Gastric mucosal nerve density: A biomarker for diabetic autonomic neuropathy?

M. M. Selim, G. Wendelschafer-Crabb, Bruce B Redmon, Alexander Khoruts, James S Hodges, K. Koch, David Walk, William R Kennedy

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21 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)973-981
Number of pages9
JournalNeurology
Volume75
Issue number11
DOIs
StatePublished - Sep 14 2010

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Diabetic Neuropathies
Stomach
Biomarkers
Biopsy
Gastroparesis
Neural Conduction
Gastric Mucosa
Nerve Fibers
Nervous System Malformations
Pancreas Transplantation
Skin
Orthostatic Hypotension
Neurologic Examination
Diabetes Complications
Type 1 Diabetes Mellitus
Basement Membrane
Nervous System
Endoscopy
Observational Studies
Fasting

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Gastric mucosal nerve density : A biomarker for diabetic autonomic neuropathy? / Selim, M. M.; Wendelschafer-Crabb, G.; Redmon, Bruce B; Khoruts, Alexander; Hodges, James S; Koch, K.; Walk, David; Kennedy, William R.

In: Neurology, Vol. 75, No. 11, 14.09.2010, p. 973-981.

Research output: Contribution to journalArticle

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