technetium-tc-99m-sulfur-colloid and Diabetes-Mellitus--Type-2

Gastric emptying of a liquid glucose meal was measured with scintigraphic techniques in nine recently diagnosed Type 2 diabetic patients and nine sex- and age-matched nondiabetic control subjects. Seven of the nine Type 2 diabetic patients were receiving oral hypoglycemic therapy which was discontinued the evening prior to the study. The other two diabetic patients were taking no medication. The average gastric half-emptying time was 33.6 min (s.e.m. = 3.2) for the diabetic patients and 64.6 min (s.e.m. = 4.2) for the nondiabetic controls (p = 0.0005). These measurements indicate rapid gastric emptying in Type 2 diabetic patients which may contribute to worsening of glucose control in these patients.

Topics: Administration, Oral; Adult; Diabetes Mellitus, Type 2; Female; Gastric Emptying; Glucose; Humans; Male; Middle Aged; Radionuclide Imaging; Solutions; Technetium Tc 99m Sulfur Colloid; Time Factors

Current methods for measuring gastric emptying by breath test require sampling over several hours and are too inaccurate for clinical use. The aim of this study was to develop an office-based method for measuring gastric emptying of solids in patients with diabetes using a [13C]octanoic acid breath test.. In 22 symptomatic diabetic patients (17 insulin-dependent diabetes, 5 non-insulin-dependent diabetes) and 6 controls, we simultaneously measured gastric emptying of an egg meal (420 kcal) by scintigraphy and [13C]octanoic acid breath test. Conventional (nonlinear) methods for scintigraphic and [13C]octanoic acid breath test emptying and generalized linear regression method to predict scintigraphic half-life (t(1/2)) using four breath samples obtained during the first 3 h.. Despite 8 h of breath sampling, the t(1/2) estimate using the conventional method was markedly different from the scintigraphic value (delta t(1/2): median, 113 min; range, 19-282 min). The generalized linear model (using samples at baseline, 30, and 120 or 150 min) yielded predicted scintigraphic tLAG and t(1/2) that were more accurate than the conventional method; mean standard deviations of differences were 16 and 27 min, respectively. Breath test correctly assessed normal or prolonged emptying in 21 of 22 patients.. The [13C]octanoic acid breath test can be simplified to measure gastric tLAG and t(1/2) and can be expected to correctly identify normal t(1/2) in symptomatic diabetics. Further refinement of the model will need to include studies of patients with markedly delayed t(1/2).

Topics: Adult; Aged; Ambulatory Care; Breath Tests; Caprylates; Carbon Radioisotopes; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Female; Gastric Emptying; Gastroparesis; Humans; Male; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Reference Values; Technetium Tc 99m Sulfur Colloid

Helicobacter pylori (HP) is the most common cause of nonerosive nonspecific gastritis. Gastric and duadenal ulcer both are found to be associated with HP infection. Another consequence of HP infection is that it may progress to chronic atrophic gastritis which is a well recognized risk factor for adenocarcinoma of the stomach. So by extension, HP infection can be accepted as a risk factor for gastric cancer. From this aspect, identification of risk groups is increasingly important. It is well-known that patients with diabetes mellitus are more prone to infection. Besides this, presence of gastroparesis diabeticorum may lead to bacterial overgrowth in the upper gastrointestinal (GI) tract. The present crossectional study was planned to study the presence of HP infection in diabetic patients with alterations in upper GI motility and to compare the results with healthy control group. Group I consisted of 51 patients with type II diabetes mellitus (as defined by National Data Group criteria) without any dyspeptic symptoms. Twenty-five age-matched healthy people served as a control in group II. Radionuclide-labelled solid meals were used to calculate gastric emptying time (GET). According to the results, patients in group I were divided into two groups. Patients with prolonged GET were grouped as group IA, while group IB consisted of patients with normal or shortened GET. Presence of HP gastritis is determined by histopathologic examination of endoscopic biopsy specimen. The results showed that the prevalence of HP gastritis in group I and II were 80.4% and 56% respectively and the difference was significant statistically (p: 0.03). In group IA, the prevalence of HP infection was estimated to be 88.2%, while in group IB it was 76.5% but the difference was not significant (p: 0.31). We have not found any correlation between HbA1c levels and the presence of HP infection in both group IA and IB (p values 0.26 and 0.15 respectively). We conclude that the prevalence of HP gastritis is higher in asymptomatic diabetic patients compared with healthy people. But there is no association between the alterations in GET and the presence of HP gastritis as indicated by our results. So prolonged GET may not be regarded as a specific pathogenic mechanism or a cause of HP infection in NIDDM patients.

