Upper gastrointestinal dysmotility - from endocrinological pathogenesis to symptoms

Abstract: Gastrointestinal dysmotility is common, particularly in patients with diabetes mellitus. The aim of this thesis is to explore whether gastrointestinal dysmotility and endocrine secretion are interrelated, and how the symptoms manifest themselves in these patients. Patients with diabetes mellitus and gastrointestinal symptoms underwent gastric emptying scintigraphy, esophageal manometry and deep-breathing tests. After a fat-rich meal, blood was collected for hormonal analyses. Healthy subjects participated in satiety and gastric emptying tests, while their satiety was scored. Tests were performed while infusions of either saline or various oxytocin concentrations were being administered. Patients with gastroparesis underwent gastric emptying scintigraphy and patients with dyspepsia performed satiety tests. Tests were performed with saline and with oxytocin infusion, respectively, and satiety was scored. We found that: • 58% of the patients had esophageal dysfunction and 68% had delayed gastric emptying. Abdominal fullness was associated with delayed gastric emptying (p=0.02). • There was an increase in postprandial oxytocin plasma concentration in patients with normal gastric emptying (p=0.02) whereas this was lacking in patients with gastroparesis. Patients with esophageal dysmotility tended to have hyperCCKemia (p=0.05) and those with autonomic neuropathy had hypergastrinemia (p=0.01). • There was no difference in the volume intake during oxytocin and saline infusions in healthy subjects, but less satiety was observed with oxytocin (p=0.03), 40mU/min being the most effective dosage (p=0.01). Oxytocin did not affect the gastric emptying time. • In patients with gastroparesis oxytocin prolonged the gastric emptying (p=0.03), but had no effect on satiety or volume of intake in patients with dyspepsia.