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Blunting of Colon Contractions in Diabetics with Gastroparesis Quantified by Wireless Motility Capsule Methods.

Coleski R, Wilding GE, Semler JR, Hasler WL - PLoS ONE (2015)

Bottom Line: Generalized gut transit abnormalities are observed in some diabetics with gastroparesis.In conclusion, diabetics with gastroparesis exhibit delayed colon transit associated with reductions in contractions that are prominently blunted in latter transit phases and which correlate with delayed gastric emptying, while diabetics with normal emptying show no significant colonic impairments.These findings emphasize diabetic gastroparesis may be part of a generalized dysmotility syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, United States of America.

ABSTRACT
Generalized gut transit abnormalities are observed in some diabetics with gastroparesis. Relations of gastric emptying abnormalities to colon contractile dysfunction are poorly characterized. We measured colon transit and contractility using wireless motility capsules (WMC) in 41 healthy subjects, 12 diabetics with gastroparesis (defined by gastric retention >5 hours), and 8 diabetics with normal gastric emptying (≤5 hours). Overall numbers of colon contractions >25 mmHg were calculated in all subjects and were correlated with gastric emptying times for diabetics with gastroparesis. Colon transit periods were divided into quartiles by time and contraction numbers were calculated for each quartile to estimate regional colon contractility. Colon transit in diabetics with gastroparesis was prolonged vs. healthy subjects (P<0.0001). Overall numbers of colon contractions in gastroparetics were lower than controls (P = 0.02). Diabetics with normal emptying showed transit and contraction numbers similar to controls. Gastric emptying inversely correlated with overall contraction numbers in gastroparetics (r = -0.49). Numbers of contractions increased from the 1st to 4th colon transit quartile in controls and diabetics with normal emptying (P≤0.04), but not gastroparetics. Numbers of contractions in the 3rd and 4th quartiles were reduced in gastroparetics vs. healthy controls (P≤0.05) and in the 4th quartile vs. diabetics with normal emptying (P = 0.02). Numbers of contractions were greatest in the final 15 minutes of transit, but were reduced in gastroparetics vs. healthy controls and diabetics with normal emptying (P≤0.005). On multivariate analyses, differences in numbers of contractions were not explained by demographic or clinical variables. In conclusion, diabetics with gastroparesis exhibit delayed colon transit associated with reductions in contractions that are prominently blunted in latter transit phases and which correlate with delayed gastric emptying, while diabetics with normal emptying show no significant colonic impairments. These findings emphasize diabetic gastroparesis may be part of a generalized dysmotility syndrome.

No MeSH data available.


Related in: MedlinePlus

Representative WMC Recordings.Representative WMC recordings are shown from a healthy volunteer (A, C) and a diabetic with gastroparesis (B, D). In the complete recording from the healthy subject, there is an abrupt pH decrease (red) at 10 hours and 15 minutes reflecting ileocecal (IC) transit (A). The capsule is expelled at 37 hours and 39 minutes. In the diabetic, IC transit occurs at 33 hours and 15 minutes and the capsule is expelled at 97 hours and 14 minutes (B). Pressure activity (blue) increases prior to WMC expulsion in the healthy subject, but not in the diabetic with gastroparesis. In the final 15 minutes of colon transit, contractions (blue) are frequent and intense in the healthy volunteer (C) but are reduced in the diabetic (D).
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pone.0141183.g001: Representative WMC Recordings.Representative WMC recordings are shown from a healthy volunteer (A, C) and a diabetic with gastroparesis (B, D). In the complete recording from the healthy subject, there is an abrupt pH decrease (red) at 10 hours and 15 minutes reflecting ileocecal (IC) transit (A). The capsule is expelled at 37 hours and 39 minutes. In the diabetic, IC transit occurs at 33 hours and 15 minutes and the capsule is expelled at 97 hours and 14 minutes (B). Pressure activity (blue) increases prior to WMC expulsion in the healthy subject, but not in the diabetic with gastroparesis. In the final 15 minutes of colon transit, contractions (blue) are frequent and intense in the healthy volunteer (C) but are reduced in the diabetic (D).

Mentions: Representative WMC recordings are shown from a healthy volunteer and a diabetic patient with gastroparesis (WMC gastric emptying time >5 hours). In the pH tracing (red) from the healthy subject, subtracting times of ileocecal transit (10:15) from anal expulsion (37:39) results in a colon transit time of 27 hours and 24 minutes (Fig 1A). During the period of colon transit, contractions (blue) were variable but increased prior to WMC expulsion. In the pH recording from the diabetic patient with gastroparesis (red)(WMC gastric emptying time 29:45), colonic transit (63:59) was calculated by subtracting ileocecal passage (33:15) from anal expulsion (97:14)(Fig 1B). In contrast to the healthy subject, contractions (blue) did not increase before the WMC was anally expelled. Pressure activity significantly increased in the 15 minutes before WMC expulsion from the anus in the healthy volunteer, but decreased in this latter phase of colon transit in the diabetic patient. Expanded views of the final 15 minutes (blue) show frequent contractions in the healthy subject compared to the infrequent motor activity in the individual with diabetic gastroparesis (Fig 1C and 1D).


