Impaired Gastric Emptying in Diabetic Patients With Cardiac Autonomic Neuropathy

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Abstract
The aim of our study was to measure the gastric emptying rate for a solid meal in diabetic patients who had no gastrointestinal complaints with (group 1, n = 12) or without (group 2, n = 10) cardiac autonomic neuropathy and in normal controls comparable in age and sex (group 3, n = 10). Gastric emptying rate was assessed with a sequential scintiscanning method. The percentages of the initial isotope activity remaining in the stomach at different times (20, 40, 60, 80, 100, and 120 min) after the ingestion of a Tc-99m-labeled test meal and the emptying half-time were calculated. Cardiac autonomic neuropathy was determined by the beat-to-beat variations in heart rate during deep breathing. A significant reduction of the gastric emptying rate was observed in group 1. Indeed, at 80, 100, and 120 min the percentage of residual isotope activity was 73 ± 4, 60 ± 6, and 50 ± 6% (mean ± SE), respectively, in group 1 versus 61 ± 3 (P < .05), 45 ± 4 (P < .05), and 32 ± 4% (P < .02) in group 2. In group 3, residual isotope activity was 57 ± 4 (P < .05 vs. group 1), 41 ± 4 (P < .05), and 29 ± 4% (P < .02), respectively. Emptying half-time was also longer in group 1 (121 ± 9 min) than in group 2 (95 ± 6 min, P < .05) or group 3 (90 ± 4 min, P < .02). For a given diabetic patient, there was no correlation between abnormal low gastric emptying and cardiac autonomic neuropathy. In conclusion, this study shows that in a group of diabetic patients with cardiac autonomic neuropathy, mean gastric emptying rate for solid meals is significantly impaired when compared with patients without cardiac autonomic neuropathy or normal controls, even when gastrointestinal symptoms are absent.

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