Kornum Ditte S, Brock Christina, Okdahl Tina, Bertoli Davide, Kufaishi Huda, Wegeberg Anne-Marie, Høyer Katrine L, Mark Esben B, Brock Birgitte, Hansen Christian S, Knop Filip K, Drewes Asbjørn M, Krogh Klaus
Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
Neurogastroenterol Motil. 2024 Nov 1:e14956. doi: 10.1111/nmo.14956.
Diabetic gastroenteropathy can cause significant diagnostic challenges. Still, it remains unknown if measures of extraintestinal autonomic function reflect diabetic gastroenteropathy. We aimed to assess the associations between (1) gastrointestinal symptoms and motility measures and (2) gastrointestinal symptoms/motility measures and extraintestinal autonomic markers.
We included 81 persons with type 1 or type 2 diabetes (65% female, mean age 54) with gastrointestinal symptoms and autonomic neuropathy. The Gastroparesis Cardinal Symptom Index (GCSI) and the Gastrointestinal Symptom Rating Scale (GSRS) assessed gastrointestinal symptoms. The wireless motility capsule (Smartpill™) assessed panenteric transit times and motility indices. Cardiovascular reflex tests (VAGUS™) and cardiac vagal tone (eMotion Faros) estimated cardiovascular autonomic neuropathy, while the SUDOSCAN™ evaluated sudomotor function.
Proximal gastrointestinal symptoms were positively associated with the gastric motility index (GCSI: 1.18 (1.04-1.35), p = 0.01; GSRS: 1.15 (1.03-1.29), p = 0.02; median ratio (95% CI)), while only satiety correlated with gastric emptying time (1.24 (1.03-1.49), p = 0.02). Diarrhea was associated with decreased small bowel transit time (0.93 (0.89-0.98), p = 0.005), while constipation were associated with prolonged colonic transit time (1.16 (1.03-1.31), p = 0.02). Gastrointestinal symptoms increased with the degree of abnormal cardiovascular reflex tests (GCSI: 0.67 (0.16-1.19), p = 0.03; GSRS: 0.87 (0.30-1.45), p = 0.01; mean difference (95% CI)) but not with motility measures. Cardiac vagal tone and sudomotor function were not associated with gastrointestinal markers.
CONCLUSIONS & INFERENCES: Gastrointestinal and extraintestinal autonomic measures were not associated. However, proximal gastrointestinal symptoms were associated with the gastric motility index and cardiovascular reflex tests. Hence, the latter may contribute to evaluating whether proximal gastrointestinal symptoms are autonomically derived.
糖尿病性胃肠病会带来重大的诊断挑战。然而，肠外自主神经功能指标是否能反映糖尿病性胃肠病仍不清楚。我们旨在评估（1）胃肠道症状与动力指标之间以及（2）胃肠道症状/动力指标与肠外自主神经标志物之间的关联。
我们纳入了81例患有1型或2型糖尿病（65%为女性，平均年龄54岁）且有胃肠道症状和自主神经病变的患者。胃轻瘫主要症状指数（GCSI）和胃肠道症状评分量表（GSRS）用于评估胃肠道症状。无线动力胶囊（Smartpill™）用于评估全肠道转运时间和动力指数。心血管反射测试（VAGUS™）和心脏迷走神经张力（eMotion Faros）用于评估心血管自主神经病变，而SUDOSCAN™用于评估汗腺运动功能。
近端胃肠道症状与胃动力指数呈正相关（GCSI：1.18（1.04 - 1.35），p = 0.01；GSRS：1.15（1.03 - 1.29），p = 0.02；中位数比值（95%置信区间）），而只有饱腹感与胃排空时间相关（1.24（1.03 - 1.49），p = 0.02）。腹泻与小肠转运时间缩短相关（0.93（0.89 - 0.98），p = 0.005），而便秘与结肠转运时间延长相关（1.16（1.03 - 1.31），p = 0.02）。胃肠道症状随着心血管反射测试异常程度的增加而增加（GCSI：0.67（0.16 - 1.19），p = 0.03；GSRS：0.87（0.30 - 1.45），p = 0.01；平均差异（95%置信区间）），但与动力指标无关。心脏迷走神经张力和汗腺运动功能与胃肠道标志物无关。
胃肠道和肠外自主神经指标不相关。然而，近端胃肠道症状与胃动力指数和心血管反射测试相关。因此，后者可能有助于评估近端胃肠道症状是否由自主神经因素引起。