Blunting of Colon Contractions in Diabetics with Gastroparesis Quantified by Wireless Motility Capsule Methods.

Coleski R, Wilding GE, Semler JR, Hasler WL - PLoS ONE (2015)

Representative WMC Recordings.Representative WMC recordings are shown from a healthy volunteer (A, C) and a diabetic with gastroparesis (B, D). In the complete recording from the healthy subject, there is an abrupt pH decrease (red) at 10 hours and 15 minutes reflecting ileocecal (IC) transit (A). The capsule is expelled at 37 hours and 39 minutes. In the diabetic, IC transit occurs at 33 hours and 15 minutes and the capsule is expelled at 97 hours and 14 minutes (B). Pressure activity (blue) increases prior to WMC expulsion in the healthy subject, but not in the diabetic with gastroparesis. In the final 15 minutes of colon transit, contractions (blue) are frequent and intense in the healthy volunteer (C) but are reduced in the diabetic (D).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4624915&req=5

pone.0141183.g001: Representative WMC Recordings.Representative WMC recordings are shown from a healthy volunteer (A, C) and a diabetic with gastroparesis (B, D). In the complete recording from the healthy subject, there is an abrupt pH decrease (red) at 10 hours and 15 minutes reflecting ileocecal (IC) transit (A). The capsule is expelled at 37 hours and 39 minutes. In the diabetic, IC transit occurs at 33 hours and 15 minutes and the capsule is expelled at 97 hours and 14 minutes (B). Pressure activity (blue) increases prior to WMC expulsion in the healthy subject, but not in the diabetic with gastroparesis. In the final 15 minutes of colon transit, contractions (blue) are frequent and intense in the healthy volunteer (C) but are reduced in the diabetic (D).
Mentions: Representative WMC recordings are shown from a healthy volunteer and a diabetic patient with gastroparesis (WMC gastric emptying time >5 hours). In the pH tracing (red) from the healthy subject, subtracting times of ileocecal transit (10:15) from anal expulsion (37:39) results in a colon transit time of 27 hours and 24 minutes (Fig 1A). During the period of colon transit, contractions (blue) were variable but increased prior to WMC expulsion. In the pH recording from the diabetic patient with gastroparesis (red)(WMC gastric emptying time 29:45), colonic transit (63:59) was calculated by subtracting ileocecal passage (33:15) from anal expulsion (97:14)(Fig 1B). In contrast to the healthy subject, contractions (blue) did not increase before the WMC was anally expelled. Pressure activity significantly increased in the 15 minutes before WMC expulsion from the anus in the healthy volunteer, but decreased in this latter phase of colon transit in the diabetic patient. Expanded views of the final 15 minutes (blue) show frequent contractions in the healthy subject compared to the infrequent motor activity in the individual with diabetic gastroparesis (Fig 1C and 1D).

Bottom Line: Generalized gut transit abnormalities are observed in some diabetics with gastroparesis.In conclusion, diabetics with gastroparesis exhibit delayed colon transit associated with reductions in contractions that are prominently blunted in latter transit phases and which correlate with delayed gastric emptying, while diabetics with normal emptying show no significant colonic impairments.These findings emphasize diabetic gastroparesis may be part of a generalized dysmotility syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, United States of America.

ABSTRACT
Generalized gut transit abnormalities are observed in some diabetics with gastroparesis. Relations of gastric emptying abnormalities to colon contractile dysfunction are poorly characterized. We measured colon transit and contractility using wireless motility capsules (WMC) in 41 healthy subjects, 12 diabetics with gastroparesis (defined by gastric retention >5 hours), and 8 diabetics with normal gastric emptying (≤5 hours). Overall numbers of colon contractions >25 mmHg were calculated in all subjects and were correlated with gastric emptying times for diabetics with gastroparesis. Colon transit periods were divided into quartiles by time and contraction numbers were calculated for each quartile to estimate regional colon contractility. Colon transit in diabetics with gastroparesis was prolonged vs. healthy subjects (P<0.0001). Overall numbers of colon contractions in gastroparetics were lower than controls (P = 0.02). Diabetics with normal emptying showed transit and contraction numbers similar to controls. Gastric emptying inversely correlated with overall contraction numbers in gastroparetics (r = -0.49). Numbers of contractions increased from the 1st to 4th colon transit quartile in controls and diabetics with normal emptying (P≤0.04), but not gastroparetics. Numbers of contractions in the 3rd and 4th quartiles were reduced in gastroparetics vs. healthy controls (P≤0.05) and in the 4th quartile vs. diabetics with normal emptying (P = 0.02). Numbers of contractions were greatest in the final 15 minutes of transit, but were reduced in gastroparetics vs. healthy controls and diabetics with normal emptying (P≤0.005). On multivariate analyses, differences in numbers of contractions were not explained by demographic or clinical variables. In conclusion, diabetics with gastroparesis exhibit delayed colon transit associated with reductions in contractions that are prominently blunted in latter transit phases and which correlate with delayed gastric emptying, while diabetics with normal emptying show no significant colonic impairments. These findings emphasize diabetic gastroparesis may be part of a generalized dysmotility syndrome.

No MeSH data available.


Related in: MedlinePlus