Topics: Cross-Sectional Studies; Databases as Topic; Diabetes Mellitus, Type 2; Female; Gastric Emptying; Gastritis; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Prevalence; Radiopharmaceuticals; Reference Values; Technetium Tc 99m Sulfur Colloid; Turkey

Although relatively frequent. diabetic involvement of digestive tract motility has not been investigated extensively in different organs. The authors studied esophageal, gastric, and gallbladder motor function in 35 type 2 (noninsulin-dependent) diabetic patients to determine the extent of gut involvement. Of these patients, 27 (77%) had peripheral neuropathy, 12 (34%) had both peripheral and autonomic neuropathy, and 22 (63%) had gastrointestinal symptoms. Esophageal manometric abnormalities were recorded in 18 patients, and delayed radionuclide emptying of the esophagus was documented in 16 patients, with a 83% concordance between the two tests. Scintigraphic gastric emptying of solids was delayed in 56% of patients, whereas gallbladder emptying after cholecystokinin stimulation was reduced in 69% of them. In 74% of patients at least one of the viscera under investigation showed abnormal motor function; however, only 36% of patients displayed involvement of the three organs. Gastrointestinal symptoms, duration and therapy of diabetes, previous poor glycemic control, and retinopathy did not correlate with the presence or the extent of motor disorders. Neuropathy was not predictive of gastrointestinal involvement and its extent; however, when motor abnormalities were present in patients with neuropathy, these were usually more severe. Gastrointestinal motor disorders are frequent and widespread in type 2 diabetics, regardless of symptoms. Autonomic neuropathy has a poor predictive value on motor disorders (0.75 for the esophagus, 0.5 for the stomach, 0.8 for the gallbladder), thus suggesting the coexistence of other pathophysiologic mechanisms.

Topics: Adult; Aged; Autonomic Nervous System Diseases; Case-Control Studies; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Esophageal Motility Disorders; Female; Gallbladder Emptying; Gastric Emptying; Gastrointestinal Motility; Humans; Male; Manometry; Middle Aged; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Both delayed and accelerated gastric emptying rate (GER) have been reported in patients with diabetes mellitus. Delayed GER has been attributed to autonomic neuropathy in established diabetes but rapid GER was demonstrated in early Type 2 diabetes. The aim of the study was to investigate rapid gastric emptying in a group of people with long-duration Type 2 diabetes. GER of a radiolabelled liquid meal was studied scintigraphically in 20 Type 2 patients with a mean (+/-SEM) duration of diabetes 13 (+/-1) years. The 50% emptying time (t50) for the liquid meal was shorter in diabetic patients (29.6+/-2.1 min) than in controls (39.2+/-1.9 min; p<0.0005). Accelerated emptying (t50 value below the shortest t50 of controls) was evidenced in 14/20 patients and delayed emptying (t50 value exceeding the upper t50 of controls) in none. Patients with accelerated GER were comparable for BMI, diabetes duration, HbA1c and fasting glycaemia to those with normal GER. Rapid GER for liquids was found in the presence or absence of autonomic neuropathy. Seven of the patients with rapid emptying of the liquid meal were reassessed using a solid meal. Only one patient demonstrated rapid emptying of the solid meal, which was normal in 3 and delayed in 3 patients. In conclusion, accelerated GER can be found in long-term Type 2 diabetes but there is no concordance between GER of a liquid and a solid meal.

