Central Processing of Gut Pain in Diabetes Patients with Gastrointestinal Symptoms

doi:10.2337/dc09-0324

Central Processing of Gut Pain in Diabetes Patients with Gastrointestinal Symptoms

Jens Brøndum Frøkjær, PhD (jf{at}mech-sense.com)¹,²,
Eirik Søfteland, MD³,⁴,
Carina Graversen, MSc¹,
Georg Dimcevski, PhD⁵,
Line Lindhardt Egsgaard, MSc⁶,
Lars Arendt-Nielsen, DMSc⁶ and
Asbjørn Mohr Drewes, DMSc¹,⁷

1. Mech-Sense, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
2. Department of Radiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
3. Department of Endocrinology, Haukeland University Hospital, Bergen, Norway
4. Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
5. Department of Gastroenterology, Haukeland University Hospital, Bergen, Norway
6. Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Denmark
7. Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark

Abstract

Objective: To evaluate the brain responses to painful visceral and somatic stimuli in diabetic patients with gastrointestinal symptoms.

Design and methods: The sensitivity to electrical esophageal and median nerve stimulations were assessed in 15 healthy volunteers and 14 type-1 diabetic patients with autonomic neuropathy and gastrointestinal symptoms using an 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 non-reproducible (P=0.006) latencies of evoked potentials to esophageal stimulations with 26% reduction in amplitude (P=0.011). No potential differences were seen to median nerve stimulations. In diabetics the topographic location of the first peak in potentials was more centrally (P<0.001) and gastrointestinal symptoms were correlated to 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.