Diabetic gastroenteropathy examined with wireless motility capsule

Background Diabetic gastroenteropathy may affect all parts of the gastrointestinal tract. Despite being prevalent, knowledge is limited and treatment often generalised and unsatisfactory. To deliver personalised treatment, there is a need for improved diagnostics. In this study, we have investigated the role of the wireless motility capsule in the evaluation of gastroparesis, diarrhoea, and constipation, the three main manifestations of diabetic gastroenteropathy. Methods We included 72 diabetes patients (49 women; 59 type 1 diabetes) with gastrointestinal symptoms. They were investigated with blood, urinary and faecal samples, questionnaires, autonomic function tests, and gastrointestinal motility and function tests, including wireless motility capsule and gastric emptying scintigraphy. During fasting and examinations, patients were kept on intravenous glucose-insulin infusion. We also investigated 26 healthy participants using wireless motility capsule. Results In paper 1, we found that the wireless motility capsule had high diagnostic accuracy compared to scintigraphy for determining gastric emptying. In paper 2, we found that patients with diarrhoea had increased gastric emptying time, reduced colonic transit time, and altered gastrointestinal pH levels. In paper 3, we found no difference in transit times when comparing diabetes patients with and without constipation, but both diabetes groups had slower whole gut transit than healthy controls. Conclusions The wireless motility capsule may have a role in the investigation of patients with suspected diabetic gastroenteropathy. It has high diagnostic accuracy for measuring gastric emptying and may identify clinically relevant alterations in gastrointestinal transit and pH levels. We recommend further validation of the capsule’s pH and contractility measurements before they are used in routine examinations