Relationship between electrogastrography (EGG) alteration and neuropathy in patients with pancreatic diabetes

Timing and criteria of testing for gastric dysmotility and the management of diabetic pts with pancreatic insufficiency is not well established.

The aim of the present study is to investigate the pattern of gastric myoelectrical activity (MA) and autonomic neuropathy (AN) in pts with pancreas diabetes mellitus (DM), and to clarify the relationship between AN, alcohol consumption, glucose homeostasis, diabetes duration, and gastric myoelectrical abnormalities.

Patients and methods: 30 pts with pancreas DM were enrolled into the study. Mean duration of DM was 11 (0–25)yrs, mean blood glucose levels: 8,13 (±2,7) mmol/l, HbA1c 8,3(±2,96)%.25/30 pts were treated with insulin, the others were on rigorous diet, all of them received high dose pancreatin substitution therapy. Ten matched controls without DM and pancreatic insufficiency were also examined. AN was evaluated by the cardiovascular reflex tests according to the Ewings criteria. MA was monitored for 30–30min in both fasting and in postprandial states, using a Digitrapper EGG.

Results: 9/30pts had mild to moderate parasympathetic (ps) AN, 1/30pts had sympathetic (sy) AN, 5/30pts had both ps and sy AN; 17/30 pts demonstrated myoelectric abnormalities: 5/30pts had predominant bradygastria and 3/30 tachygastria in another 9/30pts only an absence of increase in the postprandial signal amplitude was found. Overall, 7/30pts with abnormal EGG did not demonstrated AN. Abnormal dominant frequency and MA showed no correlation with actual blood sugar values or HbA1c, but it was associated with DM duration more than 10yrs. Conclusion: our results suggest, that beside neuropathy other factors, such as alcohol toxicity, sy and ps inbalance or inappropriate glucose control may be involved in the gastric myoelectric abnormalities provoked by pancreas DM.