Topics: Blood Glucose; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Diabetic Retinopathy; Energy Intake; Female; Gastric Emptying; Glycated Hemoglobin; Humans; Male; Middle Aged; Radiopharmaceuticals; Reference Values; Technetium Tc 99m Sulfur Colloid

To test in a prospective study whether the non-invasive 13C-acetate test is suitable for measuring gastric emptying time with a liquid/solid test meal. (99m)technetium scintigraphy served as the reference method.. 18 consecutive type 2 diabetics with symptoms of gastroparesis (nine men, nine women; mean age 64 [45-76] years) were, after a nocturnal fasting period, given a liquid/solid test meal (370 kcal; 100 ml coffee; doubly marked with 75 mg 13C-acetate and 0.5 mCi 99mTc-colloid). At ten-minute intervals breath samples were taken over two hours and examined by mass spectometry for the 13CO2/12CO2 ratio. In parallel scintigraphy was performed for one hour at one-minute intervals. Gastric emptying half-life (t1/2) was calculated and the correlation between the two methods determined. In addition, the 13C-acetate breath test was performed on 20 healthy subjects to assess reproducibility (ten men, ten women; mean age 44.4 [23-77] years).. Median t1/2 with the scintigraphy was 93.5 min, with the breath test 55 min, i.e. a significant correlation (r = 0.8; P < 0.001). Four of five patients with delayed gastric emptying by scintigraphy also showed delay (compared with the control group) in the breath test (median t1/2: 41 min; 95th percentile: 86 min).. The 13C-acetate test correlated significantly with the results by scintigraphy. It can therefore be recommended as a non-invasive test for assessing gastric emptying time after a liquid/solid test meal in type 2 diabetics.

Topics: Acetates; Adult; Aged; Breath Tests; Carbon Isotopes; Chronic Disease; Diabetes Mellitus, Type 2; Female; Gastric Emptying; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Stomach; Technetium Tc 99m Sulfur Colloid; Time Factors

The aims of this study were to determine in early noninsulin-dependent diabetes mellitus (NIDDM): (a) the prevalence of disordered gastric emptying of glucose; (b) the relationship between the blood glucose response to an oral glucose load and gastric emptying; and (c) the relationship between appetite and gastric emptying.. Sixteen patients (ages 39-79 yr) with recently diagnosed NIDDM consumed 350 ml water containing 75 g glucose and 99mTc-sulfur colloid while sitting in front of a gamma camera. Blood glucose concentrations were monitored immediately before and after the drink. Hunger and fullness were evaluated using visual analog scales. The results were compared to those obtained in 13 normal subjects of similar age and body mass index. All patients and control subjects were white and non-Hispanic.. Gastric emptying was slightly slower in the NIDDM patients when compared to the control subjects (retention at 180 min 15.9 +/- 2.3% versus 3.8 +/- 1.0%, p < 0.001), but there was no significant difference in the 50% emptying time between the two groups. In the NIDDM patients, there was an inverse relationship between the magnitude of the increase in the blood glucose concentration and gastric emptying, e.g., between the area under the curve for blood glucose from 0-60 min and the intragastric retention of the drink at 60 min (r = -0.60, p < 0.05). In the NIDDM patients, fullness was greater (p < 0.005) both before and after the drink, and the score for hunger at 30 min was inversely related to the rate of gastric emptying (r = -0.52, p < 0.05).. In patients with early NIDDM, gastric emptying of 75 g glucose is similar to that of normal subjects and is a significant determinant of the glycemic response.

