Diabetic gastroparesis from autonomic neuropathy: surgical considerations and changes in vagus nerve morphology.

Guy, Rebecca; Dawson, J. L.; Garrett, J. R.; Laws, J. W.; Thomas, P. K.; Sharma, Ajay; Watkins, P J

doi:10.1136/jnnp.47.7.686

Cited by 98 publications

(53 citation statements)

References 13 publications

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“…Plasma gastrin concentrations were also increased in dogs after vagotomy [29]. Studies have shown that there was a significant difference in gastrin plasma concentrations before and after vagotomy [30][31][32].…”

Section: Discussionmentioning

confidence: 95%

Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients

Migdalis

Thomaides

Chairopoulos

et al. 2001

Clinical Autonomic Research

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The authors investigated the effect of a balanced meal on gastric emptying rate and gastrin plasma concentrations in patients with type II diabetes and autonomic neuropathy, in diabetic patients without autonomic neuropathy, and in healthy subjects (controls). Before food the gastrin plasma concentrations were higher in patients with diabetes with autonomic neuropathy. After food, gastric emptying rate was slower in patients with diabetes with autonomic neuropathy, whereas gastrin plasma concentrations increased in 30 minutes in all groups but to a greater extent in patients with diabetes with autonomic neuropathy. Sixty minutes after food, there was a significant decrease in gastrin plasma concentrations in patients with diabetes with autonomic neuropathy, compared with the other two groups. These data suggest that in patients with type II diabetes with autonomic neuropathy, food causes slower gastric emptying and different plasma gastrin level responses from those in patients with type II diabetes without autonomic neuropathy and controls. There are therefore differences in the responses to food ingestion between these groups because of vagal denervation induced by autonomic neuropathy. These tests should be reserved for patients with symptoms suggestive of disturbed gastric emptying, or for patients with autonomic neuropathy without symptoms of gastroparesis.

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Section: Discussionmentioning

confidence: 95%

Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients

Migdalis

Thomaides

Chairopoulos

et al. 2001

Clinical Autonomic Research

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“…Feldman et al found a reduced gastric acid response to sham feeding in diabetic patients, suggesting vagal neuropathy [3]. Pathologic specimens, when obtained, have shown evidence of vagal degeneration [19]. In this study, we used the pancreatic polypeptide response in response to sham feeding as a measure of vagal efferent function [4,20].…”

Section: Discussionmentioning

confidence: 99%

Abnormal Ghrelin and Pancreatic Polypeptide Responses in Gastroparesis

et al. 2006

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Vagal nerve dysfunction has been implicated in the pathogenesis of diabetic gastroparesis, but its role in idiopathic gastroparesis remains uncertain. The increase in pancreatic polypeptide with sham feeding is often used as a measure of vagal integrity. Ghrelin has been suggested to function as an appetite-stimulating hormone from the gut to the brain acting through vagal afferent pathways. Systemic ghrelin also rises in part due to vagal efferent pathways. Alterations in ghrelin and its effects on appetite could play a role in gastroparesis. In this study we aimed [1] to investigate the presence of vagal nerve dysfunction in patients with idiopathic and diabetic gastroparesis and [2] to determine if alterations in ghrelin concentrations occur in gastroparesis. Normal subjects and patients with diabetic, idiopathic, or postsurgical gastroparesis underwent a sham feeding protocol. Serial blood samples were obtained for plasma ghrelin and pancreatic polypeptide. Sham feeding was characterized by an increase in pancreatic polypeptide and ghrelin in normal controls and patients with idiopathic gastroparesis. The changes in pancreatic polypeptide and ghrelin levels in diabetic and postsurgical gastroparesis were significantly less than those in normal subjects. Vagal nerve dysfunction, as evidenced by an impaired pancreatic polypeptide response with sham feeding, is present in diabetic gastroparesis but not idiopathic gastroparesis. Systemic ghrelin concentrations increased with sham feeding in normal subjects and patients with idiopathic gastroparesis but not in diabetic or postsurgical gastroparesis. Vagal function and regulation of ghrelin levels are impaired in diabetic gastroparesis.

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“…However, there is a relatively poor correlation between gastric emptying and cardiovascular autonomic nerve dysfunction [7,8]. In animal models of diabetes, the neural innervation and neuropeptide content of the gastrointestinal tract is abnormal [41] and in preliminary human studies a decrease in the density of unmyelinated axons in the abdominal vagus was observed [42]. However, a more detailed study found no abnormalities in the gastric wall, or abdominal vagus in patients with diabetic gastroparesis [43].…”

Section: Pathogenesis -Impact Of Blood Glucose Concentrationmentioning

confidence: 99%

Disordered gastric motor function in diabetes mellitus

Horowitz

Fraser

1994

Diabetologia

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SummaryThe application of novel investigative techniques has demonstrated that disordered gastric motility occurs frequently in diabetes mellitus. Gastric emptying is abnormal in about 50 % of diabetic patients and delay in gastric emptying of nutrient-containing meals is more common than rapid emptying. The blood glucose concentration influences gastric motility in diabetes. In IDDM patients, gastric emptying is retarded during hyperglycaemia and may be accelerated by hypoglycaemia. Gastroparesis therefore does not necessarily reflect irreversible autonomic neuropathy and blood glucose concentrations must be monitored when gastric motility is evaluated in diabetic patients. There is a poor relationship between gastric emptying and gastrointestinal symptoms and the mechanisms by which abnormal motility causes symptoms are unclear. The introduction of new gastrokinetic drugs has improved therapeutic options for the management of symptomatic patients with gastroparesis considerably. The contribution of disordered gastric emptying to poor glycaemic control is unclear, but the demonstration that the rate of gastric emptying is a major factor in normal blood glucose homeostasis suggests that this is likely to be significant. [Diabetologia (1994) 37: 543-551]

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Diabetic gastroparesis from autonomic neuropathy: surgical considerations and changes in vagus nerve morphology.

Cited by 98 publications

References 13 publications

Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients

Changes of gastric emptying rate and gastrin levels are early indicators of autonomic neuropathy in type II diabetic patients

Abnormal Ghrelin and Pancreatic Polypeptide Responses in Gastroparesis

Disordered gastric motor function in diabetes mellitus

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