Diabetic gastroenteropathy: Associations between gastrointestinal symptoms, motility, and extraintestinal autonomic measures.

IF 3.5 3区医学 Q1 CLINICAL NEUROLOGY

Neurogastroenterology and Motility Pub Date : 2024-11-01 DOI:10.1111/nmo.14956

Ditte S Kornum, Christina Brock, Tina Okdahl, Davide Bertoli, Huda Kufaishi, Anne-Marie Wegeberg, Katrine L Høyer, Esben B Mark, Birgitte Brock, Christian S Hansen, Filip K Knop, Asbjørn M Drewes, Klaus Krogh

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Abstract

Background: Diabetic gastroenteropathy can cause significant diagnostic challenges. Still, it remains unknown if measures of extraintestinal autonomic function reflect diabetic gastroenteropathy. We aimed to assess the associations between (1) gastrointestinal symptoms and motility measures and (2) gastrointestinal symptoms/motility measures and extraintestinal autonomic markers.

Methods: We included 81 persons with type 1 or type 2 diabetes (65% female, mean age 54) with gastrointestinal symptoms and autonomic neuropathy. The Gastroparesis Cardinal Symptom Index (GCSI) and the Gastrointestinal Symptom Rating Scale (GSRS) assessed gastrointestinal symptoms. The wireless motility capsule (Smartpill™) assessed panenteric transit times and motility indices. Cardiovascular reflex tests (VAGUS™) and cardiac vagal tone (eMotion Faros) estimated cardiovascular autonomic neuropathy, while the SUDOSCAN™ evaluated sudomotor function.

Key results: Proximal gastrointestinal symptoms were positively associated with the gastric motility index (GCSI: 1.18 (1.04-1.35), p = 0.01; GSRS: 1.15 (1.03-1.29), p = 0.02; median ratio (95% CI)), while only satiety correlated with gastric emptying time (1.24 (1.03-1.49), p = 0.02). Diarrhea was associated with decreased small bowel transit time (0.93 (0.89-0.98), p = 0.005), while constipation were associated with prolonged colonic transit time (1.16 (1.03-1.31), p = 0.02). Gastrointestinal symptoms increased with the degree of abnormal cardiovascular reflex tests (GCSI: 0.67 (0.16-1.19), p = 0.03; GSRS: 0.87 (0.30-1.45), p = 0.01; mean difference (95% CI)) but not with motility measures. Cardiac vagal tone and sudomotor function were not associated with gastrointestinal markers.

Conclusions & inferences: Gastrointestinal and extraintestinal autonomic measures were not associated. However, proximal gastrointestinal symptoms were associated with the gastric motility index and cardiovascular reflex tests. Hence, the latter may contribute to evaluating whether proximal gastrointestinal symptoms are autonomically derived.

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糖尿病胃肠病：胃肠道症状、蠕动和肠道外自主神经测量之间的关联。

背景：糖尿病胃肠病会给诊断带来巨大挑战。然而，肠外自主神经功能的测量是否能反映糖尿病胃肠病仍是一个未知数。我们的目的是评估(1)胃肠道症状和蠕动指标与(2)胃肠道症状/蠕动指标和肠外自主神经标记物之间的关联：我们纳入了81名患有胃肠道症状和自主神经病变的1型或2型糖尿病患者（65%为女性，平均年龄54岁）。胃痉挛症状指数（GCSI）和胃肠道症状评定量表（GSRS）评估胃肠道症状。无线蠕动胶囊（Smartpill™）评估肠胃蠕动时间和蠕动指数。心血管反射测试（VAGUS™）和心脏迷走神经张力（eMotion Faros）评估心血管自律神经病变，而 SUDOSCAN™ 则评估粪便运动功能：主要结果：近端胃肠道症状与胃动力指数呈正相关（GCSI：1.18 (1.04-1.35)，p = 0.01；GSRS：1.15 (1.03-1.29)，p = 0.02；中位数比值（95% CI）），而只有饱腹感与胃排空时间相关（1.24 (1.03-1.49)，p = 0.02）。腹泻与小肠转运时间缩短有关（0.93 (0.89-0.98)，p = 0.005），而便秘与结肠转运时间延长有关（1.16 (1.03-1.31)，p = 0.02）。胃肠道症状随心血管反射测试异常程度的增加而增加（GCSI：0.67 (0.16-1.19)，p = 0.03；GSRS：0.87 (0.30-1.45)，p = 0.01；平均差 (95% CI)），但与肠蠕动指标无关。心脏迷走神经张力和泌尿运动功能与胃肠道指标无关：结论与推论：胃肠道和肠道外的自律神经指标没有关联。然而，近端胃肠道症状与胃动力指数和心血管反射测试相关。因此，后者可能有助于评估近端胃肠道症状是否源于自律神经。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurogastroenterology and Motility 医学-临床神经学

CiteScore

7.80

自引率

8.60%

发文量

178

审稿时长

3-6 weeks

期刊介绍： Neurogastroenterology & Motility (NMO) is the official Journal of the European Society of Neurogastroenterology & Motility (ESNM) and the American Neurogastroenterology and Motility Society (ANMS). It is edited by James Galligan, Albert Bredenoord, and Stephen Vanner. The editorial and peer review process is independent of the societies affiliated to the journal and publisher: Neither the ANMS, the ESNM or the Publisher have editorial decision-making power. Whenever these are relevant to the content being considered or published, the editors, journal management committee and editorial board declare their interests and affiliations.