Lower postprandial gastric volume response in diabetic patients with vagal neuropathy

Poor relaxation in the stomach after a meal may contribute to disturbed gastric emptying and abdominal discomfort in patients with diabetes mellitus. In this study we aimed to compare barostat-recorded postprandial volume responses in these patients to those in healthy controls, and to study the relationship between the proximal volume responses, antral filling and vagal neuropathy. We compared 14 consecutively recruited patients with type 1 diabetes mellitus (DM) to 18 healthy controls (HC) with respect to meal-induced gastric volume response assessed by a barostat, antral area recorded by ultrasound, and vagal tone assessed by respiratory sinus arrhythmia (RSA). Meal-induced volume response of the proximal stomach (area under time-volume curve 0-30 min) was significantly (P = 0.04) lower in DM than in HC, 49.4 min.mL +/- 60.7 vs. 114.9 min.mL +/- 100.8. Antral area was significantly larger in DM than in HC, both fasting (4.3 cm2 +/- 1.9 vs. 3.0 cm2 +/- 0.9) and 10 min after ingestion of meat soup (11.8 cm2 +/- 3.4 vs. 8.8 cm2 +/- 2.9), P = 0.03 and P = 0.02, respectively. Vagal tone was significantly (P = 0.01) lower in DM than in HC. 3.7 beats min-1 +/- 2.3 vs. 6.1 beats min-1 +/- 2.2. No significant correlation was observed between the proximal volume responses and antral widening. Maximal gastric volume response correlated significantly with vagal tone (r = 0.77, P = 0.002).

patients with diabetes mellitus type 1 have impaired meal-induced volume response, possibly as a consequence of reduced vagal tone.