Document Detail


Gastric mucosal nerve density: a biomarker for diabetic autonomic neuropathy?
MedLine Citation:
PMID:  20837965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Autonomic neuropathy is a frequent diagnosis for the gastrointestinal symptoms or postural hypotension experienced by patients with longstanding diabetes. However, neuropathologic evidence to substantiate the diagnosis is limited. We hypothesized that quantification of nerves in gastric mucosa would confirm the presence of autonomic neuropathy. METHODS: Mucosal biopsies from the stomach antrum and fundus were obtained during endoscopy from 15 healthy controls and 13 type 1 diabetic candidates for pancreas transplantation who had secondary diabetic complications affecting the eyes, kidneys, and nerves, including a diagnosis of gastroparesis. Neurologic status was evaluated by neurologic examination, nerve conduction studies, and skin biopsy. Biopsies were processed to quantify gastric mucosal nerves and epidermal nerves. RESULTS: Gastric mucosal nerves from diabetic subjects had reduced density and abnormal morphology compared to control subjects (p < 0.05). The horizontal and vertical meshwork pattern of nerve fibers that normally extends from the base of gastric glands to the basal lamina underlying the epithelial surface was deficient in diabetic subjects. Eleven of the 13 diabetic patients had residual food in the stomach after overnight fasting. Neurologic abnormalities on clinical examination were found in 12 of 13 diabetic subjects and nerve conduction studies were abnormal in all patients. The epidermal nerve fiber density was deficient in skin biopsies from diabetic subjects. CONCLUSIONS: In this observational study, gastric mucosal nerves were abnormal in patients with type 1 diabetes with secondary complications and clinical evidence of gastroparesis. Gastric mucosal biopsy is a safe, practical method for histologic diagnosis of gastric autonomic neuropathy.
Authors:
M M Selim; G Wendelschafer-Crabb; J B Redmon; A Khoruts; J S Hodges; K Koch; D Walk; W R Kennedy
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Neurology     Volume:  75     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-14     Completed Date:  2010-10-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  973-81     Citation Subset:  AIM; IM    
Affiliation:
Departments of Neurology, University of Minnesota, Minneapolis, USA. selim002@umn.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Biological Markers
Diabetes Mellitus, Type 1 / surgery
Diabetes Mellitus, Type 2 / complications,  pathology
Diabetic Neuropathies / pathology*
Endoscopy
Female
Gastric Emptying / physiology
Gastric Mucosa / innervation*,  pathology*
Gastroparesis / etiology
Humans
Male
Microscopy, Confocal
Middle Aged
Nerve Fibers / physiology
Neural Conduction / physiology
Pancreas Transplantation
Skin / innervation,  pathology
Grant Support
ID/Acronym/Agency:
1R01-HD044763/HD/NICHD NIH HHS; 1R21 NS067324-01/NS/NINDS NIH HHS; 5U01DK073974/DK/NIDDK NIH HHS; AI056270/AI/NIAID NIH HHS; DE14338/DE/NIDCR NIH HHS; IU01-DK57182-0/DK/NIDDK NIH HHS; M01 RR00400/RR/NCRR NIH HHS; N01-HC-95183/HC/NHLBI NIH HHS; P01 CA124787/CA/NCI NIH HHS; P01-AI074340-02/AI/NIAID NIH HHS; R21-AI083811-02/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Biological Markers

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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