Topics: Adult; Aged; Appetite; Blood Glucose; Diabetes Mellitus, Type 2; Female; Gastric Emptying; Humans; Male; Middle Aged; Radionuclide Imaging; Stomach; Technetium Tc 99m Sulfur Colloid

Mexican Americans, a group at high risk for type II diabetes mellitus, have higher postprandial insulin and glucose levels when compared to non-Hispanic whites. A rapid rate of gastric emptying contributes to an increased rate of nutrient absorption and subsequent greater elevation of postprandial glucose and insulin levels. A more rapid rate of gastric emptying and hyperinsulinemia have been observed in patients with recently diagnosed type II diabetes mellitus. In this study, we examined whether Mexican Americans have a more rapid rate of gastric emptying than non-Hispanic whites. Gastric emptying studies were performed on 32 nondiabetic Mexican Americans and on 31 nondiabetic non-Hispanic whites. The rate of gastric emptying following a liquid glucose meal was measured. Serum insulin, plasma glucose, and GIP levels were measured in fasting and postprandial blood samples collected at 15-min intervals for 2 hr. Adjusting for age, body mass index, and gender, the gastric half-emptying time of a glucose meal was significantly (P < 0.05) more rapid for the Mexican American subjects (56.5 +/- 3.4 min) compared to the non-Hispanic white subjects (66.4 +/- 3.5 min). Nondiabetic Mexican Americans empty a liquid glucose meal more rapidly from their stomachs than nondiabetic non-Hispanic whites. Rapid gastric emptying is associated with hyperinsulinemia as a normal physiologic response to increased nutrient availability. The rapid gastric emptying observed in nondiabetic Mexican Americans is associated with hyperinsulinemia and could be a contributing factor for the increased risk of obesity and type II diabetes in this population.

Topics: Blood Glucose; Diabetes Mellitus, Type 2; Female; Gastric Emptying; Gastric Inhibitory Polypeptide; Glucose; Humans; Hyperinsulinism; Incidence; Insulin; Male; Mexican Americans; Mexico; Obesity; Risk Factors; Technetium Tc 99m Sulfur Colloid; White People

The aim of this study was to evaluate the prevalence of disordered intragastric meal distribution and the relationships between gastric emptying, intragastric distribution, glycemic control and gastrointestinal symptoms in diabetes mellitus.. Eighty-six patients with diabetes mellitus had measurements of gastric emptying and intragastric distribution of a radioisotopically labeled solid/liquid meal (100 g beef and 150 ml 10% dextrose), glycemic control (plasma glucose concentrations), upper gastrointestinal symptoms (questionnaire) and autonomic nerve function (cardiovascular reflexes). Results were compared to those obtained in 20 normal volunteers.. Solid and liquid gastric emptying were delayed in the diabetic patients and correlated weakly. Intragastric meal distribution was also often abnormal, with increased retention of both solid and liquid in the proximal stomach and increased retention of solid but not liquid in the distal stomach. In all patients with increased retention of solid in the proximal stomach, emptying from the total stomach was delayed. Gastric emptying of liquid was slower in those subjects who had a mean plasma glucose > 15 mmol/liter during the gastric emptying measurement, when compared to the remainder of the group.. In patients with diabetes mellitus, there is poor relationship between solid and liquid gastric emptying and intragastric meal distribution is frequently abnormal. Interpretation of the results of gastric emptying measurements should consider meal composition and plasma glucose concentrations.

Topics: Blood Glucose; Case-Control Studies; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Diabetic Retinopathy; Female; Food; Gastric Emptying; Gastroparesis; Humans; Indium Radioisotopes; Male; Middle Aged; Pentetic Acid; Prevalence; Radionuclide Imaging; Stomach; Technetium Tc 99m Sulfur Colloid

