Characterization of Upper Gastrointestinal Symptoms, Gastric Motor Functions, and Associations in Patients with Diabetes at a Referral Center

Victor Chedid, Justin Brandler, Priya Vijayvargiya, Seon Young Park, Lawrence Szarka, Michael Camilleri

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Our aim was to characterize upper gastrointestinal (UGI) symptoms and associations in individuals with diabetes mellitus (DM) who had undergone evaluation of gastric emptying (GE) and accommodation (GA) at a referral center. Methods: From the Mayo Clinic Rochester electronic medical records of adults with diabetes types 1 and 2 (DM1 and DM2) evaluated between January 1997 and December 2015, we extracted demographics, UGI symptoms, current medications, treatments for diabetes, GE solids by scintigraphy, GA by single photon emission computed tomography (SPECT), and diabetes complications. We compared subgroups with delayed (GE at 2 h <25% or GE at 4 h <75%), rapid (GE at 1 h > 35%), and normal GE, as well as reduced (<428 mL) and normal GA. Results: We reviewed 108 patients (60.2% females, median age 49.0 years). Overall, 71.3% had DM2; one-third of these were insulin dependent and had fairly well-controlled diabetes (median HbA1c 6.7% (IQR 6.2; 7.9)). Manifestations of diabetic triopathy (peripheral neuropathy, nephropathy, and retinopathy) were uncommon at presentation with UGI symptoms. Nausea was the most common symptom (80.6%). There were single or combined GE (total 56%: rapid in 37%, slow in 19%) and GA (total 39%) abnormalities; there was normal GA and GE in 28%; 40.3% of the DM2 patients had accelerated GE at 1 h. GE at 1 h is associated with nausea/vomiting, and fasting gastric volume is associated with bloating. Conclusions: Among referred diabetic patients with UGI symptoms, GE and GA testing identifies potential targets for individualizing treatment and avoidance of empirical trials for the 28% with no disturbance of GE and GA.

Original languageEnglish (US)
JournalAmerican Journal of Gastroenterology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Gastric Emptying
Stomach
Referral and Consultation
Nausea
Electronic Health Records
Peripheral Nervous System Diseases
Diabetes Complications
Single-Photon Emission-Computed Tomography
Type 1 Diabetes Mellitus
Radionuclide Imaging
Type 2 Diabetes Mellitus
Vomiting
Fasting
Diabetes Mellitus
Demography
Insulin

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Characterization of Upper Gastrointestinal Symptoms, Gastric Motor Functions, and Associations in Patients with Diabetes at a Referral Center. / Chedid, Victor; Brandler, Justin; Vijayvargiya, Priya; Park, Seon Young; Szarka, Lawrence; Camilleri, Michael.

In: American Journal of Gastroenterology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Objectives: Our aim was to characterize upper gastrointestinal (UGI) symptoms and associations in individuals with diabetes mellitus (DM) who had undergone evaluation of gastric emptying (GE) and accommodation (GA) at a referral center. Methods: From the Mayo Clinic Rochester electronic medical records of adults with diabetes types 1 and 2 (DM1 and DM2) evaluated between January 1997 and December 2015, we extracted demographics, UGI symptoms, current medications, treatments for diabetes, GE solids by scintigraphy, GA by single photon emission computed tomography (SPECT), and diabetes complications. We compared subgroups with delayed (GE at 2 h <25{\%} or GE at 4 h <75{\%}), rapid (GE at 1 h > 35{\%}), and normal GE, as well as reduced (<428 mL) and normal GA. Results: We reviewed 108 patients (60.2{\%} females, median age 49.0 years). Overall, 71.3{\%} had DM2; one-third of these were insulin dependent and had fairly well-controlled diabetes (median HbA1c 6.7{\%} (IQR 6.2; 7.9)). Manifestations of diabetic triopathy (peripheral neuropathy, nephropathy, and retinopathy) were uncommon at presentation with UGI symptoms. Nausea was the most common symptom (80.6{\%}). There were single or combined GE (total 56{\%}: rapid in 37{\%}, slow in 19{\%}) and GA (total 39{\%}) abnormalities; there was normal GA and GE in 28{\%}; 40.3{\%} of the DM2 patients had accelerated GE at 1 h. GE at 1 h is associated with nausea/vomiting, and fasting gastric volume is associated with bloating. Conclusions: Among referred diabetic patients with UGI symptoms, GE and GA testing identifies potential targets for individualizing treatment and avoidance of empirical trials for the 28{\%} with no disturbance of GE and GA.",
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