title: Impaired contractility and remodeling of the upper gastrointestinal tract in diabetes mellitus type-1.
abstract: OBJECTIVE
  To investigate that both the neuronal function of the contractile system and structural apparatus of the gastrointestinal tract are affected in patients with longstanding diabetes and auto mic neuropathy.
  
  
  METHODS
  The evoked esophageal and duodenal contractile activity to standardized bag distension was assessed using a specialized ultrasound-based probe. Twelve type-1 diabetic patients with autonomic neuropathy and severe gastrointestinal symptoms and 12 healthy controls were studied. The geometry and biomechanical parameters (strain, tension/stress, and stiffness) were assessed.
  
  
  RESULTS
  The diabetic patients had increased frequency of distension-induced contractions (6.0 +/- 0.6 vs 3.3 +/- 0.5, P < 0.001). This increased reactivity was correlated with the duration of the disease (P = 0.009). Impaired coordination of the contractile activity in diabetic patients was demonstrated as imbalance between the time required to evoke the first contraction at the distension site and proximal to it (1.5 +/- 0.6 vs 0.5 +/- 0.1, P = 0.03). The esophageal wall and especially the mucosa-submucosa layer had increased thickness in the patients (P < 0.001), and the longitudinal and radial compressive stretch was less in diabetics (P < 0.001). The esophageal and duodenal wall stiffness and circumferential deformation induced by the distensions were not affected in the patients (all P > 0.14).
  
  
  CONCLUSIONS
  The impaired contractile activity with an imbalance in the distension-induced contractions likely reflects neuronal abnormalities due to autonomic neuropathy. However, structural changes and remodeling of the gastrointestinal tract are also evident and may add to the neuronal changes. This may contribute to the pathophysiology of diabetic gut dysfunction and impact on future management of diabetic patients with gastrointestinal symptoms.
authors.affiliation: Center for Visceral Biomechanics and Pain, Department of Radiology, Aalborg Hospital, DK-9100 Aalborg, Denmark. jf@mech-sense.com
authors.forename: Jens Brondum
authors.initials: JB
authors.lastname: Frokjaer
authors.forename: Soren-Due
authors.initials: SD
authors.lastname: Andersen
authors.forename: Niels
authors.initials: N
authors.lastname: Ejskjaer
authors.forename: Peter
authors.initials: P
authors.lastname: Funch-Jensen
authors.forename: Asbjorn-Mohr
authors.initials: AM
authors.lastname: Drewes
authors.forename: Hans
authors.initials: H
authors.lastname: Gregersen
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D004386:Duodenum / Q000000981:diagnostic imaging / Q000503:physiopathology*; D019160:Endosonography; D004947:Esophagus / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology*