Delayed Gastric Emptying and Gastric Autoimmunity in Type 1 Diabetes

• Published in: Diabetes care Vol. 25; no. 5; pp. 912 - 917
• Main Authors: DE BLOCK, Christophe E. M, DE LEEUW, Ivo H, PELCKMANS, Paul A, CALLENS, Dirk, MADAY, Emöke, VAN GAAL, Luc F
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-05-2002
• Subjects: Adult; Associated diseases and complications; Autoantibodies - blood; Autoimmunity; Biological and medical sciences; Breath Tests; Carbon Radioisotopes; Complications and side effects; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - immunology; Diabetes Mellitus, Type 1 - physiopathology; Diabetes. Impaired glucose tolerance; Digestive system; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Gastric Emptying - physiology; Gastrointestinal system; Gastroparesis - etiology; Gastroparesis - immunology; Gastroparesis - physiopathology; Glycated Hemoglobin A; Humans; Immunology; Male; Medical sciences; Metabolism; Middle Aged; Parietal Cells, Gastric - immunology; Physiological aspects; Risk Factors; Type 1 diabetes; United States; Endocrinopathy; Autoimmunity; Human; Immunopathology; Stomach; Motility; Spirillales; Antibody; Acute; Spirillaceae; Autoimmune disease; Gastric emptying; Thyroid stimulating hormone; Gastrointestinal; Glycine; Symptomatology; Hyperglycemia; Breath test; Acids; Helicobacter pylori; Insulin dependent diabetes; Bacteria; Autonomic neuropathy; Cell
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.25.5.912

Delayed Gastric Emptying and Gastric Autoimmunity in Type 1 Diabetes
Christophe E.M. De Block , MD 1 ,
Ivo H. De Leeuw , MD, PHD 1 ,
Paul A. Pelckmans , MD, PHD 2 ,
Dirk Callens 2 ,
Emöke Máday , MSC, PHD 1 and
Luc F. Van Gaal , MD, PHD 1
1 Department of Endocrinology-Diabetology, Faculty of Medicine, University of Antwerp, University Hospital Antwerp, Edegem,
Belgium
2 Department of Gastroenterology & Hepatology, Faculty of Medicine, University of Antwerp, University Hospital Antwerp, Edegem,
Belgium
Abstract
OBJECTIVE —Delayed gastric emptying and/or gastrointestinal symptoms occur in 30–50% of diabetic patients. Known contributing factors
are autonomic neuropathy and acute hyperglycemia, but the role of gastric autoimmunity has never been investigated, although
15–20% of type 1 diabetic patients exhibit parietal cell antibodies (PCAs). We studied gastric motility in diabetes in relation
to PCA status, autonomic nerve function, HbA 1c , thyroid-stimulating hormone (TSH), Helicobacter pylori (HP), acid production, and gastric histology.
RESEARCH DESIGN AND METHODS —Gastric emptying of solids and liquids (measured by 13 C-octanoic acid and 13 C-glycine breath tests, respectively) was tested in euglycemic conditions in 42 type 1 diabetic patients (male/female: 29/13;
15 PCA+; mean age 40 ± 15 years; mean HbA 1c 7.8 ± 0.9%). Gastrointestinal symptoms, autonomic nerve function (Ewing tests), PCA status (indirect immunofluorescence),
gastric histology, and acid secretion (pentagastrin) were assessed.
RESULTS —Solid gastric emptying was delayed in 40% and liquid emptying in 36% of patients. Gastric motility did not correlate with
symptoms. PCA status, gastric morphology, and acid secretion were similar in those with and without gastroparesis. HbA 1c level (β = 1.34, P = 0.011) was the only risk factor for delayed solid emptying in a logistic regression model testing HbA 1c , autonomic nerve function, PCA, HP status, age, sex, diabetes duration, and TSH. Half-emptying time for liquids correlated
with TSH level ( r = 0.83, P < 0.0001) and autonomic neuropathy score ( r = −0.79, P = 0.001).
CONCLUSIONS —We found that ∼50% of type 1 diabetic patients studied had delayed gastric emptying that did not correlate with symptoms.
Gastric autoimmunity did not contribute to diabetic gastroparesis. Metabolic control was worse in patients with delayed solid
emptying.
CAN, cardiovascular autonomic neuropathy
CV, coefficient of variation
fT4, free T4
GEC, gastric emptying coefficient
HP, Helicobacter pylori
PCA, parietal cell antibody
t1/2, gastric half-emptying time
TSH, thyroid-stimulating hormone
Footnotes
Address correspondence and reprint requests to Christophe De Block, MD, Department of Endocrinology-Diabetology, Faculty of
Medicine, University of Antwerp, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. E-mail: cdeblock{at}uia.ua.ac.be .
Received for publication 2 August 2001 and accepted in revised form 7 February 2002.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.