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Delayed Gastric Emptying and Gastric Autoimmunity in Type 1 Diabetes

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

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 ¹³C-octanoic acid and ¹³C-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 (ß = 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.

Abbreviations: CAN, cardiovascular autonomic neuropathy • CV, coefficient of variation • fT4, free T4 • GEC, gastric emptying coefficient • HP, Helicobacter pylori • PCA, parietal cell antibody • t_1/2, gastric half-emptying time • TSH, thyroid-stimulating hormone

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