Relationship between esophageal motility and transit in patients with type I diabetes mellitus

Objectives: Delayed esophageal transit and abnormal esophageal motility occur frequently in patients with long-standing diabetes mellitus. However, the relationship between transit and motility has not been assessed directly. The aim of this study was to investigate the patterns of esophageal motor function documented previously to have delayed esophageal emptying and esophageal transit in patients with insulin-dependent diabetes mellitus. Methods: Concurrent esophageal manometry and radionuclide measurement of transit of liquids and solids were performed in 11 patients with insulin-dependent diabetes, 10 age-matched controls, and 11 young normal subjects. Results: Patients with diabetes had a greater frequency of transit hold-up for solids (96%) than did older controls (65%) or young normals (42%) (p < 0.001), whereas the frequency of transit hold-up for liquid boluses was similar among the three groups (diabetics, 36%; older normals, 17%; young normals, 17%). The major mechanism responsible for bolus hold-up in diabetics was peristaltic failure (liquid, 52%; solid, 67%) and the level of hold-up coincided with the level of bolus hold-up for 10/11 liquid and 27/28 solid boluses. Conclusions: In insulin-dependent diabetes, retarded esophageal transit usually reflects either peristaltic failure or focal low-amplitude pressure waves.