Horm Metab Res 2013; 45(01): 47-53
DOI: 10.1055/s-0032-1323689
Humans, Clinical
© Georg Thieme Verlag KG Stuttgart · New York

Gastric Dysmotility and Low Serum Vitamin D Levels in Patients with Gastroparesis

A. Kedar
1   Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
Y. Nikitina
1   Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
O. R. Henry
1   Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
K. B. Abell
1   Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
V. Vedanarayanan
2   Departments of Pediatrics and Neurology, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
M. E. Griswold
4   Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
C. Subramony
3   Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi, USA
,
T. L. Abell
1   Division of Digestive Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
› Author Affiliations
Further Information

Publication History

received 09 February 2012

accepted 24 July 2012

Publication Date:
06 September 2012 (online)

Abstract

Nutritional abnormalities are common in patients with gastroparesis (Gp), a disorder that may affect gastric motility and may delay emptying. The aim of this work was to identify relationships between serum nutrition markers including 25-OH vitamin D and gastric motility measures in Gp patients. We enrolled 59 consecutive gastric motility clinic patients (48 females, 11 males; mean age 44 years; 42 idiopathic; 17 diabetes mellitus) with Gp symptoms. The 25-OH vitamin D levels, for most patients slightly above the lower limit of normal (96.98 nmol/l±60.99), were lowest in diabetic range (DM) (75.68 nmol/l±34.22) vs. idiopathic (ID) (105.03 nmol/l±67.08) gastroparesis patients. First hour GET: one unit increase in 25-OH vitamin D level was associated 0.11% improvement (95% CI  − 0.22, 0.01 p=0.056) in gastric motility in all patients; this association, although marked in ID Gp patients, ( − 0.13, CI  − 0.25,  − 0.01 p=0.034), was not seen in DM Gp, (0.2, CI  − 0.45, 0.87, p=0.525). Fourth hour GET: Every unit increase of 25-OH vitamin D was associated with significant improvement in all patients, ( 0.11% CI  − 0.23, 0.01, p=0.053), and some weak improvement in ID group, (0.11%  − 0.24, 0.01, p=0.076) and absent in patients with DM (0.03, CI  − 0.66, 0.72, p=0.932). It is concluded that 25-OH vitamin D levels may influence gastric emptying. Underlying mechanisms for this observation might include the impact of 25-OH vitamin D on the health of the enteric nervous system. 25-OH vitamin D contributions to enteric nerve functions should be explored, particularly where autonomic nervous system comorbidities exist.

