Type 1 diabetic patients with peripheral neuropathy have pan-enteric prolongation of gastrointestinal transit times and an altered caecal pH profile

Farmer, Adam D.; Pedersen, Anne Grave; Brock, Birgitte; Jakobsen, Poul Erik; Karmisholt, Jesper; Mohammed, Sahar; Scott, S. M.; Drewes, Asbjørn Mohr; Brock, Christina

doi:10.1007/s00125-016-4199-6

Cited by 54 publications

(74 citation statements)

References 46 publications

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“…By expanding focus beyond the pylorus, recent studies have indeed uncovered a possible link between small bowel dysmotility and symptoms suggestive of gastroparesis . Here, the WMC may play an important role in further research, providing pH and pressure profiles from gut segments otherwise largely unavailable for examination …”

Section: Discussionmentioning

confidence: 99%

“…Firstly, patients with suspected diabetic gastroparesis often present a diversity of unspecific symptoms, not only limited to cardinal symptoms of nausea, vomiting, early satiety, fullness, and bloating, but often also abdominal pain, reflux, diarrhea, constipation, and fecal incontinence . Adding to the confusion, delayed GE is present in 30%‐50% with longstanding diabetes regardless of symptoms, probably as a consequence of autonomic neuropathy . Secondly, there are multiple pathophysiological alterations associated with diabetic gastroparesis, both locally in the gut and in the autonomic and central nervous system.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to GES and other methods for evaluating gastric emptying, WMC has the great advantage of examining several GI regions during the same test. This is especially relevant in diabetes patients, often presenting multiregional dysmotility . In contrast to GES, it does not involve radiation and has a universally standardized meal .…”

Section: Discussionmentioning

confidence: 99%

“…Delayed GE is associated with both short‐ and long‐term hyperglycemia . Gastroparesis may also influence the absorption of oral medications, emphasizing the need for reliable, inexpensive, and accessible tests for measuring GE …”

Section: Introductionmentioning

confidence: 99%

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Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Sangnes

Søfteland

Bekkelund

et al. 2019

Neurogastroenterology Motil

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Background Gastroparesis is a potentially severe late complication of diabetes mellitus. Today, delayed gastric emptying (GE) is mandatory for establishing the diagnosis. In this study, we compared wireless motility capsule (WMC) with gastric emptying scintigraphy (GES). Methods Seventy‐two patients (49 women) with diabetes mellitus (59 type 1) and symptoms compatible with gastroparesis were prospectively included between 2014 and 2018. Patients were simultaneously examined with GES and WMC. Symptoms were assessed with the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI‐SYM) questionnaire. All patients were on intravenous glucose‐insulin infusion during testing. Key Results WMC and GES correlated r = .74, P < .001. Compared to GES, WMC at ordinary cutoff for delayed GE (300 minutes) had a sensitivity of 0.92, specificity 0.73, accuracy 0.80, and Cohen's kappa κ = 0.61 (P < .001). By receiver operating characteristics (ROC), the area under the curve was 0.95 (P < .001). A cutoff value for delayed GE of 385 minutes produced sensitivity 0.92, specificity 0.83, accuracy 0.86, and Cohen's kappa κ = 0.72 (P < .001). Inter‐rater reliability for GE time with WMC was r = .996, κ = 0.97, both P < .001. There was no difference in symptom severity between patients with normal and delayed GE. Conclusions & Inferences Our findings demonstrate the applicability of WMC as a reliable test to assess gastric emptying in diabetic gastroparesis showing very high inter‐observer correlation. By elevating the cutoff value for delayed emptying from 300 to 385 minutes, we found higher specificity without reducing sensitivity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Sangnes

Søfteland

Bekkelund

et al. 2019

Neurogastroenterology Motil

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“…Generalized neuropathy has previously been described in diabetes mellitus. 7,23 In accordance, diseases, such as amyloidosis and Fabry disease, characterized by amyloid deposits and progressive lysosomal accumulation of lipids, respectively, have been described to develop both severe GI dysmotility, as well as autonomic and peripheral neuropathy. 24,25 GI symptoms secondary to Ehlers-Danlos syndrome are wellknown in clinical practice, often entitled as functional bowel disorders.…”

Section: F I G U R E 1 Horizontally Cut Section With Myenteric Gangliamentioning

confidence: 99%

Autonomic and peripheral neuropathy with reduced intraepidermal nerve fiber density can be observed in patients with gastrointestinal dysmotility

Ohlsson

Dahlin

Englund

et al. 2019

Clinical Case Reports

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Neuropathy should be considered as a possible etiological factor in patients with severe gastrointestinal symptoms, without signs of disease on routine investigations.Examinations of the autonomic and peripheral nervous systems may be helpful to select the patients who should be investigated with full-thickness intestinal biopsy, and to give appropriate care. K E Y W O R D Sautonomic dysfunction, enteric neuropathy, gastrointestinal dysmotility, intraepidermal nerve fiber density, peripheral neuropathy How to cite this article: Ohlsson B, Dahlin LB, Englund E, Veress B. Autonomic and peripheral neuropathy with reduced intraepidermal nerve fiber density can be observed in patients with gastrointestinal dysmotility. Clin Case Rep.

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Autonomic Visceral Neuropathy and Gastrointestinal Disorders

Drewes

Brock

Drewes

2019

The Diabetes Textbook

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Type 1 diabetic patients with peripheral neuropathy have pan-enteric prolongation of gastrointestinal transit times and an altered caecal pH profile

Abstract: EUDRA CT: 2013-004375-12.

Cited by 54 publications

References 46 publications

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Wireless motility capsule compared with scintigraphy in the assessment of diabetic gastroparesis

Autonomic and peripheral neuropathy with reduced intraepidermal nerve fiber density can be observed in patients with gastrointestinal dysmotility

Autonomic Visceral Neuropathy and Gastrointestinal Disorders

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