Central Processing of Gut Pain in Diabetic Patients With Gastrointestinal Symptoms
- Jens Brøndum Frøkjær, PHD1,2,
- Eirik Søfteland, MD3,4,
- Carina Graversen, MSC1,
- Georg Dimcevski, PHD5,
- Line Lindhardt Egsgaard, MSC6,
- Lars Arendt-Nielsen, DMSC6 and
- Asbjørn Mohr Drewes, DMSC1,7
- 1Mech-Sense, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark;
- 2Department of Radiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark;
- 3Department of Endocrinology, Haukeland University Hospital, Bergen, Norway;
- 4Hormone Laboratory, Haukeland University Hospital, Bergen, Norway;
- 5Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway;
- 6Department of Health Science and Technology, Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark;
- 7Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark.
- Corresponding author: Jens Brøndum Frøkjær, frokjaer{at}mail.tele.dk.
Abstract
OBJECTIVE To evaluate the brain's responses to painful visceral and somatic stimuli in diabetic patients with gastrointestinal symptoms.
RESEARCH DESIGN AND 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.
Footnotes
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received February 18, 2009.
- Accepted April 8, 2009.
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Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
- © 2009 by the American Diabetes Association.
