Recto-anal manometric characteristics of type 2 diabetic patients who have sensation of incomplete defecation.

INTRODUCTION: Many diabetic patients report symptoms of incomplete defecation. We aimed to clarify the recto-anal manometric characteristics related to these symptoms. MATERIAL AND METHODS: A questionnaire regarding gastrointestinal symptoms was distributed to 35 diabetics (19 women and 16 men) aged between 39 and 81 years. Nineteen reported incomplete defecation sensation (WS) and 16 did not (NS). Recto-anal manometry was performed for all patients. Data are presented as mean±SD. RESULTS: Resting rectal pressure was 14.4±10.1 mmHg and 8.8±3.9 mmHg, p<.03; first sensation was 61.0±27.8 ml and 83.1±35.7 ml, p<.04; and maximum tolerable volume was 174.2±81.5 ml and 235.0±89.5 ml, p<.04 for WS and NS, respectively. The WS group was further divided into 2 groups according to symptom severity (less severe and very severe). Significant differences were found in resting external anal sphincter pressure (50.4±15.6 and 34.3±17.4, p<.04) and the recto anal inhibitory reflex (48.6±19.8 and 26.3±23.2, p<.03) between the less severe and very severe groups, respectively. CONCLUSIONS: (1) Resting rectal pressure was significantly higher in symptomatic individuals. (2) First sensation and maximum tolerable volume were higher in asymptomatic diabetics. (3) In diabetics with more severe symptoms, the resting external anal sphincter pressures were significantly lower. (4) The degree of relaxation in the recto-anal inhibitory reflex was significantly higher in individuals without complaints.

Esophageal body motility in people with diabetes: comparison with non-diabetic healthy individuals.

AIMS: The aim of this study was to compare esophageal motor characteristics between diabetics and healthy individuals. METHODS: Esophageal manometry was performed in 34 type 2 diabetics and 32 healthy individuals. Waves were evaluated in the 3 thirds of the esophagus (P1=upper, P2=middle, and P3=distal). RESULTS: In diabetics vs. controls, wave distribution was as follows: peristaltic waves, 83.5 ± 22.2% vs. 96.3 ± 4.4%, p<0.002; simultaneous waves, 3.26 ± 5.8% vs. 0.53 ± 1.3%, p<0.01; no transmitted waves, 10.62 ± 20.7% vs. 2.75 ± 3.0%, p<0.002; and retrograde waves, 2.68 ± 4.0% vs. 0.31 ± 1.1%, p<0.03. Wave amplitude was similar between groups. Average upstroke (mmHg/s) in diabetics vs. non-diabetics was P2, 33.8 ± 13.9 vs. 40.2 ± 17.7, p<0.03; and P3, 29.8 ± 15.3 vs. 41.3 ± 14.0, p<0.002. CONCLUSIONS: (1) Simultaneous waves, no transmitted waves, and retrograde esophageal waves were significantly more frequent in diabetics. (2) Average upstroke was significantly lower within the middle and distal esophagus of diabetic individuals. (3) Wave amplitude was similar in both groups.

Percutaneous endoscopic gastrostomy (PEG) and pulmonary function in patients with amyotrophic lateral sclerosis (ALS). / Gastrostomia endoscópica percutânea (PEG) e função pulmonar em doentes com esclerose lateral amiotrófica (ELA).

UNLABELLED: In ALS PEG tube placement attenuates malnutrition, secondary to bulbar dysphagia, and prevents other frequently fatal complications such as chocking and respiratory arrest. Respiratory insufficiency may be associated to the complications observed in this procedure. PEG tubes were placed in 26 patients (10M/16F) with dysphagia using the Gauderer technique, mild sedatives and local anaesthetics. Results are presented in absolute numbers; average; standard deviation: Age -26, 64,3±11,5; CVF% - 17, 64,5±35,6; PaCO2 - 26, 41,6±7,1; PaO2 - 26, 81,6±14,3. Four of the seventeen patients with spirometric evaluation had FVC inferior to 50%. Nine patients had chronic respiratory failure (CRF). Complications were identified in 2 patients (transient laryngeal spasm) and most likely secondary to bulbar involvement rather than pulmonary function. CONCLUSION: Our experience shows PEG to be a safe procedure even in patients with advanced disease and reduced pulmonary capacity.