ASYMPTOMATIC GASTRIC RETENTION IN DIABETICS (GASTROPARESIS DIABETICORUM)

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Abstract
Incidental discovery of asymptomatic retention in a diabetic resulted in this study. Gastrointestinal disturbances manifested by accelerated or prolonged transit through the intestines have been known to accompany diabetes, and were recognized as impairment of the autonomic nervous system. Twenty-seven diabetics were studied as follows "mild-moderate, Group I" (9 cases), 6 showed normal G.I. series, 3 had gastric or duodenal pathology without asymptomatic gastric retention. The "moderate-severe Group II" (18 cases) showed one case with duodenal ulcer, 11 had normal G.I. series. All 6 cases with asymptomatic gastric retention were in this group, giving an incidence of gastroparesis of 33% for the moderate-severe diabetes group and an incidence of 22.2% of gastroparesis for the total of 27 diabetics studied. Six of these had gastric retention of 50% or more after 3 hours without clinical symptomatology; 3 of these retaining 25-50% after 6 hours; 2 of these 15-30% after 24 hours. These cases represent disturbances of propulsion, specifically expulsion, of stomach contents with a patulous pylorus similar to findings after vagotomy. This syndrome is asymptomatic, onset and course insidious and masked, occurring in anorexic, diarrheic diabetics using long-lasting insulin with manifest "neuropathy" as well as in those who have no other symptoms but uncontrolled diabetes. Time of onset, duration, treatment of this syndrome are unknown. This gastric hypotonia may be a part of diabetic neuropathy involving the vagus nerve and may adversely influence treatment of diabetes.

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