Regional gastrointestinal pH profile is altered in patients with type 1 diabetes and peripheral neuropathy

• Published in: Neurogastroenterology and motility Vol. 30; no. 11; pp. e13407 - n/a
• Main Authors: Wegeberg, A.‐M. L., Brock, C., Brock, B., Farmer, A. D., Hobson, A. R., Semler, J. R., Scott, S. M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.11.2018
• Subjects: Autonomic nervous system; Bioavailability; Diabetes; diabetes autonomic neuropathy; Diabetes mellitus; Diabetes mellitus (insulin dependent); enteric nervous system; gastrointestinal tract; Heart rate; Insulin; Nausea; Peripheral neuropathy; pH effects; pharmacotherapeutic; Small intestine; wireless motility capsule; pH; gastrointestinal tract; pharmacotherapeutic; enteric nervous system; diabetes autonomic neuropathy; wireless motility capsule
• ISSN: 1350-1925; 1365-2982; 1365-2982
• DOI: 10.1111/nmo.13407

Background Gastrointestinal (GI) symptoms, such as nausea and bloating, are common in people with type 1 diabetes (T1DM). Autonomic dysfunction can lead to changes in the GI secreto‐motor function which can be associated with GI symptom development. We hypothesized that regional pH profiles in T1DM differs from health and would be associated with objective physiological/clinical markers. Methods Forty‐seven T1DM with confirmed diabetic sensory peripheral neuropathy and 41 healthy age‐matched subjects underwent standardized wireless motility capsule testing. T1DM completed the gastroparesis cardinal symptom index (GCSI) and the gastrointestinal symptom rating scale. Disease duration, glycemic control, insulin usage, and 24‐hour heart rate variability testing were evaluated. Key Results In comparison to healthy subjects, gastric, and large bowel median pH were lower in T1DM (1.8 ± 1.6 vs 2.9 ± 1.5, P = 0.001 and 6.7 ± 0.6 vs 7.0 ± 0.5, P = 0.003, respectively). Additionally, change in pH across the pylorus was lower while change in pH across the ileocecal junction was higher in T1DM (5.2 ± 1.5 vs 5.8 ± 0.5, P = 0.003 and 1.8 ± 0.4 vs 1.3 ± 0.4, P < 0.0001, respectively). No difference was found in small bowel median pH. Gastric median pH was associated with small bowel transit time (r = 0.30, P = 0.049). Change in pH across the pylorus was negatively associated with fasting glycose (r = −0.35, P = 0.027). Small bowel median pH was associated with nausea (r = 0.42, P = 0.005) and small bowel transit time (r = 0.48, P = 0.0007). Large bowel median pH was associated with nausea (r = 0.35, P = 0.018) and the total GCSI score (r = 0.34, P = 0.023). Conclusions and Inferences The GI pH profile in T1DM with DSPN is different from healthy subjects. Changes in pH profile may have important therapeutic implications and influence pharmacotherapeutic bioavailability. Forty‐seven people with type 1 diabetes and confirmed diabetic sensory peripheral neuropathy and 41 healthy age‐matched subjects underwent standardized wireless motility capsule testing showing lower gastric and large bowel median pH in patients than in healthy.