Cardiovascular autonomic tests in diabetic patients with gastroparesis

Araujo, Leila M.B.; Freeman, Roy; Broadbridge, Christoferson

doi:10.1590/S0004-282X1997000200010

Abstracts

The aim of this report was to study the cardiovascular autonomic tests in the evaluation of diabetic patients with gastroparesis. Forty diabetic subjects were divided into two groups: one group with gastroparesis (GP, n=20) and another group paired by age and duration of diabetes without any complaint of autonomic neuropathy (DC, n=20) . They were evaluated clinically and submitted to a battery of five cardiovascular autonomic tests. The presence and severity of autonomic neuropathy were defined according to the number of normal cardiovascular tests. Each test had a score: zero ( normal ), one ( borderline ) and two ( abnormal ). The GP group showed a higher abnormal total score in the cardiovascular autonomic test than the group without any complaint (6.6 ± 3.0 vs. 2.7 ± 1.4, p <0.01). These data suggest that diabetic with gastroparesis presents more abnormal cardiovascular autonomic tests than diabetic without autonomic neuropathy and these tests should be included in the evaluation of diabetic patients with gastroparesis.

gastroparesis; autonomic neuropathy; cardiovascular autonomic test; diabetic neuropathy

O objetivo deste estudo foi investigar a importância dos testes autonômicos na avaliação de pacientes diabéticos com gastroparesia. Foram estudados 40 diabéticos, divididos em dois grupos: um grupo de pacientes com gastroparesia (GP, n = 20) e outro constituído de diabéticos sem qualquer queixa de neuropatia autonomica (DC, n = 20), pareados por idade e duração do diabetes. Eles foram avaliados clinicamente e submetidos a bateria de cinco testes autonômicos. A presença e a seriedade da neuropatia foi definida de acordo com os testes cardiovasculares anormais. Cada teste teve escore: zero(normal), um (limítrofe) e dois (anormal). O grupo GP teve maior escore total de testes cardiovasculares autonômicos do que o grupo DC (6,6 ± 3,0 versus 2,7 ± 1,7 , p < 0,01). Estes dados sugerem que diabéticos com gastroparesia apresentam maior número de testes cardiovasculares anormais do que o grupo controle e estes testes devem ser incluídos na avaliação diagnostica do paciente diabético com gastroparesia.

gastroparesia; neuropatia autonômica; teste cardiovascular autonômico; neuropatia diabética

Cardiovascular autonomic tests in diabetic patients with gastroparesis

Testes autonômicos cardiovasculares em diabéticos com gastroparesia

Leila M.B. Araujo^I; Roy Freeman^II; Christoferson Broadbridge^II

^IServiço de Endocrinologia do Hospital Universitário Prof. Edgard Santos da Faculdade de Medicina da Universidade Federal da Bahia (UFBA)

^IIDepartment of Neurology, New England Deaconess Hospital, Harvard University, Boston, Massachussetts, USA

ABSTRACT

The aim of this report was to study the cardiovascular autonomic tests in the evaluation of diabetic patients with gastroparesis. Forty diabetic subjects were divided into two groups: one group with gastroparesis (GP, n=20) and another group paired by age and duration of diabetes without any complaint of autonomic neuropathy (DC, n=20) . They were evaluated clinically and submitted to a battery of five cardiovascular autonomic tests. The presence and severity of autonomic neuropathy were defined according to the number of normal cardiovascular tests. Each test had a score: zero ( normal ), one ( borderline ) and two ( abnormal ). The GP group showed a higher abnormal total score in the cardiovascular autonomic test than the group without any complaint (6.6 ± 3.0 vs. 2.7 ± 1.4, p <0.01). These data suggest that diabetic with gastroparesis presents more abnormal cardiovascular autonomic tests than diabetic without autonomic neuropathy and these tests should be included in the evaluation of diabetic patients with gastroparesis.

Key words: gastroparesis, autonomic neuropathy, cardiovascular autonomic test, diabetic neuropathy.

