title: 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.
authors.affiliation: Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway ; Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway.
authors.forename: Eirik
authors.identifier: 0000-0002-7221-1013
authors.initials: E
authors.lastname: Søfteland
authors.affiliation: Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark.
authors.forename: Christina
authors.identifier: 0000-0002-3381-1884
authors.initials: C
authors.lastname: Brock
authors.affiliation: Mech-Sense, Department of Radiology, Aalborg University Hospital, 9000 Aalborg, Denmark.
authors.forename: Jens B
authors.initials: JB
authors.lastname: Frøkjær
authors.affiliation: Institute of Medicine, Department of Internal Medicine & Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.affiliation: Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, 9000 Aalborg, Denmark ; Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9000 Aalborg, Denmark.
authors.forename: Asbjørn M
authors.identifier: 0000-0001-7465-964X
authors.initials: AM
authors.lastname: Drewes
authors.affiliation: Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway ; National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, 5020 Bergen, Norway.
authors.forename: Georg
authors.initials: G
authors.lastname: Dimcevski
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D004558:Electric Stimulation; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D006339:Heart Rate; D006358:Hot Temperature; D006801:Humans; D008297:Male; D040542:Mechanotransduction, Cellular; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold; D011312:Pressure; D011788:Quality of Life; D012007:Rectum / Q000294:innervation*; D011795:Surveys and Questionnaires; D013697:Thermosensing; D059265:Visceral Pain / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology