Rectal Sensitivity in Diabetes Patients with Symptoms of Gastroparesis

Abstract

In a clinical setting, diabetic autonomic complications (cardiac, gastrointestinal, urogenital, etc.) are often handled as separate entities. We investigated rectal sensitivity to heat, mechanical distension, and electrical stimulations in 20 patients with diabetes and symptoms of gastroparesis, to evaluate the extent of visceral neuronal damage. Furthermore, to evaluate the relation between the nervous structures we examined gastric emptying and cardiac autonomic function with the hypothesis being an association between these. We found that 60% of patients had delayed gastric empting. Rectal hyposensitivity was a general finding as they tolerated 67% higher thermal, 42% more mechanical, and 33% higher electrical current intensity compared to healthy controls. In patients, most heart rate variability parameters were reduced; they reported significantly more gastrointestinal symptoms and a reduced quality of life in all SF-36 domains. Shortened RR interval correlated with reduced rectal temperature sensitivity, and gastric retention rate was negatively associated with symptoms of nausea and vomiting. To conclude, in these patients with signs and symptoms of diabetic gastroparesis, rectal sensitivity was reduced, and heart rate variability was impaired. Thus, we suggest regarding diabetic autonomic neuropathy as a diffuse disorder. Symptoms of widespread autonomic dysfunction and sensory disorders should be expected and treated in these patients.

Rectal Mechano-sensory Function in Patients with Carcinoid Diarrhea

“…Søfteland et al 29 Thus, the findings in the present study seem reliable. Fourteen of the healthy subjects in the present study have been part of previous studies where electrical stimulation was performed before the thermal stimuli.…”

“…Fourteen of the healthy subjects in the present study have been part of previous studies where electrical stimulation was performed before the thermal stimuli. 27,29,40 This may be a potential source of error, but we consider the effect very small as electrical stimulation activates the nerve endings directly, in contrast to thermal and mechanical stimuli, which activates peripheral receptors in the GI wall. Mechanical stimulation is probably more robust because it is preceded by preconditioning that minimizes the effects of elastic tissue properties, and ensures more reliable assessment of the sensory response.…”

“…Data from 14 healthy subjects have been used in other studies. [27][28][29] Five patients had been part of a previous study on GI transit times in patients with carcinoid diarrhea. 15 The study was conducted in accordance with the Declaration …”

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

“…Symptoms stemming from complications concerning small and large intestine are diarrhea (20%) [7][8][9] or constipation (according to various authors between 25% [7] and 60% [9] of patients), as well as other anorectal function disorders, e.g. fecal incontinence or visceral sensitivity disorders [10][11][12]. A lot of research concerning disorders of the upper gastrointestinal tract in patients with diabetes can be found in available literature; much less research, however, has been done concerning the lower gastrointestinal tract [11].…”

“…fecal incontinence or visceral sensitivity disorders [10][11][12]. A lot of research concerning disorders of the upper gastrointestinal tract in patients with diabetes can be found in available literature; much less research, however, has been done concerning the lower gastrointestinal tract [11]. Taking into account considerable complexity and variety of mechanisms underlying gastrointestinal disorders in diabetes, there seems to be validity in the view of some researchers that the ineffectiveness of current treatment is due to the complexity of the problem and the fact that it is usually focused only on one of the many mechanisms [13].…”