RESUMO

O objetivo deste estudo foi investigar a importância dos testes autonômicos na avaliação de pacientes diabéticos com gastroparesia. Foram estudados 40 diabéticos, divididos em dois grupos: um grupo de pacientes com gastroparesia (GP, n = 20) e outro constituído de diabéticos sem qualquer queixa de neuropatia autonomica (DC, n = 20), pareados por idade e duração do diabetes. Eles foram avaliados clinicamente e submetidos a bateria de cinco testes autonômicos. A presença e a seriedade da neuropatia foi definida de acordo com os testes cardiovasculares anormais. Cada teste teve escore: zero(normal), um (limítrofe) e dois (anormal). O grupo GP teve maior escore total de testes cardiovasculares autonômicos do que o grupo DC (6,6 ± 3,0 versus 2,7 ± 1,7 , p < 0,01). Estes dados sugerem que diabéticos com gastroparesia apresentam maior número de testes cardiovasculares anormais do que o grupo controle e estes testes devem ser incluídos na avaliação diagnostica do paciente diabético com gastroparesia.

Palavras-chave: gastroparesia, neuropatia autonômica, teste cardiovascular autonômico, neuropatia diabética.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 13-janeiro-1997.

Dra. Leila M. B. Araújo - Serviço de Endocrinologia do Hospital Universitário Prof. Edgard Santos, UFBA -Rua João das Botas s/no, 6º andar - 40110-160 Salvador BA - Brasil. Fax 55 71 339 6611 R 6228.

1. Bennett T, Hosking DJ, Hampton JR. Cardiovascular control in diabetes mellitus. Br Med J 1975,2:585-587.
2. Buysschaert M, Moulart M, Urbuin JL, Pauwels S, de Roy L, Ketelslegens JM, Lambert AE. Impaired gastric emptying in diabetic patients will cardiac autonomic neuropathy. Diabetes Care 1987;10:448-452.
3. Campbell IW, Heading RC, Tothill P, Buist TAS, Ewing DJ, Clark BF. Gastric emptying in diabetic autonomic neuropathy. Gut 1977;18:81-86.
4. Clouse RE, Lustman P.J. Gastric intestinal symptoms in diabetic patients: lack of association with neuropathy. Am J Gastroent 1989;84:866-872.
5. Ewing DJ, Campbell IW, Murray A. Nelson JMM, Clarke BF . Immediate heart rate response to standing: simple test for autonomic neuropathy in diabetes. Diabetologia 1980;19:433-481.
6. Ewing DJ, Martin CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985;8:491-498.
7. Feldman M & Schiller LR . Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 1983;98:378-384.
8. Fraser RJ, Horowitz M, Maddox A F, Harding PE, Chatterton BE, Dent J. Hyperglycemia slows gastric emptying in type I (insulin-dependent) diabetes mellitus. Diabetologia 1990;33:675-680.
9. Horowitz M, Harding PE, Maddox AF, Wishart JM, Akkermans LMA, Chatterton BE, Shearman DJC. Gastric and oesophageal emptying in patients with Type 2 ( non-insulin-dependent) diabetes mellitus. Diabetologia 1989;32:151-159.
10. Hume L, Ewing DJ, Campbell W .Heart rate response to sustained handgrip. Clin Sci 1979;56:287-291.
11. Keshavarzian A, Iber FL, Vaeth J . Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroent 1987:82:29-35.
12. Levin AB. A simple test of cardiac function based upon the heart rate changes induced by the Valsalva maneuver. Am J Cardiol 1966;18:901-998.
13. Oh JJ, Kim CH. Gastroparesis after a presumed viral illness: clinical and laboratory features and natural history. Mayo Clin Proc 1990;65:636-642.
14. Pozzi M, Rivolta M, Gelosa M, Capra M, Poggiolo G, Bernasconi A, Lomuscio G. Upper gastrointestinal involvement in diabetes mellitus: study of esophago-gastric function. Acta Diabetol Lat 1988;25:333-340.
15. Samsom M, Jebbink RJA, Akkermans LMA, van Berge-Henegouwen GP, Smout JPM. Abnormalities of antroduodenal motility in type I diabetes. Diabetes Care 1996;19:21-27
16. Soler NG & Illinois S. Diabetic gastroparesis without autonomic neuropathy. Diabetes Care 1980;3:200-291.
17. Sundkvist G. Aimer LO. Lilja B. Respiratory influence of the heart rate in diabetes mellitus. Br Med J 1979; 1:924-925.
18. Wright RA, Clemente R, Wathen R. Diabetic gastroparesis: an abnormality of gastric emptying of solids. Am J Med Sci 1985;289:240-242.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
June 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bennett T, Hosking DJ, Hampton JR. Cardiovascular control in diabetes mellitus. Br Med J 1975,2:585-587.

