{"id":1055,"date":"2021-09-03T14:28:27","date_gmt":"2021-09-03T19:28:27","guid":{"rendered":"https:\/\/testbreath.com\/?p=1055"},"modified":"2021-10-20T14:39:31","modified_gmt":"2021-10-20T19:39:31","slug":"breath-hydrogen-testing-identifies-patients-with-diabetic-gastroparesis","status":"publish","type":"post","link":"https:\/\/testbreath.com\/breath-hydrogen-testing-identifies-patients-with-diabetic-gastroparesis\/","title":{"rendered":"Diabetic Gastroparesis"},"content":{"rendered":"
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Diabetes Care. June 2000 v23 i6 p860.<\/em><\/p>\n

Full Text<\/strong>\u00a0COPYRIGHT 2000 American Diabetes Association<\/p>\n

Delayed gastric emptying is a common and debilitating complication of longstanding diabetes [1]. Unfortunately, diagnosis of this condition with current scintigraphic techniques is limited by high cost, wide inter- and intrasubject variability, and exposure of the patient to low levels of ionizing radiation. Because the ingestion of lactulose results in the colonic production of lactate, carbon dioxide, and hydrogen ([H.sub.2]) gas, and because colonic [H.sub.2] is excreted by the lungs in direct proportion to the amount of lactulose being metabolized in the colon, lactulose-breath hydrogen testing can be used for the quantitative assessment of oral-cecal transit time in both diabetic and nondiabetic subjects [2,3]. Ingestion of complex carbohydrates, such as potato starch, also results in breath [H.sub.2] excretion [4]. We, threfore, hypothesized that breath hydrogen excretion would be abnormally prolonged in patients with previously diagnosed diabetic gastroparesis after ingestion of a potato-lactulose test meal compared with subjects without gastroparesis.<\/p>\n

This 24-h pilot study consisted of 10 healthy nondiabetic control subjects, 10 diabetic subjects without gastroparesis (gastric emptying [T.sub.1\/2] [less than]90 min), and 10 diabetic subjects with previously diagnosed gastroparesis (gastric emptying [T.sub.1\/2] [greater than]90 min). Radionucleotide determination of gastric emptying was performed as previously described [5]. Gastric motility agents were withheld 24 h before study, and euglycemia was established and maintained overnight in diabetic subjects with a continuous intravenous insulin infusion. At 600 A.M., all subjects ingested a breakfast containing 100g dry-cooked potato starch and 20 g lactulose. Breath [H.sub.2] excretion was monitored at baseline and for 12 h after ingestion of the test meal. All subjects provided written informed consent before the study as approved by the University of New Mexico Human Research Review Committee.<\/p>\n

Breath [H.sub.2] samples were analyzed in duplicate by gas chromatography using the QuinTron SC Hydrogen Breath Analyzer (QuinTron Instruments, Milwaukee, WI). Study data were analyzed using a repeated measures analysis of variance with posthoc application of Fisher’s least significant difference method of multiple pairwise comparisons, using SAS (SAS Institute, Cary, NC).<\/p>\n

There was no significant difference in plasma glucose concentrations during the 12-h study period between the diabetic group and the gastroparetic group (P = 0.79). Baseline breath [H.sub.2] levels were elevated in the diabetic plus gastroparetic group (normal control group = 3.6 [plus or minus] 5.2, diabetic group = 4.1 [plus or minus] 5.9, diabetic plus gastroparetic group = 13.1 [plus or minus] 12.4 ppm; P = 0.06 compared with the groups with no gastroparesis). There was no significant difference between the groups in peak breath [H.sub.2] concentrations or in time-to-peak breath [H.sub.2]. However, the time course of breath [H.sub.2] concentrations was significantly different in the gastroparetic group compared with those of the other 2 groups by repeated measures analysis of variance (P[less than]0.01). Figure 1 shows that baseline-adjusted breath [H.sub.2] concentrations were significantly elevated in the diabetic plus gastroparetic group compared with the diabetic and normal control groups 12 h after i ngestion of the test meal.<\/p>\n

