Ambulatory long-term jejunal meanometry in diabetic patients with cardiac autonomic neuopathy N Hackelsberger et al, Neurogastroenerol Mot 1997;9:77-83

Background
Autonomic neuopathy is a frequent complication of long-standing diabetes. In comparison with clinically important well characterized cardiovascular dysfunction the gastrointestinal tract is not so well defined. Gastroparesis is the best evaluated motor disturbances of the gastrointestinal tract in diabetic patients. Less extensively investigated are alterations of the small bowel motor function, and also the studies undertaken so far characterized motility in fasting and the post-prandial state, and also over a very limited period of time, and under stationary conditions.

Results
24 hrs ambulant small bowel manometry was performed in diabetic patients with cardiac autonomic neuropathy and compared with a large group of healthy colunteers. In summary, three main findings resulted * a disturbance in the generation of and the normal migration of MMC phase III activity; in 5 of 15 patients tehere was a retrograde migration or simulantance occurrence of phase III, in 2/15 total absence of phase III over a 24-h period - it points the presence of an enteric neuropathy, resembling the findings in chronic idopathic pseudoobstruction of presumably neurogenic origin - this may lead to bacterial overgrowth because phase III has a gatekeeper function * an impairment in the circadian variation of the MMC cycle with an inversion of normal phase I and II relationship, suggested to be centrally mediated * A marked postprandial hypomotility, suggesting enteric and extrensic neural involvement, a grossly reduced contraction fequency in response to food - this could lead to an impairment of mixing and normal motor transport of the food, and not defined if it is the vagal dysfunction or a delayed gastric emptying contributing to it