 
  • References

  • 1 Creel WB, Abell TL, Lobrano A, Deitcher SR, Dugdale M, Smalley D, Johnson WD. To clot or not to clot: are there predictors of clinically significant thrombus formation in patients with gastroparesis and prolonged IV access?. Dig Dis Sci 2008; 53: 1532-1536
  • 2 Jung HK, Choung RS, Locke 3rd GR, Schleck CD, Zinsmeister AR, Szarka LA, Mullan B, Talley NJ. The incidence, prevalence, and outcomes of patients with gastroparesis in. Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology 2009; 136: 1225-1233
  • 3 Nilsson PH. Diabetic gastroparesis: a review. J Diabetes Complications 1996; 10: 113-122
  • 4 Cherian D, Sachdeva P, Fisher RS, Parkman HP. Abdominal pain is a frequent symptom of gastroparesis. Clin Gastroenterol Hepatol 2010; 8: 676-681
  • 5 Parkman HP, Yates KP, Hasler WL, Nguyan L, Pasricha PJ, Snape WJ, Farrugia G, Calles J, Koch KL, Abell TL, McCallum RW, Petito D, Parrish CR, Duffy F, Lee L, Unalp-Arida A, Tonascia J, Hamilton F. NIDDK Gastroparesis Clinical Research Consortium . Dietary intake and nutritional deficiencies in patients with diabetic or idiopathic gastroparesis. Gastroenterology 2011; 141: 486-498
  • 6 Aggarwal A, Cutts TF, Abell TL, Cardoso S, Familoni B, Bremer J, Karas J. Predominant symptoms in irritable bowel syndrome correlate with specific autonomic nervous system abnormalities. Gastroenterology 1994; 106: 945-950
  • 7 Reusch J, Ackermann H, Badenhoop K. Cyclic changes of vitamin D and PTH are primarily regulated by solar radiation: 5-year analysis of a German (50 degrees (N) population. Horm Metab Res 2009; 41: 402-407
  • 8 Cantorna MT, Zhao J, Yang L. Vitamin D, invariant natural killer T-cells and experimental autoimmune disease. Proc Nutr Soc 2012; 71: 62-66
  • 9 Ullah MI, Uwaifo GI, Nicholas WC, Koch CA. Does vitamin d deficiency cause hypertension? Current evidence from clinical studies and potential mechanisms. Int J Endocrinol 2010; 2010: 579640
  • 10 Elsammak MY, Al-Wosaibi AA, Al-Howeish A, Alsaeed J. Vitamin D deficiency in Saudi Arabs. Horm Metab Res 2010; 42: 364-368
  • 11 Perusicová J. Gastrointestinal complications in diabetes mellitus. Vnitr Lék 2004; 50: 338-343
  • 12 Fraser RJ, Horowitz M, Maddox AF, Harding PE, Chatterton BE, Dent J. Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1990; 33: 675-680
  • 13 Reddy S, Ramsubeik K, Vega KJ, Federico J, Palacio C. Do HbA1C Levels correlate with delayed gastric emptying in diabetic patients?. J Neurogastroenterol Motil 2010; 16: 414-417
  • 14 Koch CA, Uwaifo GI. Are gastrointestinal symptoms related to diabetes mellitus and glycemic control?. Eur J Gastroenterol Hepatol 2008; 20: 822-825
  • 15 Søfteland E, Dimcevski G, Graversen C, Nedrebø BG, Drewes AM, Frøkjær JB. Effects of isolated hyperinsulinaemia on sensory function in healthy adults. Exp Clin Endocrinol Diabetes 2011; 119: 604-609
  • 16 Daram SR, Tang SJ, Abell TL. Video: temporary gastric electrical stimulation for gastroparesis: endoscopic placement of electrodes (ENDOstim). Surg Endosc 2011; 25: 3444-3445
  • 17 Yong QW, Chan SP, Cheng A. Homocysteine, folate and vitamin B12 as risk factors for acute myocardial infarction in a Southeast Asian population. Ann Acad Med Singapore 2002; 31: 636-640
  • 18 Kleine TO, Merten B. Rapid manual immunoturbidimetric and immunonephelometric assays of prealbumin, albumin, IgG, IgA and IgM in cerebrospinal fluid. J Clin Chem Biochem 1980; 18: 245-254
  • 19 Gibson RB, Carr TL, Green S, Fowler WM. Photometric assay of plasma heparin. Proc Soc Exp Biol Med 1952; 79: 577-580
  • 20 Hatcher DW, Anderson NG. GeMSAEC: a new analytic tool for clinical chemistry total serum protein with the biuret reaction. Am J Clin Pathol 1969; 52: 645-651