The existence of gastrointestinal transit disorders in other intestinal segments beside the stomach in Type-1 diabetes mellitus (DM) and occurrence in Type-2 DM and in uremia has yet been confirmed only in few studies. Eleven healthy volunteers, 34 patients with Type-1, 32 patients with Type-2 DM in different stages of their disease and 34 non-diabetic patients with endstage-renal disease were investigated by use of the metal detector test. Patients were divided in three subgroups, depending on the duration of their disease: < 1 year: "Short", 1 - 10 years: "Middle", > 10 years: "Long". For comparison with the metal detector test scintigraphic studies of esophageal and gastric transit were performed in 17 patients and small intestinal transit was studied by use of the H2-lactulose breath test in 20 patients with long-standing DM Type-1. In Type-1 DM there is an increase of gastric (135 +/- 18, p < 0.01; 218 +/- 26, p < 0.0001 vs. 73 +/- 7 min.) and large intestinal transit times (79 +/- 18, P < 0.02; 76 +/- 11, p < 0.04 vs. 40 +/- 5 h) in patients with middle or long standing DM. In Type-2 DM similar transit disturbances occur (gastric emptying, long group: 120 +/- 15 min., p < 0.02; colonic transit, long group: 80 +/- 13 h, p < 0.01). In uremia transit disturbances were only found in patients with chronic ambulatory peritoneal dialysis (colonic transit: 71 +/- 9 h, p < 0.05). In 65% gastric scintigraphy and in 55% of cases the H2-lactulose breath test showed a prolongation of gastric emptying or a prolonged mouth-to-cecum transit. Transit disorders can occur in every stage of DM with preferential involvement of the stomach and the colon. These findings are of clinical relevance, since transit disturbances can result in instable metabolic condition.

Topics: Adult; Aged; Breath Tests; Copper; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Electromagnetic Fields; Esophageal Motility Disorders; Female; Gastric Emptying; Gastrointestinal Transit; Humans; Lactulose; Male; Middle Aged; Muscle, Smooth; Myoelectric Complex, Migrating; Prospective Studies; Radionuclide Imaging; Reference Values; Technetium Tc 99m Sulfur Colloid; Uremia

Radionuclide method was used to examine transport function of the esophagus in 24 patients with diabetes mellitus and symmetric distal polyneuropathy. 99mTc-+sulfur colloid was employed as a radiopharmaceutical agent. The movement of radioactivity was elucidated visually with the aid of a gamma-chamber. In 9 patients, measurements were made of the prolonged transit time of the whole esophagus as well as prolonged transit time for the lower, median and upper third of the esophagus. The same patients manifested deceleration of the evacuation of the entire esophagus and respective parts thereof. That method can be included into the diagnostic complex intended for early diagnosis of vegetative disorders in patients with diabetic polyneuropathy and for evaluating the intensity of autonomous neuropathy.

Topics: Adult; Aged; Autonomic Nervous System Diseases; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Esophageal Motility Disorders; Esophagus; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Esophageal function was prospectively studied in 50 consecutive insulin-requiring diabetes mellitus patients. The patients were stratified in three groups: A) 18 without peripheral neuropathy (PN); B) 20 with PN but no autonomic neuropathy; C) 12 with PN and autonomic neuropathy. Twelve patients (four B, eight C) had gastrointestinal symptoms including six with dysphagia. Radionuclide esophageal emptying was abnormal in 55, 70, and 83% of patients in groups A, B, and C, respectively. Eleven of the 12 (92%) symptomatic and 23 of the 38 (60%) asymptomatic diabetes mellitus patients had abnormal emptying. Five of six patients with dysphagia had abnormal emptying. Esophageal manometry was also performed in 15 patients. Twelve patients had abnormal manometry. These included nutcracker esophagus in two, achalasia in one, and increased percentage of multipeaked and simultaneous contractions in nine. There were no significant correlations between radionuclide esophageal emptying, manometric changes and symptoms. Gastrointestinal symptoms were more common in the presence of autonomic neuropathy. Delayed esophageal emptying was more profound in the presence of PN, but abnormal esophageal emptying was present in patients with neuropathy as commonly as patients without. Furthermore, the presence of diabetic retinopathy, duration or control of diabetics, and fasting blood sugar did not influence the frequency of abnormal esophageal emptying. Our data indicate that esophageal dysfunction is common in male diabetics even in the absence of clinical PN and retinopathy, suggesting that diabetic gastroenteropathy can occur in the absence of significant diabetic complications. Commonly observed abnormal esophageal manometry in diabetics is not necessarily accompanied by significant functional disturbances or symptoms.

Topics: Autonomic Nervous System Diseases; Deglutition Disorders; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Neuropathies; Esophagus; Humans; Male; Manometry; Peristalsis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid