Gastric meal accommodation and symptoms in diabetes. A placebo-controlled study of glyceryl trinitrate

Eur J Gastroenterol Hepatol. 1998 Aug;10(8):677-81.


Objective: To study mechanisms behind postprandial symptoms in patients with diabetes mellitus and the effect of nitric oxide (NO) on gastric accommodation and symptoms in these patients.

Design: A double-blind, placebo-controlled, randomized trial was designed in 20 patients with type 1 diabetes (10 male and 10 female, aged 35.3 +/- 7.6 years).

Methods: 0.5 mg sublingual glyceryl trinitrate (GTN), a donor of exogenous NO, or placebo was administered 5 min prior to a 500 ml soup meal. Gastric accommodation of the meal was assessed by abdominal ultrasound. Accommodation in proximal stomach was visualized in a sagittal area (Psa) and a frontal diameter (Pfd) and accommodation in distal stomach was visualized in a sagittal area of the antrum (Asa). Symptoms were assessed using visual analogue scales.

Results: Psa correlated significantly (r = 0.57, P = 0.015) with perception of fullness 5 min after the meal, whereas Pfd correlated significantly (r = 0.67, P = 0.004) with nausea at 15 and at 25 min after the meal. Asa correlated (r = 0.50, P = 0.05) with pain at 5 min, 10 min (r = 0.50, P = 0.05) and 25 min (r = 0.68, P = 0.007). GTN had no significant effect on Psa or Pfd, but reduced significantly (P = 0.05) Asa (1 3.5 +/- 4.5 cm2 with GTN vs 16.1 +/- 4.3 cm2 with placebo). GTN increased significantly (P = 0.04) the intragastric proximal/distal meal distribution ratio (proximal/distal sagittal area), but had no significant effect on symptom scores.

Conclusion: In patients with diabetes, a large proximal stomach is associated with perception of fullness and a large antrum is associated with perception of pain after a meal. Sublingual administration of GTN prior to the meal decreases the antral area and improves the intragastric meal distribution, but fails to improve symptoms.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cross-Over Studies
  • Diabetes Mellitus, Type 1 / physiopathology*
  • Double-Blind Method
  • Female
  • Gastrointestinal Motility* / drug effects
  • Gastrointestinal Motility* / physiology
  • Humans
  • Male
  • Nitroglycerin / pharmacology
  • Pain Measurement
  • Postprandial Period* / drug effects
  • Postprandial Period* / physiology
  • Vasodilator Agents / pharmacology


  • Vasodilator Agents
  • Nitroglycerin