Abnormalities in gallbladder dynamics of type 1 (insulin-dependent) diabetic patients with autonomic neuropathy

ABSTRACT

The aim of this study was to evaluate gallbladder dynamics in insulin-dependent diabetic patients with and without autonomic neuropathy. Gallbladder dynamics was studied by a scintigraphicmethod after a test meal in 26 insulin-dependent diabetic patients and 10 normal individuals. The presence and severity of autonomic neuropathy were defined according to the number of abnormal cardiovascular reflex tests absent (no abnormal test), mild (1-3 abnormal tests), and severe (4-5 abnormal tests). The time from the moment when the patient started to take the test meal to the begnning of gallbladder emptying was longer (P = 0.01) in diabetic patients with mild (N = 11,12.1 ñ 7.6 min) and severe neuropathy (N = 8,11.0 ñ 10.6 min) than diabetic patients without autonomic neuropathy (N = 7,3.9 ñ 4.4 min) and controls (N = 10,4.8 ñ 4.2 min). The ejection rate was higher (P = 0.02) in the group with severe autonomic neuropathy (N = 8,5.1 ñ 3.3 percent/min) than diabetic patients with mild (N = 11,2.) ñ 1.0 percent/min) or without autonomic neuropathy (N = 7,1.8 ñ 0.8 por cento/min) and controls (N = 10,2.6 ñ 1 percent/min). Thirty-two percent of the diabetic patients with autonomic neurpathy presented increased perspiration, nausea and urgency to defecate after the ingestion of the test meal. A significant positive correlation of ejection rate with the presence of these symptoms (biserial point correlation test = 0.67,P<0.01) was also observed. These data suggest that insulin-dependent diabetic patients with autonomic neuropathy present abnormalities of gallbladder emptying that could be related to specific gastrointestinal sumptoms