[2] 2. Buysschaert M, Moulart M, Urbuin JL, Pauwels S, de Roy L, Ketelslegens JM, Lambert AE. Impaired gastric emptying in diabetic patients will cardiac autonomic neuropathy. Diabetes Care 1987;10:448-452.

[3] 3. Campbell IW, Heading RC, Tothill P, Buist TAS, Ewing DJ, Clark BF. Gastric emptying in diabetic autonomic neuropathy. Gut 1977;18:81-86.

[4] 4. Clouse RE, Lustman P.J. Gastric intestinal symptoms in diabetic patients: lack of association with neuropathy. Am J Gastroent 1989;84:866-872.

[5] 5. Ewing DJ, Campbell IW, Murray A. Nelson JMM, Clarke BF . Immediate heart rate response to standing: simple test for autonomic neuropathy in diabetes. Diabetologia 1980;19:433-481.

[6] 6. Ewing DJ, Martin CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985;8:491-498.

[7] 7. Feldman M & Schiller LR . Disorders of gastrointestinal motility associated with diabetes mellitus. Ann Intern Med 1983;98:378-384.

[8] 8. Fraser RJ, Horowitz M, Maddox A F, Harding PE, Chatterton BE, Dent J. Hyperglycemia slows gastric emptying in type I (insulin-dependent) diabetes mellitus. Diabetologia 1990;33:675-680.

[9] 9. Horowitz M, Harding PE, Maddox AF, Wishart JM, Akkermans LMA, Chatterton BE, Shearman DJC. Gastric and oesophageal emptying in patients with Type 2 ( non-insulin-dependent) diabetes mellitus. Diabetologia 1989;32:151-159.

[10] 10. Hume L, Ewing DJ, Campbell W .Heart rate response to sustained handgrip. Clin Sci 1979;56:287-291.

[11] 11. Keshavarzian A, Iber FL, Vaeth J . Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroent 1987:82:29-35.

[12] 12. Levin AB. A simple test of cardiac function based upon the heart rate changes induced by the Valsalva maneuver. Am J Cardiol 1966;18:901-998.

[13] 13. Oh JJ, Kim CH. Gastroparesis after a presumed viral illness: clinical and laboratory features and natural history. Mayo Clin Proc 1990;65:636-642.

[14] 14. Pozzi M, Rivolta M, Gelosa M, Capra M, Poggiolo G, Bernasconi A, Lomuscio G. Upper gastrointestinal involvement in diabetes mellitus: study of esophago-gastric function. Acta Diabetol Lat 1988;25:333-340.

[15] 15. Samsom M, Jebbink RJA, Akkermans LMA, van Berge-Henegouwen GP, Smout JPM. Abnormalities of antroduodenal motility in type I diabetes. Diabetes Care 1996;19:21-27

[16] 16. Soler NG & Illinois S. Diabetic gastroparesis without autonomic neuropathy. Diabetes Care 1980;3:200-291.

[17] 17. Sundkvist G. Aimer LO. Lilja B. Respiratory influence of the heart rate in diabetes mellitus. Br Med J 1979; 1:924-925.

[18] 18. Wright RA, Clemente R, Wathen R. Diabetic gastroparesis: an abnormality of gastric emptying of solids. Am J Med Sci 1985;289:240-242.