Although current standards of practice call for a radionucleotide gastric-emptying study to aid in the diagnosis of gastrointestinal motility disorders in diabetic patients, the development of a functional test of upper gasrointestinal function after the ingestion of a solid meal may prove to be a valuable daignostic aid for patients affected with this problem [1,6-10]. This pilot study suggests that the presence of an elevated baseline-adjusted breath [H.sub.2] concentration, 12 h after the ingestion of an easily prepared test meal containing potato starch and lactulose, accurately identifies those patients with previously diagnosed diabetic gastroparesis. Such a test may prove to be a useful outpatient screening test for the identification of those symptomatic patients who should receive a more definitive (but expensive) scintigraphic study and those in whom the presence of gastroparesis can be excluded.<\/p>\n

MARK R. BURGE, MD
\nMARK S. TUTTLE, BA
\nJODI L. VIOLETT, MD
\nCHRISTOPHER L. STEPHENSON, BA
\nDAVID S. SCHADE, MD<\/p>\n

From the Department of Medicine\/Endocrinology, University of New Mexico School of Medicine, Albuquerque, New Mexico.<\/p>\n

Address correspondence to Mark R. Burge, MD, Assistant Professor of Medicine, Department of Medicine\/Endocrinology-5ACC, University of New Mexico School of Medicine, Albuquerque, NM 87131. Email mburge@salud.unm.edu.<\/p>\n

Acknowledgments\u00a0— This research was supported by the University of New Mexico General Clinical Research Center (NIH NCRR GCRC Grant 5M01-RR00997) and by NIH National Institute of Diabetes and Digestive and Kidney Diseases Grant 1-K23-DK02680-01.<\/p>\n

REFERENCES<\/h3>\n
(1.) Varis K Diabetic gastroparesis a review. J Diabetes Complications 5207-217, 1991<\/em><\/h6>\n
(2.) Sahota SS, Bramley PM, Menzies IS The fermentation of lactulose by colonic bacteria. J Gen Microbiol 128319-325, 1982<\/em><\/h6>\n
(3.) Sciarretta G, Furno A, Mazzoni M, Garagnani B, Malaguti P Lactulose hydrogen breath test in orocecal transit assessment critical evaluation by means of scintigraphic method. Dig Dis Sci 391505-1510, 1994<\/em><\/h6>\n
(4.) Levitt MD, Hirsh P, Fetzer CA, Sheahan M, Levine AS [H.sub.2] excretion after ingestion of complex carbohydrates. Gastroenterology 92383-389, 1987<\/em><\/h6>\n
(5.) Mettler FA The gastrointestinal tract. In Essentials of Nuclear Medicine Imaging. 4th ed. Mettler FA, Guiberteau MJ, Eds. Philadelphia, WB Saunders, 1998, p. 237-281<\/em><\/h6>\n
(6.) Loo FD, Palmer DW, Soergel KH, Kalbfleisch JH, Wood CM Gastric emptying in patients with diabetes mellitus. Gastroenterology 866485-494, 1984<\/em><\/h6>\n
(7.) Lartigue S, Bizais Y, Des Varannes SB, Murat A, Pouliquen B, Galmiche JP Inter-and intra-subject variability of solid and liquid gastric emptying parameters a scintigraphic study in healthy subjects and diabetic patients. Dig Dis Sci 39109-115, 1994<\/em><\/h6>\n
(8.) Schvarcz E, Palmer M, Aman J, Horowitz M, Stridsberg M, Berne C Physiologic hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus. Gastroenterology 11360-66, 1997<\/em><\/h6>\n
(9.) Malmud LS, Fisher RS, Knight LC, Rock E Scintigraphic evaluation of gastric emptying. Semin Nucl Med 2116-125, 1982<\/em><\/h6>\n
(10.) Poitras P, Picard M, Dery R, Giguere A, Picard D, Maorais J, Plourde V, Boivin M Evaluation of gastric emptying function in clinical practice. Dig Dis Sci 422183-2189, 1997<\/em><\/h6>\n

Received 2 January 2001
\nAccepted 22 April 2001
\nScand J Gastroenterol 2001 (12)
\n1278 M. Di Stefano et al.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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