Gut sensations in diabetic autonomic neuropathy

Abstract

The pathogenesis of gastrointestinal symptoms in diabetes mellitus is complex and multi-factorial. Diabetes induced peripheral and central changes in the neuronal pain matrix may be of importance and were explored using a new multi-modal and multi-segmental sensory testing approach. The sensitivity to mechanical, thermal and electrical stimulations in the oesophagus and duodenum was assessed in 12 type-1 diabetic patients with proven autonomic neuropathy and severe gastrointestinal symptoms using a comprehensive stimulation device aiming to activate different gut nerves and pain mechanisms. Twelve healthy subjects served as controls. The sensory response and the somatic referred pain areas were recorded. In the diabetic patients an overall hyposensitivity to the combination of all stimulations was found in the oesophagus and duodenum (P=0.02). Post hoc analysis revealed hyposensitivity to mechanical stimulations in the oesophagus (P=0.006) and duodenum (P=0.002), and to thermal (P<0.001) and electrical (P=0.005) stimulations in the oesophagus and duodenum combined. The hyposensitivity in the gut was accompanied by a 46% increase in the somatic referred pain areas (P=0.04) indicating central neuronal changes. The multi-modal and multi-segmental sensory testing approach indicates that the sensory nerves are widely affected in the GI tract and generalized to nerves in all layers of the gut. Changes in the neuronal pain matrix including interactions between peripheral and central pain mechanisms may be involved in the pathogenesis of gastrointestinal symptoms in long-standing diabetes. Future targets in the treatment of gastrointestinal symptoms in diabetic patients with autonomic neuropathy could be based on modulation of the central nervous system excitability.

Biomechanical and Histomorphometric Colon Remodelling in STZ-Induced Diabetic Rats

“…Consequently, the perception and motility of the colon will change as well. However, so far, the data are sparse regarding the association between the morphologic and biomechanical remodelling of the GI tract and sensorymotor dysfunction in diabetes [8,39,40]. Combining studies of the colon sensory-motor dysfunction and morphologic and biomechanical remodelling related to diabetes will improve the understanding about the pathophysiology of colon disorders in diabetic patients.…”

Esophageal function worsens with long duration of diabetes

“…[33][34][35][36] Patients with diabetes frequently have neuropathy without any symptoms because the efferent and afferent nerves have been damaged simultaneously. 37,38 Consequently, an exact evaluation of esophageal dysfunction on the basis of symptoms may be diffi cult in patients with diabetes. 4,39 Typical refl ux symptoms may be vague in diabetic patients.…”

Dysfunction of the lower gastrointestinal tract as a complication of diabetes — a problematic issue in the diabetic care

“…The symptoms of diabetes complications in respect to lower gastrointestinal tract are taking the form of diarrhea, constipation or anorectal disorders occur fairly often in patients with diabetes [26,27]; according to various sources from 60% [3] and up to 76% [28] of patients. These symptoms significantly decrease the patients' quality of life [26].…”

“…These symptoms significantly decrease the patients' quality of life [26]. Despite being a common occurrence in patients awareness of gastrointestinal disorders among doctors remains to be low [29].…”