Gastroparesis is associated with oxytocin deficiency, oesophageal dysmotility with hyperCCKemia, and autonomic neuropathy with hypergastrinemia

Julia Borg, Olle Melander, Linda Johansson, Kerstin Uvnäs-Moberg, Jens F Rehfeld, Bodil Ohlsson, Julia Borg, Olle Melander, Linda Johansson, Kerstin Uvnäs-Moberg, Jens F Rehfeld, Bodil Ohlsson

Abstract

Background: Gastrointestinal (GI) dysmotility and autonomic neuropathy are common problems among diabetics with largely unknown aetiology. Many peptides are involved in the autonomic nervous system regulating the GI tract. The aim of this study was to examine if concentrations of oxytocin, cholecystokinin (CCK), gastrin and vasopressin in plasma differ between diabetics with normal function and dysfunction in GI motility.

Methods: Nineteen patients with symptoms from the GI tract who had been examined with gastric emptying scintigraphy, oesophageal manometry, and deep-breathing test were included. They further received a fat-rich meal, after which blood samples were collected and plasma frozen until analysed for hormonal concentrations.

Results: There was an increase in postprandial oxytocin plasma concentration in the group with normal gastric emptying (p = 0.015) whereas subjects with delayed gastric emptying had no increased oxytocin secretion (p = 0.114). Both CCK and gastrin levels increased after the meal, with no differences between subjects with normal respective delayed gastric emptying. The concentration of vasopressin did not increase after the meal. In patients with oesophageal dysmotility the basal level of CCK tended to be higher (p = 0.051) and those with autonomic neuropathy had a higher area under the curve (AUC) of gastrin compared to normal subjects (p = 0.007).

Conclusion: Reduced postprandial secretion of oxytocin was found in patients with delayed gastric emptying, CCK secretion was increased in patients with oesophageal dysmotility, and gastrin secretion was increased in patients with autonomic neuropathy. The findings suggest that disturbed peptide secretion may be part of the pathophysiology of digestive complications in diabetics.

Figures

Figure 1
Figure 1
The plasma concentration of oxytocin (oxy) at basal conditions and peakpostprandially, in subjects with and without gastroparesis. The basal value is the mean of the two samples taken before the meal. Peak value is the highest level measured in plasma after the meal. Median [IQR]. Wilcoxon signed test. There was no difference in basal or peak values between the groups, Mann-Whitney U-test.
Figure 2
Figure 2
The fluctuations of the mean oxytocin concentration in plasma postprandial, in subjects with and without gastroparesis. GP = gastroparesis, n = 10, no gastroparesis, n = 9. There was no statistical significant difference between the groups. Mann Whitney U-test.
Figure 3
Figure 3
The plasma concentration of cholecystokinin (CCK) at basal conditions and peakpostprandially, in subjects with and without gastroparesis. The basal value is the mean of the two samples taken before the meal. Peak value is the highest level measured in plasma after the meal. Median [IQR]. Wilcoxon signed test. There was no difference in basal or peak values between the groups, Mann-Whitney U-test.
Figure 4
Figure 4
The plasma concentration of gastrin at basal conditions and postprandially, in subjects with and without gastroparesis. The basal value is the mean of the two samples taken before the meal. Peak value is the highest level measured in plasma after the meal. Median [IQR]. Wilcoxon signed test. There was no difference in basal or peak values between the groups, Mann-Whitney U-test.
Figure 5
Figure 5
The plasma concentration of cholecystokinin (CCK) at basal conditions, in subjects with and without oesophageal dysmotility (EDM). The basal value is the mean of the two samples taken before the meal. Median [IQR]. Mann Whitney U test.
Figure 6
Figure 6
Area under curve (AUC) of plasma gastrin concentration in subjects with and without autonomic neuropathy. Median [IQR]. Mann Whitney U test.

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