Morphological comparison of small nerve fibres in gastric mucosa in non‐diabetic and Type 2 diabetic subjects

Jin, Heung Yong; Kang, Yu-hua; Kim, C. Y.; Kim, S. H.; Liu, W. J.; Piao, Ming Han; Park, J. H.; Baek, Hong Sun; Park, T. S.

doi:10.1111/j.1464-5491.2009.02787.x

Cited by 8 publications

(7 citation statements)

References 10 publications

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“…An overall hyposensitivity due to visceral neuropathy, altered central processing to visceral stimulation, and frequent antiplatelet use in diabetic patients has been suggested (5,28,29). Recent studies further demonstrated a reduced density and abnormal morphology of gastric mucosal nerve fibers in both type 1 and type 2 diabetic subjects (30,31). As chronic GERD is associated with the development of Barrett's esophagus and esophageal adenocarcinoma, untreated peptic ulcers due to unawareness may be complicated by GI hemorrhage or perforation (32) and further increase mortality (33).…”

Section: Discussionmentioning

confidence: 98%

Association of Diabetes and HbA1c Levels With Gastrointestinal Manifestations

et al. 2012

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OBJECTIVETo determine the prevalence of gastrointestinal (GI) manifestations associated with diabetes mellitus (DM) in a Taiwanese population undergoing bidirectional endoscopies.RESEARCH DESIGN AND METHODSSubjects voluntarily undergoing upper endoscopy/colonoscopy as part of a medical examination at the National Taiwan University Hospital were recruited during 2009. Diagnosis of DM included past history of DM, fasting plasma glucose ≥126 mg/dL, or glycated hemoglobin (HbA1c) ≥6.5%. Comparisons were made between diabetic and nondiabetic subjects, subjects with lower and higher HbA1c levels, and diabetic subjects with and without complications, respectively, for their GI symptoms, noninvasive GI testing results, and endoscopic findings.RESULTSAmong 7,770 study subjects, 722 (9.3%) were diagnosed with DM. The overall prevalence of GI symptoms was lower in DM subjects (30.3 vs. 35.4%, P = 0.006). In contrast, the prevalence of erosive esophagitis (34.3 vs. 28.6%, P = 0.002), Barrett's esophagus (0.6 vs. 0.1%, P = 0.001), peptic ulcer disease (14.8 vs. 8.5%, P < 0.001), gastric neoplasms (1.8 vs. 0.7%, P = 0.003), and colonic neoplasms (26.6 vs. 16.5%, P < 0.001) was higher in diabetic subjects. Diagnostic accuracy of immunochemical fecal occult blood test for colonic neoplasms was significantly decreased in DM (70.7 vs. 81.7%, P < 0.001). Higher HbA1c levels were associated with a decrease of GI symptoms and an increase of endoscopic abnormalities. Diabetic subjects with complications had a higher prevalence of colonic neoplasms (39.2 vs. 24.5%, P = 0.002) than those without.CONCLUSIONSDM and higher levels of HbA1c were associated with lower prevalence of GI symptoms but higher prevalence of endoscopic abnormalities.

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Section: Discussionmentioning

confidence: 98%

Association of Diabetes and HbA1c Levels With Gastrointestinal Manifestations

et al. 2012

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“…In addition to postural balance, lower-limb muscle strength is closely correlated with fall risk (Jin et al 2009). The lower limb muscles influence postural balance, and reductions in lower-limb muscle strength hinder the maintenance of correct posture and increase fall risk (Persch et al 2009).…”

Section: Discussionmentioning

confidence: 99%

Whole-Body Vibration Training Improves Balance, Muscle Strength and Glycosylated Hemoglobin in Elderly Patients with Diabetic Neuropathy

Lee

Song

2013

Tohoku J. Exp. Med.

