Measurement of transit disorders in different gastrointestinal segments of patients with diabetes mellitus in relation to duration and severity of the disease by use of the metal-detector test.

The existence of gastrointestinal transit disorders in other intestinal segments beside the stomach in Type-1 diabetes mellitus (DM) and occurrence in Type-2 DM and in uremia has yet been confirmed only in few studies. Eleven healthy volunteers, 34 patients with Type-1, 32 patients with Type-2 DM in different stages of their disease and 34 non-diabetic patients with endstage-renal disease were investigated by use of the metal detector test. Patients were divided in three subgroups, depending on the duration of their disease: < 1 year: "Short", 1 - 10 years: "Middle", > 10 years: "Long". For comparison with the metal detector test scintigraphic studies of esophageal and gastric transit were performed in 17 patients and small intestinal transit was studied by use of the H2-lactulose breath test in 20 patients with long-standing DM Type-1. In Type-1 DM there is an increase of gastric (135 +/- 18, p < 0.01; 218 +/- 26, p < 0.0001 vs. 73 +/- 7 min.) and large intestinal transit times (79 +/- 18, P < 0.02; 76 +/- 11, p < 0.04 vs. 40 +/- 5 h) in patients with middle or long standing DM. In Type-2 DM similar transit disturbances occur (gastric emptying, long group: 120 +/- 15 min., p < 0.02; colonic transit, long group: 80 +/- 13 h, p < 0.01). In uremia transit disturbances were only found in patients with chronic ambulatory peritoneal dialysis (colonic transit: 71 +/- 9 h, p < 0.05). In 65% gastric scintigraphy and in 55% of cases the H2-lactulose breath test showed a prolongation of gastric emptying or a prolonged mouth-to-cecum transit. Transit disorders can occur in every stage of DM with preferential involvement of the stomach and the colon. These findings are of clinical relevance, since transit disturbances can result in instable metabolic condition.