Gastrointestinal autonomic neuropathy in diabetes

Chinmay S Marathe; Karen L Jones; Tongzhi Wu; Christopher K Rayner; Michael Horowitz

doi:10.1016/j.autneu.2020.102718

Gastrointestinal autonomic neuropathy in diabetes

Auton Neurosci. 2020 Dec:229:102718. doi: 10.1016/j.autneu.2020.102718. Epub 2020 Aug 15.

Authors

Chinmay S Marathe¹, Karen L Jones², Tongzhi Wu³, Christopher K Rayner⁴, Michael Horowitz⁵

Affiliations

¹ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Australia. Electronic address: chinmay.marathe@adelaide.edu.au.
² Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Australia. Electronic address: Karen.jones@adelaide.edu.au.
³ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia. Electronic address: Tongzhi.wu@adelaide.edu.au.
⁴ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Australia. Electronic address: Chris.rayner@adelaide.edu.au.
⁵ Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia; Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia; Endocrine and Metabolic Unit, Royal Adelaide Hospital, Australia. Electronic address: Michael.horowitz@adelaide.edu.au.

PMID: 32916479
DOI: 10.1016/j.autneu.2020.102718

Abstract

Gastrointestinal autonomic neuropathy represents an important and diverse, but poorly appreciated, manifestation of diabetic autonomic neuropathy that impacts negatively on quality of life. There is no test to assess gastrointestinal autonomic nerve damage directly in humans; cardiovascular autonomic reflex tests are often used as a surrogate, but are suboptimal. Gastrointestinal symptoms are common in diabetes, but usually correlate only weakly with disordered motility. Diabetic gastroparesis, or abnormally delayed gastric emptying, occurs frequently and is the best characterized manifestation of gastrointestinal autonomic neuropathy. There is a bi-directional relationship between postprandial glycaemia and the rate of gastric emptying. However, autonomic neuropathy can affect the function of any gut segment from the esophagus to the anus. Current management options for gastrointestinal autonomic neuropathy are, for the main part, empirical and sub-optimal.

Keywords: Diabetes; Gastric emptying; Gastrointestinal autonomic neuropathy; Gastroparesis.

Publication types

Review

MeSH terms

Autonomic Nervous System Diseases* / drug therapy
Autonomic Nervous System Diseases* / etiology
Autonomic Nervous System Diseases* / physiopathology
Diabetic Neuropathies* / complications
Diabetic Neuropathies* / drug therapy
Diabetic Neuropathies* / physiopathology
Gastrointestinal Diseases* / drug therapy
Gastrointestinal Diseases* / etiology
Gastrointestinal Diseases* / physiopathology
Humans