, such as nausea and bloating, are common in people with type 1 diabetes (T1 DM ). Autonomic dysfunction can lead to changes in the GI secreto‐motor function which can be associated with GI symptom development. We hypothesized that regional pH profiles in T1 DM differs from health and would be associated with objective physiological/clinical markers. Methods Forty‐seven T1 DM with confirmed diabetic sensory peripheral neuropathy and 41 healthy age‐matched subjects underwent standardized wireless motility capsule testing. T1 DM completed the gastroparesis cardinal symptom index ( GCSI ) and the gastrointestinal symptom rating scale. Disease duration, glycemic control, insulin usage, and 24‐hour heart rate variability testing were evaluated. Key Results In comparison to healthy subjects, gastric, and large bowel median pH were lower in T1 DM (1.8 ± 1.6 vs 2.9 ± 1.5, P = 0.001 and 6.7 ± 0.6 vs 7.0 ± 0.5, P = 0.003, respectively). Additionally, change in pH across the pylorus was lower while change in pH across the ileocecal junction was higher in T1 DM (5.2 ± 1.5 vs 5.8 ± 0.5, P = 0.003 and 1.8 ± 0.4 vs 1.3 ± 0.4, P < 0.0001, respectively). No difference was found in small bowel median pH . Gastric median pH was associated with small bowel transit time ( r = 0.30, P = 0.049). Change in pH across the pylorus was negatively associated with fasting glycose ( r = −0.35, P = 0.027). Small bowel median pH was associated with nausea ( r = 0.42, P = 0.005) and small bowel transit time ( r = 0.48, P = 0.0007). Large bowel median pH was associated with nausea ( r = 0.35, P = 0.018) and the total GCSI score ( r = 0.34, P = 0.023). Conclusions and Inferences The GI pH profile in T1 DM with DSPN is different from healthy subjects. Changes in pH profile may have important therapeutic implications and influence pharmacotherapeutic bioavailability.