Introduction The wireless motility capsule (WMC) is a minimally invasive ambulatory technology that concurrently measures pressure, pH and temperature as it traverses the gastrointestinal (GI) tract. Knowledge gaps remain concerning GI motility in type 1 diabetes (T1DM) with established diabetic sensorimotor polyneuropathy (DSPN). It has been recently suggested that the change in pH across the ileocaecal valve (ICV) is a surrogate marker of bacterial fermentation inthe caecum.1 The aim was to explore whether T1DM patients with DSPN have demonstrable GI dysmotility with in comparison to matched healthy controls. Furthermore, we aimed to investigate the co-relationships between motility, self-reported GI symptoms, quality of life and objective markers of DSPN.
Methods 41 patients with T1DM with DSPN (33 male, mean age 51 years, range 35–71) and 41 healthy controls (28 male, mean age 51 years, range 28–78) underwent a WMC study using a standardised protocol following consumption of a meal of known nutritional composition (SmartBar).2 Segmental transit was derived from measures around known anatomical landmarks as identified by compartmental pH changes. In patients, vibration thresholds and the Michigan Neuropathy Screening Instrument (MNSI) were collected in conjunction with self-reported GI symptoms (Patient Assessment of Upper Gastrointestinal Disorder Severity Symptom Index (PAGI-SYM)).
Results Differences in regional and whole gut transit times are shown in Table 1. ICJ pH drop was associated with prolonged colonic transit (r = 0.34, p = 0.01). Multivariate linear regression, controlling for age, gender, duration of T1DM and glycaemic control, did not demonstrate an association between PAGI-SYM, regional or total transit times but higher vibration thresholds and MSNI were associated with prolonged gastric emptying time (p = 0.03, p = 0.002 respectively).
Conclusion T1DM is associated with prolongation of regional and whole gut transit prior to the development symptoms independent of disease duration and glycaemic control. Moreover, such prolongation is associated with clinical markers of DPSN. Further work is warranted to examine the longitudinal nature of these findings and whether pharmacotherapeutic interventions can lead to the restoration of normal motility.
References 1 Farmer, et al. WJG 2014.
2 Wang YT, et al. APT 2015.
Disclosure of Interest None Declared
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