100

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Elderly patients with diabetes and peripheral neuropathy are more likely to experience falls. However, the information available on how such falls can be prevented is scarce. We investigated the effects of wholebody vibration (WBV) combined with a balance exercise program on balance, muscle strength, and glycosylated hemoglobin (HbA1c) in elderly patients with diabetic peripheral neuropathy. Fifty-five elderly patients with diabetic neuropathy were randomly assigned to WBV with balance exercise group, balance exercise (BE) group, and control group. The WBV and BE groups performed the balance exercise program for 60 min per day, 2 times per week, for 6 weeks. Further, the WBV group performed WBV training (up to 3 × 3 min, 3 times per week, for 6 weeks). The control group did not participate in any training. The main outcome measures were assessed at baseline and after 6 weeks of training; namely, we assessed the postural sway and one leg stance (OLS) for static balance; Berg balance scale (BBS), timed up-and-go (TUG) test, and functional reach test (FRT) for dynamic balance; five-times-sit-to-stand (FTSTS) test for muscle strength; and HbA1c for predicting the progression of diabetes. Significant improvements were noted in the static balance, dynamic balance, muscle strength, and HbA1c in the WBV group, compared to the BE and control groups (P < 0.05). Thus, in combination with the balance exercise program, the shortterm WBV therapy is beneficial in improving balance, muscle strength and HbA1c, in elderly patients with diabetic neuropathy who are at high risk for suffering falls.

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“…Due to the small caliber of sensory nerve fibers, quantitative assessments of gastric mucosal innervation have been a challenge. Thus, there have been only limited reports that are focused on asymptomatic or patients with type 1 diabetes [18,19]. This report focused on type 2 diabetes, the most prevalent form, and applied comprehensive and multidimensional assessments: pathology (gastric mucosal innervation), and functional (gastric emptying time), and clinical symptomatology (validated gastroparesis questionnaire).…”

Section: Discussionmentioning

confidence: 99%

Diabetic visceral neuropathy of gastroparesis: Gastric mucosal innervation and clinical significance

Tseng

Chao

Cheng

et al. 2022

Euro J of Neurology

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Background and purpose The pathogenesis of diabetic gastroparesis due to visceral neuropathy involves multidimensional mechanisms with limited exploration of gastric mucosal innervation. This study aimed to examine quantitatively this topic and its relationship with gastroparesis symptoms and gastric emptying in diabetes. Methods We prospectively enrolled 22 patients with type 2 diabetes and gastroparesis symptoms and 25 age‐ and gender‐matched healthy controls for comparison. The assessments included: (i) neuropathology with quantification of gastric mucosal innervation density (MID) on endoscopic biopsy; (ii) clinical manifestations based on the Gastroparesis Cardinal Symptom Index (GCSI) questionnaire; and (iii) functional tests of gastric emptying scintigraphy (GES). Results In patients with diabetes, stomach fullness, bloating and feeling excessively full after meals constituted the most common GCSI symptoms. Seven patients with diabetes (32%) had prolonged gastric emptying patterns. In diabetes, gastric MID was significantly lower in all the regions examined compared with the controls: antrum (294.8 ± 237.0 vs. 644.0 ± 222.0 mm/mm3; p < 0.001), body (292.2 ± 239.0 vs. 652.6 ± 260.9 mm/mm3; p < 0.001), and fundus (238.0 ± 109.1 vs. 657.2 ± 332.8 mm/mm3; p < 0.001). Gastric MID was negatively correlated with gastroparesis symptoms and total scores on the GCSI (p < 0.001). Furthermore, gastric MID in the fundus was negatively correlated with fasting glucose and glycated hemoglobin levels. Gastric emptying variables, including half emptying time and gastric retention, were prolonged in patients with diabetes, and gastric retention at 3 h was correlated with fasting glucose level. Conclusion In diabetes, gastric MID was reduced and GES parameters were prolonged. Both were correlated with gastroparesis symptoms and glycemic control. These findings provide pathology and functional biomarkers for diabetic visceral neuropathy of gastroparesis and underlying pathophysiology.

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Morphological comparison of small nerve fibres in gastric mucosa in non‐diabetic and Type 2 diabetic subjects

Abstract: This study sets the scene for further research to investigate the relationship between gastric mucosal nerves and autonomic neuropathy or diabetic peripheral neuropathy.

Cited by 8 publications

References 10 publications

Association of Diabetes and HbA1c Levels With Gastrointestinal Manifestations

Association of Diabetes and HbA1c Levels With Gastrointestinal Manifestations

Whole-Body Vibration Training Improves Balance, Muscle Strength and Glycosylated Hemoglobin in Elderly Patients with Diabetic Neuropathy

Diabetic visceral neuropathy of gastroparesis: Gastric mucosal innervation and clinical significance

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