Gastric meal accommodation and symptoms in diabetes. A placebo-controlled study of glyceryl trinitrate

To study mechanisms behind postprandial symptoms in patients with diabetes mellitus and the effect of nitric oxide (NO) on gastric accommodation and symptoms in these patients.

A double-blind, placebo-controlled, randomized trial was designed in 20 patients with type 1 diabetes (10 male and 10 female, aged 35.3 +/- 7.6 years).

0.5 mg sublingual glyceryl trinitrate (GTN), a donor of exogenous NO, or placebo was administered 5 min prior to a 500 ml soup meal. Gastric accommodation of the meal was assessed by abdominal ultrasound. Accommodation in proximal stomach was visualized in a sagittal area (Psa) and a frontal diameter (Pfd) and accommodation in distal stomach was visualized in a sagittal area of the antrum (Asa). Symptoms were assessed using visual analogue scales.

Psa correlated significantly (r = 0.57, P = 0.015) with perception of fullness 5 min after the meal, whereas Pfd correlated significantly (r = 0.67, P = 0.004) with nausea at 15 and at 25 min after the meal. Asa correlated (r = 0.50, P = 0.05) with pain at 5 min, 10 min (r = 0.50, P = 0.05) and 25 min (r = 0.68, P = 0.007). GTN had no significant effect on Psa or Pfd, but reduced significantly (P = 0.05) Asa (1 3.5 +/- 4.5 cm2 with GTN vs 16.1 +/- 4.3 cm2 with placebo). GTN increased significantly (P = 0.04) the intragastric proximal/distal meal distribution ratio (proximal/distal sagittal area), but had no significant effect on symptom scores.

In patients with diabetes, a large proximal stomach is associated with perception of fullness and a large antrum is associated with perception of pain after a meal. Sublingual administration of GTN prior to the meal decreases the antral area and improves the intragastric meal distribution, but fails to improve symptoms.