Central processing of gut pain in diabetic patients with gastrointestinal symptoms.
OBJECTIVE
To evaluate the brain's responses to painful visceral and somatic stimuli in diabetic patients with gastrointestinal symptoms.


METHODS
The sensitivity to electrical esophageal and median nerve stimulations was assessed in 15 healthy volunteers and 14 type 1 diabetic patients with autonomic neuropathy and gastrointestinal symptoms using a euglycemic-hyperinsulinemic clamp. Evoked brain potentials were recorded.


RESULTS
Patients had reduced sensitivity to esophageal (48%; P < 0.001) and median nerve (80%; P < 0.001) stimulations. They also had increased (8.8%; P = 0.007) and nonreproducible (P = 0.006) latencies of evoked potentials in response to esophageal stimulations, with 26% reduction in amplitude (P = 0.011). No potential differences were seen to median nerve stimulations. In diabetic patients, the topographic location of the first peak in potentials was more central (P < 0.001) and gastrointestinal symptoms correlated with characteristics of brain potentials (P = 0.049).


CONCLUSIONS
This study supports that diabetes induces changes in peripheral visceral nerves as well as in the central nervous system.
Frøkjaer
Jens Brøndum
JB
Mech-Sense, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark. frokjaer@mail.tele.dk
Søfteland
Eirik
E
Graversen
Carina
C
Dimcevski
Georg
G
Egsgaard
Line Lindhardt
LL
Arendt-Nielsen
Lars
L
Drewes
Asbjørn Mohr
AM
D015746:Abdominal Pain / Q000503:physiopathology*; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology / Q000503:physiopathology*; D001786:Blood Glucose / Q000378:metabolism; D001921:Brain / Q000502:physiology / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology*; D004558:Electric Stimulation; D004947:Esophagus / Q000294:innervation; D005073:Evoked Potentials, Somatosensory; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000503:physiopathology*; D015309:Glucose Clamp Technique; D006801:Humans; D006946:Hyperinsulinism; D008297:Male; D008475:Median Nerve / Q000503:physiopathology*; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult
D001786:Blood Glucose