Clinical Research
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 14, 2007; 13(2): 270-275
Published online Jan 14, 2007. doi: 10.3748/wjg.v13.i2.270
Proximal gastric motility in critically ill patients with type 2 diabetes mellitus
Nam Q Nguyen, Robert J Fraser, Laura K Bryant, Marianne Chapman, Richard H Holloway
Nam Q Nguyen, Richard H Holloway, Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, South Australia
Robert J Fraser, Laura K Bryant, Investigation and Procedures Unit, Repatriation General Hospital; South Australia
Marianne Chapman, Anaesthesia and Intensive Care, Royal Adelaide Hospital, South Australia
Author contributions: All authors contributed equally to the work.
Supported by a project grant from the National Health and Medical Research Council of Australia.
Correspondence to: Dr Nam Q Nguyen, Department of Gastroenterology, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. qnguyen@mail.rah.sa.gov.au
Telephone: + 61-8-82225207 Fax: + 61-8-82225885
Received: October 25, 2006
Revised: November 13, 2006
Accepted: December 12, 2006
Published online: January 14, 2007
Abstract

AIM: To investigate the proximal gastric motor response to duodenal nutrients in critically ill patients with long-standing type 2 diabetes mellitus.

METHODS: Proximal gastric motility was assessed (using a barostat) in 10 critically ill patients with type 2 diabetes mellitus (59 ± 3 years) during two 60-min duodenal infusions of Ensure® (1 and 2 kcal/min), in random order, separated by 2 h fasting. Data were compared with 15 non-diabetic critically ill patients (48 ± 5 years) and 10 healthy volunteers (28 ± 3 years).

RESULTS: Baseline proximal gastric volumes were similar between the three groups. In diabetic patients, proximal gastric relaxation during 1 kcal/min nutrient infusion was similar to non-diabetic patients and healthy controls. In contrast, relaxation during 2 kcal/min infusion was initially reduced in diabetic patients (p < 0.05) but increased to a level similar to healthy humans, unlike non-diabetic patients where relaxation was impaired throughout the infusion. Duodenal nutrient stimulation reduced the fundic wave frequency in a dose-dependent fashion in both the critically ill diabetic patients and healthy subjects, but not in critically ill patients without diabetes. Fundic wave frequency in diabetic patients and healthy subjects was greater than in non-diabetic patients.

CONCLUSION: In patients with diabetes mellitus, proximal gastric motility is less disturbed than non-diabetic patients during critical illness, suggesting that these patients may not be at greater risk of delayed gastric emptying.

Keywords: Proximal gastric function; Diabetes mellitus type 2; Critical illness; Enteral nutrition