Go to chapter: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39
Chapter 37 (page 187)
The above patients all had symptoms and signs warranting the clinical diagnosis of
diabetic gastroparesis. Radiological studies in all showed absent cyclical activity of the
pyloric sphincteric cylinder. It has been shown that normal motility of the sphincteric
cylinder consists of alternating cycles of contraction and relaxation, occurring at a rte of
approximately 3 per minute (Chap. 13); in diabetic gastroparesis these cycles are absent,
the cylinder remaining in a state of permanent, partial contraction. As a maximal or
complete contraction of the cylinder does not occur, there is a failure of muscular closure
of the pyloric aperture (Chap. 13), which remains patent.
The patulous pylorus allows continuous emptying of fluid barium (Case 37.3). Emptying
of solid food residues is retarded (Cases 37.1 and 37.2) due to failure of normal cyclical
contraction of the sphincteric cylinder, i.e. failure of the normal mechanism of propulsion
of solids. The retention of solid tablets with a diameter of 8.0 mm (Case 37.2) indicates
failure of trituration of these tablets.
These conclusions tally with some of those of previous authors, and especially with those
of Malagelada et al. (l980) and Camilleri and Malagelada (l984). However, we believe
that the "antral" motor dysfunction mentioned by them as well as by Achem-Karam etal
(l985) and others, can be placed on a firm anatomical footing if reference is made to the
findings of Cunningham (l906), Forssell (l913) and Torgersen (l942) (Chap. 3).
The sustained contraction of the pyloric sphincteric cylinder seen radiologically in
diabetic gastroparesis will also explain the "peculiar continuous 3 minute antral
contractile activity" found by Camilleri and Malagelada (l984) during manometric studies
in some of their patients. One agrees with these authors that the disorder is not invariably
of a paretic type; in fact, there appears to be hypomotility due to a spastic or hypertonic
condition of the gastric smooth musculature, and in particular of the pyloric sphincteric
- Achem-Karam SR, Funakoshi A, Vinik AI, et al. Plasma motilin concentration
and interdigestive motor complex in diabetic gastroparesis: effect of
metoclopramide. Gastroenterology l985, 88, 492-499.
- Camilleri M, Malagelada JR. Gastric motility in disease. In: Gastric and
Gastroduodenal Motility, ed Akkermans LMA, Johnson AG, Read NW.
Praeger Publ, New York l984, pp 213-214.
- Camilleri M, Malagelada JR. Abnormal intestinal motility in diabetics with the
gastroparesis syndrome. Eur J Clin Invest l984, 14, 420-427.
- Campbell IW, Heading RC, Tothill P, et al. Gastric emptyin in diabetic
autonomic neuropathy. Gut l977, l8, 462-467.
- Carandang NV, Schuman BM, Whitehouse FW. The gastric mucosa of patients
in diabetic ketoacidosis: a gastro-camera study. Gastroint Endosc
l969, 16, 156-158.
- Cunningham DJ. The varying form of the stomach in man and the anthropoid
ape. Trans Roy Soc Edin l906, 45, 9-47.
- Feldman M, Corbett DB, Ramsey EJ, et al. Abnormal gastric function in long-
standing, insulin-dependent diabetic patients. Gastroenterology l979,
- Feldman M, Schiller LR. Disorders of gastrointestinal motility associated with
diabetes mellitus. Ann Int Med l983, 98, 378-384.
- Feldman M, Smith HJ, Simon TR. Gastric emptying of solid radio-opaque
markers: studies in healthy subjects and diabetic patients.
Gastroenterology l984, 87, 895-902.
- Forssell G, Über die Beziehung der Röntgenbilder des menschlichen
Magens zu seinem anatomischen Bau. Fortschr Geb
Röntgenstr 1913, Suppl 30, 1-265.
- Goyal RK, Spiro HM. Gastrointestinal manifestations of diabetes mellitus.
Med Clin North Amer 1971, 55, 1031-1044.
- Gramm HF, Reuter K, Costello P. Radiologic manifestations of diabetic gastric
neuropathy and its differential diagnosis. Gastrointes Radiol l978, 3,
- Horowitz M, Maddox A, Harding PE, et al. Effect of cisapride on gastric and
oesophageal emptying in insulin-dependent diabetes mellitus.
Gastroenterology l987, 92, 1899-1907.
- Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis
diabeticorum). Ann Int Med l958, 48, 797-812.
- Malagelada JR, Rees WDW, Mazzotta LJ, et al. Gastric motor abnormalities in
diabetic and postvagotomy gastroparesis: effect of metoclopramide and
bethanecol. Gastroenterology l980, 78, 286-293.
- Marshak RH, Maklansky D. Diabetic gastropathy. Amer J Dig Dis
l964, 9, 366-370.
- Rundles RW. Diabetic neuropathy: general review with report of 125 cases.
Medicine l945, 24, 111-160.
- Scarpello JHB, Barber DC, Hague RV, et al. Gastric emptying of solid meals in
diabetics. Brit Med J l976, 2, 671-673.
- Torgersen J. The muscular build and movements of the stomach and duodenal
bulb. Acta Rad l942, Suppl 45, 1-191.
- Varis K. Diabetic gastroparesis (a review). Scand J Gastroenterol
l989, 24, 897-903.
- Wright RA, Clemente R, Wathen R. Diabetic gastroparesis: an abnormality of
gastri emptying of solids. Amer J Med Sci l985, 289, 240-242.
- Yoshida MM, Schuffler MD, Sumi SM. There are no morphologic abnormalities
of the gastric wall or abdominal vagus in patients with diabetic gastroparesis.
Gastroenterology l988, 94, 907-910.
- Zitomer BR, Gramm HF, Kozak GP. Gastric neuropathy in diabetes mellitus:
clinical and radiologic observations. Metabolism l968, l7, 199-211.
Previous Page | Table of Contents | Next Page
© Copyright PLiG 1998