title: Gut symptoms in diabetics correlate with components of the rectoanal inhibitory reflex, but not with pudendal nerve motor latencies or systemic autonomic neuropathy.
abstract: OBJECTIVE
  Fecal incontinence (FI) occurs in up to 20% of diabetes mellitus (DM) patients. Rectoanal inhibitory reflex (RAIR) is an enteric anorectal reflex that reflects the integrity of mechanisms in the physiology of FI. We aimed to investigate whether diabetic patients with FI, not constipation, had prolongation of RAIR and altered gut-specific autonomic tone.
  
  
  METHODS
  In this prospective case-matched study 31 type I DM (19 FI and 12 constipation) and 42 type II DM (26 FI and 16 constipation). Another 21 participants were included as controls. Patients underwent the following assessments: cardiovagal autonomic tone (Modified Mayo Clinic composite autonomic severity score), rectal mucosal blood flow (RMBF) (assessment of gut-specific autonomic tone) and RAIR. Three phases of RAIR and the amplitude of maximal reflex relaxation were compared between groups. All participants completed symptom scores for FI and constipation.
  
  
  RESULTS
  RAIR recovery time back to resting pressure was slower in diabetic patients with FI than controls (8.7 s vs 3.6 s, P < 0.05) and was an independent variable correlating with symptoms of FI (P < 0.05). RAIR recovery time was correlated with RMBF (r = 0.58, P = 0.04).
  
  
  CONCLUSIONS
  RAIR is correlated with anorectal symptoms of FI and was associated with gut-specific autonomic neuropathy.
authors.affiliation: Physiology Unit, Department of Gastroenterology, University College Hospital London, London, UK.|Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Kumaran
authors.initials: K
authors.lastname: Thiruppathy
authors.affiliation: Physiology Unit, Department of Gastroenterology, University College Hospital London, London, UK.
authors.forename: Adeel
authors.initials: A
authors.lastname: Bajwa
authors.affiliation: Department of Surgery, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Kean Guan
authors.initials: KG
authors.lastname: Kuan
authors.affiliation: Department of Gastroenterology, Royal Free Hospital, London, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Murray
authors.affiliation: Physiology Unit, Department of Gastroenterology, University College Hospital London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Cohen
authors.affiliation: Physiology Unit, Department of Gastroenterology, University College Hospital London, London, UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Emmanuel
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology*; D016022:Case-Control Studies; D003248:Constipation / Q000209:etiology; D048909:Diabetes Complications; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D011446:Prospective Studies; D060525:Pudendal Nerve / Q000503:physiopathology*; D012007:Rectum / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012018:Reflex / Q000502:physiology*; D012044:Regression Analysis; D014463:Ultrasonography
keywords: anorectal physiology; constipation; diabetes mellitus; fecal incontinence; rectoanal inhibitory reflex