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Autonomic and enteric function profiling can predict disordered gastric emptying in diabetic gastropathy

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Abstract

Gastric emptying tests (GET) are the gold standard for diagnosing gastroparesis, but many patients do not have delayed emptying. We aimed to examine the combination of autonomic nervous system testing (ANS) and the enteric measure (ENS) of electrogastrography (EGG) to predict disordered GET. Seventy-six patients (47 F, 29 M mean age 40 years) with diabetes mellitus underwent evaluation for end-organ failure including gastroparesis. ANS testing assessed autonomic function by finger capillary pulse to positional changes (PAR), vasoconstriction to cold (VC), and EKG R-R interval change (RRI) with deep breathing; the ENS measures of cutaneous EGG assessed gastric myoelectrical activity. Solid (S) GET subgroups were based on 50% emptying (TS50). Via linear regression analysis: VC, PAR, and EGG had a significant inverse correlation with GET TS50 and decreased in response to a delay in gastric emptying (p < 0.05). Via ordinal logistic regression RRI and EGG-predicted gastric emptying (p < 0.01). Patients with a higher RRI and EGG value were 0.93 and 0.14 times more likely to be diagnosed with rapid gastric emptying. The areas under the curve for receiver operator characteristics (AUROC) for all measures were 0.72 in comparison to 0.59 with EGG. Based on the results, four components (RRI, VC, PAR, and EGG) quantitatively describe gastric emptying in patients with signs of diabetic gastropathy better than EGG alone.

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Abbreviations

T50S:

Time for 50% of a solid meal to emptying

GET:

Gastric emptying test

EGG:

Electrogastrogram

RRI:

EKG R to R Interval

PAR:

Postural adjustment ratio

VC:

Vasoconstriction

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Acknowledgments

The authors would like to thank Naseem Aslam from the University of Tennessee for help in data collection and Babajide Familoni from the University of Memphis for helpful comments. They would also like to thank the staff of the Autonomic Lab as well as the Pancreas-Kidney Transplant Program at the University of Tennessee-Memphis and Catherine McBride at the University of Louisville for help with manuscript preparation.

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Authors and Affiliations

  1. Department of Medicine, Division of GI, Hepatology and Nutrition, University of Louisville, 550 South Jackson Street, Louisville, Kentucky, 40202, USA

    Hamza Hassan, Hani Rashed & Thomas Abell

  2. Department of Internal Medicine, University of Louisville, Louisville, KY, USA

    Surosree Ganguli

  3. Department of Bio-Statistics, Pennington Centre, LSU, Baton Rouge, LA, USA

    William Johnson

  4. Department of Bio-Statistics, University of Louisville, Louisville, KY, USA

    Bikash Bhandari

Authors
  1. Hamza Hassan
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  2. Surosree Ganguli
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  3. Hani Rashed
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  4. William Johnson
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  6. Thomas Abell
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Contributions

All authors made substantial contributions to conception and design, acquisition of data, and analysis and interpretation of data. All assisted in drafting the article or revising it critically for important intellectual content. They have all given final approval of the version to be published and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Thomas Abell.

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Conflict of interest

Drs. Abell, Johnson, and Rashed have certain aspects of autonomic and enteric function covered under intellectual property awarded to the University of Mississippi.

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Hassan, H., Ganguli, S., Rashed, H. et al. Autonomic and enteric function profiling can predict disordered gastric emptying in diabetic gastropathy. Med Biol Eng Comput 59, 327–332 (2021). https://doi.org/10.1007/s11517-020-02300-y

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