Small Intestinal Transit, Bacterial Growth,.pdf

Pancreas Vol. 4, No. 1, pp. 65-70 8 1989 Raven Press, Ltd., New York Small Intestinal Transit, Bacterial Growth, and Bowel Habits in Diabetes Mellitus U. Spengler, SF. Stellaard, G. Ruckdeschel, C. Scheurlen, and tW. Kruis Department of Internal Medicine II and *Department of Microbiology, Klinikum Grosshadern, University of Munich, Munich, and ?Department of Internal Medicine I , University of Cologne, Cologne, F.R.G., and f VU-Ziekenhuis, Laboratorium Kindergeneeskunde, Amsterdam, The Netherlands Summary: To investigate diabetic alterations of small intestinal transit and bacterial growth, we performed hydrogen breath tests (10 g lactulose via duo- denal tube at the ligament of Treitz), bacterial cultures, and determinations of unconjugated serum bile acids in 19 patients with long-standing diabetes and 7 healthy controls. Asymptomatic diabetics had a late rise in breath hydrogen, indicating prolonged jejunal-cecal transit (86 f 10 min, p 0.05) as an early pathogenic event. Rise in breath hydrogen in symptomatic diabetics (consti- pation: 50 f 6 min; diarrhea: 41 2 11 min) was not significantly different from controls (57 f 8 min). Bacterial studies and increased unconjugated serum bile acids suggest bacterial overgrowth in some symptomatic diabetics. Bacterial overgrowth was associated more frequently (p 0.05) with a rise in breath hydrogen before 45 min or after 75 min. Changes in the hydrogen breath test, bacterial growth, or unconjugated serum bile acids did not correlate with gas- trointestinal symptoms of diabetes. Key Words: Diabetic enteropathy- Hydrogen breath test-Small intestinal transit-Bacterial overgrowth- Unconjugated serum bile acids. Involvement of the gastrointestinal tract is a trou- blesome complication of long standing diabetes mellitus. Diarrhea or constipation may occur in as many as 20% of diabetic patients (1,2) and point to small and large bowel malfunction, which is as yet poorly understood. Abnormal int