  • 21 Brown CR, Higgins KW, Frazer K, Schoelz LK, Dyminski JW, Marinkovich VA, Miller SP, Burd JF. Simultaneous determination of total IgE and allergen-specific IgE in serum by the MAST chemiluminescent assay system. Clin Chem 1985; 31: 1500-1505
  • 22 Midttun O, Hustad S, Solheim E, Schneede J, Ueland PM. Multianalyte quantification of vitamin B6 and B2 species in the nanomolar range in human plasma by liquid chromatography-tandem mass spectrometry. Clin Chem 2005; 51: 1206-1216
  • 23 Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape Jr WJ, Ziessman HA. American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine . Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol 2008; 36: 44-54
  • 24 Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J, Hocking MP, Quigley EM, Koch KL, Tokayer AZ, Stanghellini V, Chen Y, Huizinga JD, Rydén J, Bourgeois I, McCallum RW. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 2000; 95: 1456-1462
  • 25 Hastie TJ, Tibshirani RJ In: Smoothing. Generalized Additive Models. Cox DR, Hinkley DV, Rubin D, Silverman BW. (eds.). New York: Chapman and Hall; 1990: 9-38
  • 26 Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape Jr WJ, Ziessman HA. American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine . Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol 2008; 36: 44-54
  • 27 Earthman CP, Beckman LM, Masodkar K, Sibley SD. The link between obesity and low circulating 25-hydroxyvitamin D concentrations: considerations and implications. Int J Obes (Lond) 2012; 36: 387-396
  • 28 Drincic AT, Armas LA, Van Diest EE, Heaney RP. Volumetric dilution, rather than sequestration best explains the low vitamin D status of obesity. Obesity (Silver Spring) 2012; 20: 1444-1448
  • 29 Kaline K, Bornstein SR, Bergmann A, Hauner H, Schwarz PE. The importance and effect of dietary fiber in diabetes prevention with particular consideration of whole grain products. Horm Metab Res 2007; 39: 687-693
  • 30 Devaraj S, Jialal G, Cook T, Siegel D, Jialal I. Low vitamin D levels in Northern American adults with the metabolic syndrome. Horm Metab Res 2011; 43: 72-74
  • 31 Kedar A, Vedanarayanan V, Subramony C, Lahr CJ, Sunesara I, Griswold ME, Marshall GD, Abell TL. Quantification of Inflammation in the Enteric Plexus: Differences in Patients With Gastroparesis Who Have Acute vs. Non-Acute Symptom Onset. Gastroenterology 2011; Sa2032.373
  • 32 Karam C, Scelsa SN. Can vitamin D delay the progression of ALS?. Med Hypotheses 2011; 76: 643-645
  • 33 Mason RS. Vitamin D: a hormone for all seasons. Climacteric 2011; 14: 197-203
  • 34 Reichrath J, Lehmann B, Carlberg C, Varani J, Zouboulis CC. Vitamins as hormones. Horm Metab Res 2007; 39: 71-84
  • 35 Knekt P, Laaksonen M, Mattila C, Härkänen T, Marniemi J, Heliövaara M, Rissanen H, Montonen J, Reunanen A. Serum vitamin D and subsequent occurrence of type 2 diabetes. Epidemiology 2008; 19: 666-671
  • 36 Blanton D, Han Z, Bierschenk L, Linga-Reddy MV, Wang H, Clare-Salzler M, Haller M, Schatz D, Myhr C, She JX, Wasserfall C, Atkinson M. Reduced serum vitamin D-binding protein levels are associated with type 1 diabetes. Diabetes 2011; 60: 2566-2570
  • 37 Yang DT, Cook RJ. Spurious elevations of vitamin B12 with pernicious anemia. N Engl J Med 2012; 366: 1742-1743
  • 38 Bossé Y, Maghni K, Hudson TJ. 1alpha,25-dihydroxy-vitamin D3 stimulation of bronchial smooth muscle cells induces autocrine, contractility, and remodeling processes. Physiol Genomics 2007; 29: 161-168
  • 39 Morelli A, Squecco R, Failli P, Filippi S, Vignozzi L, Chavalmane AK, Fibbi B, Mancina R, Luciani G, Gacci M, Colli E, Francini F, Adorini L, Maggi M. The vitamin D receptor agonist elocalcitol upregulates L-type calcium channel activity in human and rat bladder. Am J Physiol Cell Physiol 2008; 294: C1206-C1214
  • 40 Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging 2006; 10: 377-385