Recto-anal manometric characteristics of type 2 diabetic patients who have sensation of incomplete defecation.

INTRODUCTION: Many diabetic patients report symptoms of incomplete defecation. We aimed to clarify the recto-anal manometric characteristics related to these symptoms. MATERIAL AND METHODS: A questionnaire regarding gastrointestinal symptoms was distributed to 35 diabetics (19 women and 16 men) aged between 39 and 81 years. Nineteen reported incomplete defecation sensation (WS) and 16 did not (NS). Recto-anal manometry was performed for all patients. Data are presented as mean±SD. RESULTS: Resting rectal pressure was 14.4±10.1 mmHg and 8.8±3.9 mmHg, p<.03; first sensation was 61.0±27.8 ml and 83.1±35.7 ml, p<.04; and maximum tolerable volume was 174.2±81.5 ml and 235.0±89.5 ml, p<.04 for WS and NS, respectively. The WS group was further divided into 2 groups according to symptom severity (less severe and very severe). Significant differences were found in resting external anal sphincter pressure (50.4±15.6 and 34.3±17.4, p<.04) and the recto anal inhibitory reflex (48.6±19.8 and 26.3±23.2, p<.03) between the less severe and very severe groups, respectively. CONCLUSIONS: (1) Resting rectal pressure was significantly higher in symptomatic individuals. (2) First sensation and maximum tolerable volume were higher in asymptomatic diabetics. (3) In diabetics with more severe symptoms, the resting external anal sphincter pressures were significantly lower. (4) The degree of relaxation in the recto-anal inhibitory reflex was significantly higher in individuals without complaints.

Esophageal body motility in people with diabetes: comparison with non-diabetic healthy individuals.

AIMS: The aim of this study was to compare esophageal motor characteristics between diabetics and healthy individuals. METHODS: Esophageal manometry was performed in 34 type 2 diabetics and 32 healthy individuals. Waves were evaluated in the 3 thirds of the esophagus (P1=upper, P2=middle, and P3=distal). RESULTS: In diabetics vs. controls, wave distribution was as follows: peristaltic waves, 83.5 ± 22.2% vs. 96.3 ± 4.4%, p<0.002; simultaneous waves, 3.26 ± 5.8% vs. 0.53 ± 1.3%, p<0.01; no transmitted waves, 10.62 ± 20.7% vs. 2.75 ± 3.0%, p<0.002; and retrograde waves, 2.68 ± 4.0% vs. 0.31 ± 1.1%, p<0.03. Wave amplitude was similar between groups. Average upstroke (mmHg/s) in diabetics vs. non-diabetics was P2, 33.8 ± 13.9 vs. 40.2 ± 17.7, p<0.03; and P3, 29.8 ± 15.3 vs. 41.3 ± 14.0, p<0.002. CONCLUSIONS: (1) Simultaneous waves, no transmitted waves, and retrograde esophageal waves were significantly more frequent in diabetics. (2) Average upstroke was significantly lower within the middle and distal esophagus of diabetic individuals. (3) Wave amplitude was similar in both groups.

Effects of gastroesophageal reflux on esophageal motility.

UNLABELLED: Esophageal characteristics during swallowing in individuals with reflux are not well known. This study aimed to compare manometric esophageal characteristics between a group of individuals with gastroesophageal reflux and a group without these symptoms. METHODS: A stationary esophageal manometry and a questionnaire of gastrointestinal symptoms were performed on 41 individuals, of whom 13 (31.7%) complained of gastroesophageal reflux. RESULTS: The following data were obtained in cases of non-reflux vs. reflux: mean wave amplitude, 53.4 +/- 17.9 mm Hg vs. 48.6 +/- 11.8 mm Hg; similar mean upstroke; and lower esophageal sphincter pressure of 16.7 +/- 6.4 mm Hg vs. 17.9 +/- 4.9 mm Hg (p = 0.5). The relaxing degree and duration were similar. In the analysis according to the severity of the symptoms, we verified the following differences between cases of slight and severe reflux: amplitude in proximal esophagus, 40.75 +/- 13.1 mm Hg sec vs. 23.0 +/- 9.2 mm Hg sec (p = 0.02); mean average upstroke, 36.6 +/- 8.2 mm Hg sec vs. 24.8 +/- 7.3 mm Hg sec (p = 0.02); mean maximum upstroke, 61.4 +/- 10.4 mm Hg sec vs. 47.0 +/- 12.4mm Hg sec (p = 0.04); and relaxing duration, 5.36 +/- 2.0 sec vs. 8.76 +/- 1.6 sec (p = 0.01). CONCLUSIONS: 1. No differences in the manometric characteristics of the esophagus were found between individuals with and without reflux. 2. The wave amplitude and the upstroke were significantly higher in the proximal esophagus of patients with less severe complaints. 3. The mean and maximum upstroke of the esophageal wave were lower in individuals with severe reflux. 4. The relaxation duration was higher in patients with severe complaints.

High levels of leptin modulate esophageal motor characteristics in type 2 diabetic patients.

UNLABELLED: Leptin regulates gastric and intestinal motility, but its effect on oesophageal motility is unknown. We analyzed oesophageal manometric characteristics in diabetics with elevated leptin. METHODS: Fasting blood leptin levels were measured in 32 type 2 individuals aged from 39-81 years. An oesophageal stationary manometry was then performed. Each manometric door (P) registered one third of the oesophageal activity. Results are presented as mean +/- SD. RESULTS: Twenty-one subjects had elevated leptin (HLL) while 11 displayed normal levels (NLL). Peristaltic wave distributions (%) in NLL vs. HLL were 79.4 +/- 26.3 vs. 88.6 +/- 8.3 (p = 0.2). Simultaneous and retrograde waves showed similar trends. Non-transmitted waves were 16.1 +/- 26.5 vs. 4.6 +/- 4.5% (p < 0.05). Amplitudes in NLL vs. HLL (in mm Hg) were P1: 30.2 +/- 10.8 vs. 33.2 +/- 11.7 (p = 0.4), P2: 38.4 +/- 14.4 vs. 58.0 +/- 21.2 (p = 0.01), P3: 42.4 +/- 14.4 vs. 64.7 +/-2 8.3 (p < 0.006), and average amplitudes: 37.1 +/- 12.1 vs. 52.1 +/- 17.6 (p = 0.01). Wave average upstroke (in mm Hgs) was P1: 25.6 +/- 19.1 vs. 23.3 +/- 10.1 (p = 0.6), P2: 26.8 +/- 10.7 vs. 36.2 +/- 11.6 (p < 0.03), and P3: 25.5 +/- 9.1 vs. 34.1 +/- 16.3, (p < 0.06). Wave maximum upstroke was P1: 39.0 +/- 18.6 vs. 40.5 +/- 13.8, (p = 0.8), P2: 45.5 +/- 15.5 vs. 63.8 +/- 19.2 (p = 0.01), P3: 46.6 +/- 17.8 vs. 65.0 +/- 29.1 (p <0.03). Wave duration in distal oesophagus was 4.5 +/- 0.7 vs. 5.5 +/- 1.1 s (p = 0.01), and velocity 3.3 +/- 3.3 vs. 2.96 +/- 3.7 cm/s (p = 0.6). CONCLUSION: 1--Non-transmitted waves were slightly higher in NLL. 2--In medium and distal oesophagus, the wave amplitude, medium and maximum upstroke, and duration in distal oesophagus were increased in HLL.